Hydralazine question

[CLP75]

Hey there...first time posting. I'm a new grad working on a telemetry floor (night shift). I had a patient HFrEF 20 -25%. HTN on hydralazine 100mg q 6 hours. At 9 bp wa 122/63. Gave her her 100mgs. At midnight she refused her VS so I held the hydrazaline. At 6 AM bp was 165/84...gave her the 100mg. The doc was furious with me for holding the midnight dose...said give it regardless of vital signs. I held it not knowing what her bp was...didn't want her to go hypotensive. He said its also given for HF not just for bp...I understand that but its effect is dilating vessels. What is everyone's tale on this? I'm trying to learn.

Thank you, Carollynne

[Emergent, RN]

I guess next time call the doctor. Maybe he can add a note to the order, give even if patient refuses BP. Usually there are parameters with hydralazine.

The morning BP doesn't sound alarming, maybe he had an argument with his wife or something else? He should have used the opportunity to educate not become furious, but he didn't.

[Kallie3006, ADN]

Was the hydralazine PO or IV? Was it the patient's home medication? The half life is short with hydralazine and the peak is between 1-2 hours and orally it is rapidly absorbed. I agree it is good to know the BP before giving meds especially when they are getting them every 6 hours. However if the patient was supposed to get the meds at midnight then the dose prior should have been at 6 instead of 9. If the dose was given at 9 the next should have been 3, which could have been given using the 4 o'clock VS. possibly see if you can get parameters added to the order. The doctor could have used this as an educational opportunity for you but for whatever reseaon did not. I personally would have determined if it was a home med/dose and looked at the patient's VS trends while being hospitalized to determine giving if the patient refused VS to be taken. Remember though that to hold a medication you need an order from the doctor so if all else fails call and clarify.

[AxelNewRN86]

For a BP med and refusing VS, I would always page the MD. If you learn the MDs at your hospital do not want to address that issue on night shift, then refer to the charge.

[beekee]

Did you take a look at the MD’s note? Sometimes that’ll give you information on what they want. I would have also taken a look at the patient’s BP trends (although difficult in a new med). Chances are high the I would have done the same thing, so don’t sweat it. You live, you mess up, you learn, and you don’t repeat the same “mistake.”

If the MD wanted it given regardless of the BP, a note to that effect would have been nice. Just give the MD a FYI when holding with your reason next time. Then the MD can address the situation immediately instead of in the morning. (You will, of course, get complaints about waking them up, but I’d rather get yelled at for waking someone up then not getting my patient the care they need).

[offlabel]

With that ejection fraction, end organ perfusion will fall if the systolic pressure rises too much. A systolic of 160 doesn't sound awful, but with an impaired left ventricle like that, it could represent a very low stroke volume. Maybe for a little context, I would have reviewed the last several blood pressures to determine a trend. If they were all over the place, that would be one thing, but if say, the last 5 measured pressures were within 20% of each other, I would feel comfortable giving the po hydralazine without measuring one.