hyper and hypotension question @ client.

[alliecat]

Okay, just graduated april and passed NCLEX. I have been on the job now for a few weeks, yesterday at work i had this 81 year old man who takes Lisinopril, Diovan and Clonidine. Okay the mar has all of these scheduled at the same time. He at home takes them on a totally diff. schedule but i was told to tell him he is to take it on our schedule. As if he didn't know what doesnt work best for him. so anyways his bp was 160-170's over 70's. later on in the day his bp bottomed out to like 70's over 50s. the nurse i worked with was like dont worry because he is asymptomatic. i thought he needed to be bolused, anyway she said call the dr. cause its not my job to assume what he wants. called and he said to bolus. anyway, when do begin to become concerened with low bp? only when syptomatic? and bp med. would you give those all at the same time even if that is how it is scheduled? needles to say i held the rest of the bp meds that day including the lasix because of the pressure problems. it just seems like i was concerned with the man and the nurse was like oh thats not bad. So help with advice for the future. Thanks> Alliecat

[suzanne4, RN]

They should be given at a schedule that works for him. Or something close to it, and if he doesn't take all three together at home, he should not be made to do do at the will of the facility. You can always contact pharmacy to change the time schedule for you.

[Heymickey]

Yeah, I always try to stick with the patient's home schedule. It would be torture to give 40mg Lasix BID and have the second dose at 2100. At my hospital pharm would give you a hard time changing the schedule, so I just pass it on to next shift. And, during 24 hour chart checks, I circle and change out the times, too. BP ranges differ from pt to pt. For the last two days, I was freaking out with giving Clonidine 0.2 on a pt whose BP was 93 systolic!!! He's in for Opioid Withdrawal, and it's for chest/esophageal (in that area) pain associated with withdrawal. BTW, is Clonidine also the samemedicatio n that comes in that yellow gel pill? You are not supposed to crush it, and it's also supposed to relieve spasms in the chest... It's been bugging me for months, now, and I can't find that medication anywhere.

[RNAnna]

At our facility we always ask the pt on admission what meds they take and when they take them. So, if the pt isn't taking X,Y, and Z together at home, they aren't taking them together in the hospital. I think every facility has thier own times as to what BID and QID times are. In our facility bid means 08 and 2000. So, we adjust as neccessary for the particular client. We try to match thier schedule with our schedule as closely as possible and it seems to work well. There are some things that we have to give on a "off schedule" to accomodate the pt. but not many.

If the pt is not taking the medications together at home, I would consult the physician and explain the situation and document that you notified someone. That would at least cover your rear if it isn't changed. And if you don't feel right about giving particular meds together, don't do it. Always notify the charge nurse and possibly the dr., document, and if they say do it, and you still don't feel right about it, stand firm. Your pt's life and license is more important than what a dr. orders. They are human too. Dr.s do make mistakes.

Anna

[jwrightstone]

Clonidine is an antihypertensive that is also used for pain control as well as the management of opioid withdrawl. I don't know anything about crushing it I have seen an uncoated tablet form that should be crushable. Often times they will give the med even if the BP is border line if it is being used for other causes such as the treatment of withdrawl.

Yeah, I always try to stick with the patient's home schedule. It would be torture to give 40mg Lasix BID and have the second dose at 2100. At my hospital pharm would give you a hard time changing the schedule, so I just pass it on to next shift. And, during 24 hour chart checks, I circle and change out the times, too. BP ranges differ from pt to pt. For the last two days, I was freaking out with giving Clonidine 0.2 on a pt whose BP was 93 systolic!!! He's in for Opioid Withdrawal, and it's for chest/esophageal (in that area) pain associated with withdrawal. BTW, is Clonidine also the samemedicatio n that comes in that yellow gel pill? You are not supposed to crush it, and it's also supposed to relieve spasms in the chest... It's been bugging me for months, now, and I can't find that medication anywhere.