hypertensive

[michou]

Yesterday during patient handover, the day nurse told me that she omitted hypertensive meds to a patient because his blood pressure was low (137/76). Looking on the observation chart the patient's bp is usually more or less around this reading (when taking the meds) except for 1 or 2 occasion when it dropped to 90 systolic (and his medication was not omitted then). BP of 137/76 is not low for me and in her case I would have given the meds. My question is when do you omit hypertensive? At what reading? Apart the BP reading what else is taken into account?

[barefootlady, ADN, RN]

If this nurse felt the patient's pressure was too low for the meds, she should have called the doctor and gotten an order for guidelines to hold the meds. If she did not do this, she was in error and an occurance needs to be done. Sorry, but that is how I see it.

We as nurses, think we are doing the right thing by holding meds, but we need an order to do this is most cases. If patients pressure was 90/60 then I would hold until doctor was notified, and orders obtained.

[Tweety, BSN, RN]

Agree with the above, unless there are parameters, this person was practicing medicine by withholding the meds and not notifying the MD. But I see nurses doing this all the time with antihypertensives, and antihyperglycemics.

I wouldn't have held the antihypertensives under those circumstances. It shows that you possess critical thinking that you went one step further and assess past vitals. The person is on antihypertensives for a reason.......to bring high blood pressure down. This BP shows the meds are working and should continue to be given.

[SharonH, RN]

Yesterday during patient handover, the day nurse told me that she omitted hypertensive meds to a patient because his blood pressure was low (137/76). Looking on the observation chart the patient's bp is usually more or less around this reading (when taking the meds) except for 1 or 2 occasion when it dropped to 90 systolic (and his medication was not omitted then). BP of 137/76 is not low for me and in her case I would have given the meds. My question is when do you omit hypertensive? At what reading? Apart the BP reading what else is taken into account?

That nurse needs some serious re-education regarding the actions and indications of anti-hypertensives. They are not to be used prn to lower the blood pressure but to maintain a normal BP. Generally I would hold BP meds for less than 100/60 unless the patient is always maintained at that BP on meds. And at that point, the physician would need to be notified because perhaps an adjustment needs to be made or perhaps there is something else going on which is causing the patient's BP to be low.

[llg, PhD, RN]

I agree with the above posts. Changing the medication is not within the scope of nursing practice. Without a protocol to follow, the nurse should have called the physician if she had a concern about this patient.

As far as 137/76 goes ... that systolic is still a little on the high side. The national standards have been lowered recently to 120/80. As Tweety wrote, the fact that his BP is so close to the desired levels probably indicates that the medication is working as it is supposed to and should be continued.

Also, btw, I am hypertensive and take medication twice daily for it. My BP is consistently about 125/78 and my doc and I are happy about that ... so, I keep taking my med. We'd be even happier with 120/75.

llg

[Speculating]

If this nurse felt the patient's pressure was too low for the meds, she should have called the doctor and gotten an order for guidelines to hold the meds. If she did not do this, she was in error and an occurance needs to be done. Sorry, but that is how I see it.

We as nurses, think we are doing the right thing by holding meds, but we need an order to do this is most cases. If patients pressure was 90/60 then I would hold until doctor was notified, and orders obtained.

Save your own butt because if you don't either call or give the medication it's now your rear end.