I've got a question -Taking BP before giving anti-hypertensives

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Just wondering about this. If I were handing out meds to a patient with prior hypertension in a med-surg ward and the patients chart indicated low BP because of the prescribed anti-hypertensives would I be laughed at if I took their BP before medicating? I thought it would be a safer option to do this and even withhold the meds because of the lowered blood pressure. I don't know if I am too cautious but as a new grad I don't want to make any mistakes in the haste to just pass all meds. I mean if the buck stops with us wouldn't this be the best option? Has anyone been in the situation where a persons BP has just dropped way below because either everyone was too busy to take a BP. How many of you regularly check BP's before administering or is there just not time?. It might seem like a stupid question or I might just be naive. I know if someone's BP is really low and the meds are withheld it might be mentioned in handover but what if no-one has noticed.

Specializes in Emergency Dept, M/S.

This is probably a dumb question, but I haven't encountered it yet on my clinical rotations.

Sometimes the LNA's do vitals prior to 7am, and med passes aren't until 8am. I've always checked the b/p again before giving an antihypertensive, but as an RN, do you always re-check even if the LNA just took a b/p? I've always wanted to hear with MY ears (we're not allowed to use dinamaps for am vitals!) what the b/p is, so I do a check even if it was just done by the LNA with a dinamap 15 min ago.

Is this too much? I know checking b/p too much can give inaccurate readings also, but how much is too much?

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Specializes in Telemetry.

if the bp has been charted as being checked within 30 minutes of me giving bp or beta-blockers than I will use that if checked by someone I trust. (what is the point of having aides if you cant trust any of them?). If it is someone I don't believe does quality pt care I will retake myself. I hold if it is borderline, or I check there trends from the previous day. On our floor we use acuscans where we can chart in the system the hr and bp. Won't necessarily call md for perameters right away, will ask when they come or if it is someone that is taking beta-blockers to prevent recurrance of svt's or a fib will then call for hr perameters if hr is at a questionable level, like 59 while awake. But I am still learning myself. And I know a lot of RN's on tele who don't necessarily check the bp when they give and I think that is asking for trouble.

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Specializes in tele, ICU.

the reason i asked is because i had a patient today who had borderline BP and was admitted today as well. no past records or trends to compare to. i am a new grad. i was told to hold the med by my preceptor. it was within parameters but borderline. i'm just not sure if holding a med like that is acceptable by nursing judgment- shouldn't it be the physician's judgment? i'm not saying we should be robots and do whatever it says on paper- i just dont know if it was right to hold a med without consulting the doc first on a borderline (but still w/in parameters) bp.

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Specializes in LDRP.

For AM anti hypertensives, i check the BP on the morning vitals. If it is extremely high or extremely low, i check it myself, then go look at the chart for trending. (heart rate, too)

Yes, i would hold a bp med if a pt w/ a hx of htn had a bp too low. anything below 100 systolic makes me want to hold med, unless specified like "hold if less than 90 systolic".

Also, if a pt has a high bp, and is given a prn antihypertensive, i'll check it again afterwards

heres' a story. pt w/ severe heart disease, ef 10-20%, 3+ to 4+ mitral regurg, chf w/ bnp over 3000, and of course, chronic hypotension. Last bp at 2200 was 69/48. RN gave lisinopril 1.25mg and nitroglycerin sr tabs 2.5 mg at 0600 anyways.

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Specializes in LDRP.
the reason i asked is because i had a patient today who had borderline BP and was admitted today as well. no past records or trends to compare to. i am a new grad. i was told to hold the med by my preceptor. it was within parameters but borderline. i'm just not sure if holding a med like that is acceptable by nursing judgment- shouldn't it be the physician's judgment? i'm not saying we should be robots and do whatever it says on paper- i just dont know if it was right to hold a med without consulting the doc first on a borderline (but still w/in parameters) bp

what was the bp and what was the med?

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Specializes in ER.

heres' a story. pt w/ severe heart disease, ef 10-20%, 3+ to 4+ mitral regurg, chf w/ bnp over 3000, and of course, chronic hypotension. Last bp at 2200 was 69/48. RN gave lisinopril 1.25mg and nitroglycerin sr tabs 2.5 mg at 0600 anyways.

Stop everything, call the doc get an IV line and the crash cart outside the room. And don't give the meds. (Duh what was she thinking?)

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Specializes in LDRP.

Canoehead-

turns out this pt's "chronic hypotension" meant that he was chronically in the 70's systolic. Asymptomatic (well,from the BP at least). I asked the PA if we were going to do anyting about his 75/50 bp (manual) when i had him, and she said no, he lives like that.

COuldn't do a fluid bolus-he had fluids going at 75cc/hr and said he could tell that was too much fluid, it was making him SOB.

anyhoo, he was 80/55 then 75/50 at 0700 and 1100 after getting those meds, so i guess in his own way, he was fine.

i was thinkind dopamine/dobutamine might be appropriate, but apparently that had been tried before with no success

he was a really, really sick guy though.

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Specializes in private duty/home health, med/surg.

I don't give anti-hypertensives if I don't have a very recent BP (either my own or a trusted aides.) Our rooms all have manual BPs so I will usually use those. I am all about patient safety. Besides, who wants to have to spend the last half of the shift calling the doctor & giving IV fluid boluses if the BP is too low? ;)

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Canoehead-

turns out this pt's "chronic hypotension" meant that he was chronically in the 70's systolic. Asymptomatic (well,from the BP at least). I asked the PA if we were going to do anyting about his 75/50 bp (manual) when i had him, and she said no, he lives like that.

COuldn't do a fluid bolus-he had fluids going at 75cc/hr and said he could tell that was too much fluid, it was making him SOB.

anyhoo, he was 80/55 then 75/50 at 0700 and 1100 after getting those meds, so i guess in his own way, he was fine.

i was thinkind dopamine/dobutamine might be appropriate, but apparently that had been tried before with no success

he was a really, really sick guy though.

you didn't mention there were iv fluids running.

sometimes those cardiomyopathy people need their ace inhibitors and preload meds to HELP manage their cardiac output. if you hold them, their afterload and preload just increases.

always a fine line though.

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Specializes in aged -adolescent.

Hi this is great, didn't think I'd get so many responses. It's all good advice too thanks. When you say paremeters, are these the minimum and maximum reading for BP measurement etc? As you can see I have a lot to learn and at least I feel I can ask you and not feel stupid.:penguin:

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Specializes in Emergency & Trauma/Adult ICU.
turns out this pt's "chronic hypotension" meant that he was chronically in the 70's systolic. Asymptomatic (well,from the BP at least). I asked the PA if we were going to do anyting about his 75/50 bp (manual) when i had him, and she said no, he lives like that.

COuldn't do a fluid bolus-he had fluids going at 75cc/hr and said he could tell that was too much fluid, it was making him SOB.

anyhoo, he was 80/55 then 75/50 at 0700 and 1100 after getting those meds, so i guess in his own way, he was fine.

i was thinkind dopamine/dobutamine might be appropriate, but apparently that had been tried before with no success

he was a really, really sick guy though.

I recently had 2 patients like that on the same day ... made me kinda paranoid.

Both of them were chronic renal failure/dialysis patients. Both live in the neighborhood of 80/50.

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Specializes in Rehab, Med Surg, Home Care.

At one of the places I work the MAR's have space left to write in the BP's before the med is given (or held, if that is the case).

If I have a borderline BP I will retake the BP in both arms (if possible) in about 15 minutes before deciding to give the med or not. If the pt has a pattern of borderline BP's I assess the pt clinically and see if this in normal for them plus I ask the MD for parameters.

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