Multiple BP meds & dialysis- to give or not to give....... - page 2

Currently I am 3 weeks away from graduation and doing a clinical rotation in a long term critical care setting (it is that place between ICU and rehab), Yesterday the RN asked me to pass 3 BP meds... Read More

  1. by   Mommy_of_3_in_AL..RN
    We usually hold all meds DURING dialysis, then when dialysis is finished, we draw labs, and give the meds. If the pressure is WNL, 120 systolic or above i would give them all, and watch the patient. CHances are, they wont bottom out, but the meds hopefully will keep their pressure fom climbing during the day. IF you dont give them, and 6 hours later, their pressure is 170 systolic, you would probably have to call the doc for a PRN, since it would be too close to their next scheduled dose to give them then. If their pressure did bottom out, you can always push fluids, give a pressor, and let the doc know, and hopefuly he would adjust the timing of the order so that in the future the patient would not get all at once..maybe stagger them a couple hours apart. Of course, like others have said, it is always wise to go back and look at their trends, see what their pressure usually does after the dalysis and meds, and decide from there.
  2. by   CNA764
    I'm still learning too, so here's my questions:

    What if the pt's SBP was 100 then what?

    ACE inhibitor for an HD pt? is this common?
  3. by   Mommy_of_3_in_AL..RN
    I would not give for SBP of 100..The ultimate goal is to lower the pressure, and you dont want to lower that..unless you want to give pressors and/or fluid bolus..and depending on the patient, that may not be a good idea. If you are worried about getting in trouble for holding them, go to the physician,your charge nurse, or instructor (if you are a student) and explain your rationale for not wanting to give the med, and get that second opinion. If you are comfortable with that physician enough to do so, and he/she still tells you to give it, make sure you get an order for something to raise pressure when it bottoms out!
  4. by   dorie43rn
    I"m sorry, you did not do the right thing. That patients bp was within range to give those meds, I don't care if she just got off dialysis. If the order was not written to hold them, and they were on the MAR, they should have been given. You have alot to learn about medications and critical care. Go back to your drug book and read up on meds and what they do.

    Doris
  5. by   labcat01
    I think you definitely did the right thing. It is never a bad thing to ask questions or to refrain from doing things you are not comfortable with. I think that shocker29 gave you some spot-on advice. Good luck!
  6. by   I_LOVE_TRAUMA
    Quote from dorie43rn
    I"m sorry, you did not do the right thing. That patients bp was within range to give those meds, I don't care if she just got off dialysis. If the order was not written to hold them, and they were on the MAR, they should have been given. You have alot to learn about medications and critical care. Go back to your drug book and read up on meds and what they do.

    Doris
    I really don't think that we have enough information to tell this student that he "did not do the right thing" there are a lot of times where holding bp meds is warranted (critical). I also don't agree that "If the order was not written to hold them, and they are on the MAR, they should have been given." If I followed that logic I would have killed several patients thus far! Ultimately it is my license on the line, and we need to use our critical thinking and training to determine what to do in each individual case. If the patient would have "bottomed out" there is not an MD out there that would not have questioned why the meds were not held.

    The scenario was much to vague to give much advice on (although most of the ideas posted here were right on).

    To the OP, I think that it is wonderful and very smart of you to question the rationale behind a situation like this, this is how you learn-keep up the good work, you will learn a lot. And remember this, I have been an ER/ICU nurse for a long time, and I still have a lot to learn (and learn something new everyday, don't ever think that you know it all, even when you have been a nurse for 3 years or so!
  7. by   Mommy_of_3_in_AL..RN
    Noone knows everything. Even the most seasoned nurses have to refer to some sort of reference now and then. With some meds, especially those that lower BP and HR and RR, docs often dont write an order to hold if less than whatever. At least in my facility, docs expect nurses to have the knowledge to KNOW that a certain med may harm that patient at that time, and hold if warranted. If you arent sure, always ask for a second, or maybe third opinion. If still not comfortable, there is nothing wrong with directly asking the doc. If nothing else, it covers your butt. Most docs would rather you ask than give the med and harm the patient. Just remember when you hold a med for a reason, to document that it was held, and why.

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