per nsg judgement...?

[Fancy Face]

Question: do you ever hold bp meds per nsg judgement(without MD order to hold) when systolic less than 100? Considering there aren't parameters for bp.

[Tweety, BSN, RN]

Yes, but I alway notify the MD. If the patient is not symptomatic I might wait until they arrive on rounds, but always let them know. The MD probably needs to make some adjustments in the meds, and we have to cover ourselves with an order to hold.

Nurses are to use prudent judgement, not blindly follow MD orders that could result in harm to the patient.

[Silverdragon102, BSN]

yes, would make sure documented reason to withold and inform doctor

[Hoozdo, ADN]

Question: do you ever hold bp meds per nsg judgement(without MD order to hold) when systolic less than 100? Considering there aren't parameters for bp.

Yes, all the time. But, as Tweety advised, I leave a note for the doctor when they make rounds or communicate the fact in some manner. My patients are monitored in ICU though so I know at all times what their BP is because most have A-lines. I tend to look at the MAP to determine whether to hold hypertensives rather than systolic though.

[RNperdiem, RN]

Yes, generally I would hold BP meds in less than 100 if no parameters given, and inform the docs when I next see them. It is not always that straightforward, though.

Different areas of medicine tolerate different BP's if patient is not symptomatic. Neuro patients with high intracranial pressures need high enough blood pressures to perfuse the brain against pressure. Cardiologists seem to want the lowest pressures and heart rates on their patients and may not want you to hold that BP med.

[Fancy Face]

I held bp med with parameters, but not the other--- patient end-stage heart failure, bp 90/60 at rest first thing in morning. Can you hold these meds without MD orders? What if the patient later that day had complications from elevated bp?

[clee1]

I held bp med with parameters, but not the other--- patient end-stage heart failure, bp 90/60 at rest first thing in morning. Can you hold these meds without MD orders? What if the patient later that day had complications from elevated bp?

I never give antihypertensives with a BP this low.

[CaLLaCoDe, BSN, RN]

I held bp med with parameters, but not the other--- patient end-stage heart failure, bp 90/60 at rest first thing in morning. Can you hold these meds without MD orders? What if the patient later that day had complications from elevated bp?

I hold any med I see fit not to give without hesitation. Hold colace and reglan for loose stools and hold BP meds if your concerned with bottoming out the BP...simply put, I'd rather treat a high blood pressure. Probably the patient's body physiologically is used to dealing with this chronic condition of hypertenson. Better than dealing with a low symptomatic blood pressure where your having to call the doc to bolus give dig and check for Lowered mental status or rush down to ICU with a dopamine drip ..scary! Or put your patient in dire risk for a fall. You can always give the scheduled BP med later in the shift. And rarely have I seen a low blood pressure early in the shift turn to a beyond proportional grave one in the afternoon!

And according to the other thread, inform the Doctor so he/she can adust the medication parameters....so what gives with two threads anyway?

[Fancy Face]

I meant to hit reply, not have 2 threads!

[Tweety, BSN, RN]

I meant to hit reply, not have 2 threads!

No problem. I merged them.

[Tweety, BSN, RN]

I held bp med with parameters, but not the other--- patient end-stage heart failure, bp 90/60 at rest first thing in morning. Can you hold these meds without MD orders? What if the patient later that day had complications from elevated bp?

Bottom line is this: no you can not hold medications without MD orders because that is practicing medicine. However, a prudent nurse would not give the medications, and would then notify the MD for further orders. That way if the MD says hold it, and the patient later in the day rises - which is common in patients with hypertension when they don't get their meds - you're covered.

[caliotter3]

I would document holding the med and call the doctor.