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.

[Fancy Face]

wouldnt you want to keep bp low with heart failure and impaired kidney function.

[TazziRN, RN]

Which would you rather do: give the med knowing that the pressure is low, and have the pt bottom out on you and become unresponsive and then become an emergent pt, or:

hold the med and keep a close eye on the BP until you hear from the doc? If the BP rises to the point of being a crisis then you did not monitor closely enough; you should see it rising and should know before it gets to the crisis point. An already-low BP, however, can crash very suddenly. A high BP, in and of itself, is not a problem although it can cause other problems: MI, CVA, etc. A low BP, however, is much more dangerous because of lack of perfusion. In either scenario, if you were called into court, the low BP that was medicated anyway and bottomed out will be a bigger problem than a high BP because you withheld the med and then had to give antihypertensives.

[TazziRN, RN]

wouldnt you want to keep bp low with heart failure and impaired kidney function.

Yes, but in that case the doc would have written parameters.

[caliotter3]

You inform the doctor so that he/she can determine if the BP is headed too low for whatever the medical situation. A change might be in order. At any rate, he/she needs to know what is happening. That is why people with everyday hypertension are told by their doctors to monitor their BP and to give this info at MD visits.

[Fancy Face]

I made a mistake, I need to learn from it and move on. I tend to beat myself up over poor judgement calls.

[TazziRN, RN]

Everybody makes mistakes, Fancy. As long as you learn from it, then there is a positive side. We all make mistakes and learning from them is how we become better nurses.

:kiss

[JaneyW]

You guys are giving me a good review of med surg! I work in L&D and we often give Nifedipine for pre term labor control (as a tocolytic). So, I have a healthy young woman who is pregnant and probably has normal BPs in the 90s/60s and I have to decide when to hold the 10 or 20mgs of Nifedipine. I also have to think about keeping the diastolic at a point to make sure the pressure is adequate to perfuse the placenta. But, then again, if I get her off track on the Nifedipine and she starts contracting more often and with more force and ends up in true labor I have another problem! Nursing judgement is important. Use it. Just make sure that you follow up with the correct documentation and notification of the MD.

[TazziRN, RN]

The most important point is that whichever decision you make ---to give or withhold---you need to monitor the pt closely to see if there is deterioration or stabilization. You can't give in spite of a low BP or hold because of it and just walk away.

[Silverdragon102, BSN]

Fancy

as said previously we all make mistakes, hopefully not serious ones, learn from them. You will find it makes you a better nurse. Remember if in doubt check with either another collegue or MD and document everything

[ptadvocate81]

I have held BP meds depending on pt symptoms and what not, but just remember that sometimes if a pt is use to receiving a daily med, they can rebound in a few hours and have HTN if the dose is not administered. It depends on the Dr. as to when I notify them because I work nights and most of them are okay to wait until they make morning rounds.