Questionable parameters?

silentRN · Oct 18, 2008

Just don't give the med and see what happens. It's your call to give it or not. You have the right to decide.

londaj · Oct 18, 2008

this londaj at our hospital we have to give the bp meds ..now if the md wrote parameters that is a different story but we were told we can not hold any medication because we don't have the right if the pt refuses we have to call the md or we could lose our license,i gave lasix and lopressor to a pt with bp 80/40 md was aware pt bp got no higher than 85/40,92/56

but her heartrate was upper 90's 100 so any time we second guess ourselves about bp meds or any meds that we want to hold we have to call the md ..can you imagine calling him at 3 am cause toprol,norvasc was scheduled and bp was very low and you just had that feeling:no:..

morte, LPN, LVN · Oct 18, 2008

Just don't give the med and see what happens. It's your call to give it or not. You have the right to decide.

nope, nope, nope....if you have a doc's order that has been questioned and confirmed, you cant just hold it and see what happens....uh uh....now if there were no parameters, i wouldnt be giving it, but i would be calling doc...

Babs0512 · Oct 27, 2008

I would say "what does the parameter state?" If there isn't one, I would get one ordered.

There are cases where meds have multiple uses, Lopressor can be given for elevated BP and for a patient with an active MI to open help dialate coronary arteries. I've seen it given providing HR is greater than 80 systolic. And if patient is tolerating ie: passing out bad, pink/warm/dry = good.

IMHO

GLORIAmunchkin72 · Oct 27, 2008

This would be less scary in an ER or ICU setting where the patient is constantly monitored.

I would say "what does the parameter state?" If there isn't one, I would get one ordered.
There are cases where meds have multiple uses, Lopressor can be given for elevated BP and for a patient with an active MI to open help dialate coronary arteries. I've seen it given providing HR is greater than 80 systolic. And if patient is tolerating ie: passing out bad, pink/warm/dry = good.
IMHO

trvlngrn22 · Oct 28, 2008

this londaj at our hospital we have to give the bp meds ..now if the md wrote parameters that is a different story but we were told we can not hold any medication because we don't have the right if the pt refuses we have to call the md or we could lose our license,i gave lasix and lopressor to a pt with bp 80/40 md was aware pt bp got no higher than 85/40,92/56
but her heartrate was upper 90's 100 so any time we second guess ourselves about bp meds or any meds that we want to hold we have to call the md ..can you imagine calling him at 3 am cause toprol,norvasc was scheduled and bp was very low and you just had that feeling:no:..

Londaj is correct as far as needing an MD order. JACHO is changing how we nurse. We do not 'have the right' to hold medications...it is considered practicing medicine..unless we have parameters.

But alas, JACHO wants it both ways. We also must question orders that seem unsafe. There are many reasons to give the medication. HR, Post MI, is it a new medication? a home med? the pts blood pressure may be 85 because he takes his meds.

It is difficult to be a nurse these days. Sometimes darned if you do and darned if you don't. But you need to call the MD for orders if no parameters exist. Sometimes a compromise can be reached. Give when SBP is > 90, so that a med is not held for 12 hours. Or perhaps a lower dose...I myself have given antihypertensives with such blood pressures, or betablockers with HR's in the low 40s. Sounds crazy, but in each instance the patient needed the med and did fine.

Do try to find out more on why. Know the peaks of your meds so you'll know when the patient is likely to develop problems if they do.

Good for you to question the situation though

Babs0512 · Nov 24, 2008

I would want parameters from the MD. I can think of instances where I would give it, but more instances where I wouldn't. Best coorifice of action, get parameters ordered.

medicinemanrn · Nov 29, 2008

As a nurse, we follow the physicians orders. If we are concerned we call to clarify those orders, and then we document that we we clarified the order.

I have seen metoprolol 25 mg held by other nurses for low bp, but I also understand that this low dose really doesnt affect bp as it is often given at this dose to prevent a-fib. I have seen some nurses hold NPH inulin for low blood sugars, this makes no sense as this wont reach full potential for 6-8 hours.

The problem with some nurses holding meds is that the physician isnt made aware of it, then they only see the vital signs or blood sugars and actually increase the doses.

So, if you feel a medication shouldnt be given, and there are no parameters, call the physician for clarification....and ask for parameter orders so he wont get calls at 0300.

PsychNurseWannaBe, BSN, RN · Nov 29, 2008

Don't the med books normally tell you to hold if less than 90? Are these meds books practicing medicine? The med books are designed based on the effect of the medication.

Now if the MD gave different parameter like hold if SBP less than 85, then I would give it until it reached 84. But without parameters, I will hold it if less than 90. It is part of what we do. To give the med might cause the BP to drop and lead to patient falling.

Where I get stuck is with the DBP. If the BP is 110/46, umm, do I give it? Should I never worry about DBP as long as SBP is over 90?

But MD are suppose to put parameters for BP, and blood sugars prior to admission. If not we ask for a clarification, but that can take a while. So I use my best nursing judgement. Still I find it hard to believe that I would get in trouble if there is written lit from rep sources stating not to give a med. After all, don't they know? As long as I can point to best EBP, I feel OK with it.