timing of bp meds

[NewbieKate]

Hello Everyone,

I am currently in role transition and had this happen. We held pt bp meds for dialysis. Dialysis finished around 1830 and we gave pt his once a day bp meds from the morning. The next morning we came in and gave the pt the same bp meds we gave last night. We gave the meds at 0800 His bp dropped significantly. And this scared me alot. If a bp med is meant to be given once a day...how many hours between dosages is required and do I need a new preceptor?

Also, for those of you who use Epic, if a med is on the MAR and shows overdue status, does it eventually time out from the overdue status? Will a med stay overdue forever is I don't take some kind of action?

Thanks,

Kate

[ghostchili]

meds eventually time out in Epic...i'm not sure if it's 12 hours or 24. i usually chart against it somehow (missed, cancelled entry, &c...if it's a discontinued med i chart it as a cancelled entry and put "med d/c'd" in the comment box because the red overdue box is annoying).

as far as BP meds, try to find out what time dialysis is coming. ask the cardiologist about giving them after dialysis if it's that late, and ask the nephrologist how far apart meds and dialysis have to be. what meds were they? depending on how late you gave them and the dosages, the drop in BP may have been related to something else.

[LaurenNicoleRN]

There's a rule some nurses in our facility go by. Its a rule of halves. If the med is due at 0800 and...for instance..the next dose is due at 0800 the next day, that's 24 hours apart..so with half of 24 being 12..technically you can give the 0800 dose 12 hours later and still administer the next dose on time without having to change the timing of the next dose. As long as BP and P are within range, I would say it's ok to give the med on time the next day. Of course, you'll have to watch the patient a little bit closer. I wouldn't necessarily say you need a new preceptor, but if you are uncertain of why the doses were given the way they were, just talk to your preceptor and find out their rationale. As long as you can make it into "I'd really like to have your insight on this situation" instead of challenging their judgement calls, I'm sure they'd be more than willing to help you understand. MHO..new nurse or old nurse, we can all still learn a little something every now and then..bc the one nurse who knows everything..is a dangerous nurse! Hope this helped some!

[checker1981]

It depends which blood pressure pill you are giving (ARB, beta blocker, ACE inhibitor, calcium channel blocker, immediate release, extended release) and what the blood pressure/heart rate was when you gave the med in the evening and what the blood pressure /heart rate was in the morning when you gave the second dose.