VS parameters and antihypertensive meds

RedhairedNurse, BSN, RN · Jul 7, 2009

This question has been bothering me since I entered NS, do you prefer administering the antihypertensive meds to a patient with below 90 or below 100 systolic blood pressure,thanks....? (BTW,I prefer to hold the drugs when the patient is like 105)

What?? I'm sorry, I don't understand your question.

I administer blood pressure meds whenever they're ordered, not

just if there blood pressure is high, or whatever you're trying to

say about it being below 90 or 100. I will hold the meds on

whatever the doc has ordered.

You prefer to hold the drugs if what is 105 ???

you need to make yourself more clear esp if you're going into

the nursing field.

Besides, it is not your call to hold meds. You have to have a doctors order. You can make that judgement and then call the doctor to get the order.

RNKPCE · Jul 7, 2009

Most of our doctors leave parameters. If there are no parameters and the patient's blood pressure is on the low side for me usually around 100, I will hold it and then call the doctor and get parameters. It also depends on the med or if the pt has multiple meds that will effect the blood pressure. It also depends on the patient and what their diagnosis is.

Patient's with cardiomyopathy do better with lower blood pressures and can tolerate a drug like captopril even if their blood pressure is sys 92 before giving the drug.

beachbutterfly · Jul 7, 2009

What?? I'm sorry, I don't understand your question.
I administer blood pressure meds whenever they're ordered, not
just if there blood pressure is high, or whatever you're trying to
say about it being below 90 or 100. I will hold the meds on
whatever the doc has ordered.
You prefer to hold the drugs if what is 105 ???
you need to make yourself more clear esp if you're going into
the nursing field.
Besides, it is not your call to hold meds. You have to have a doctors order. You can make that judgement and then call the doctor to get the order.

actually no,you can also refer to a drug book and look up the protocols and agency policies.

Ok let me rephrase or clarify my question; would you hold the antihypertensive med if your pt's blood pressure was in the low 100 or would you hold it only if it was below 90, and then of course notify the MD.

NightNurseRN · Jul 7, 2009

I usually hold if SBP is less than 100.

Virgo_RN, BSN, RN · Jul 7, 2009

It depends on how long the patient has been on the med and what their VS trend is, if the MD has written any parameters, if the patient is symptomatic, etc....

AllSmiles225 · Jul 7, 2009

I will NOT..absolutely WILL NOT give ANY anti-hypertensives to a patient with a systolic B/P

CABG patch kid, BSN, RN · Jul 7, 2009

We have a hospital protocol to hold the med if systolic is less than 108, sometimes docs will write their own parameters if the patient has a low ejection fraction and usually lives with a systolic of 95. You do have to take multiple factors into your decision making. One time a doc got ****** at me for holding a med when the patient didn't meet our hospital parameters, but oh well, he knows the policy and he should have written his own parameter (docs never write parameters at our hospital except for special circumstances).

Virgo_RN, BSN, RN · Jul 7, 2009

I will NOT..absolutely WILL NOT give ANY anti-hypertensives to a patient with a systolic B/P
Holding parameters for metoprolol on our cardiac floor are generally SBP
Metoprolol has more of an effect on heart rate than on blood pressure, and many patients need it for rate control, not BP control, or are on it to increase ventricular filling time, which improves cardiac output and inhibits ventricular remodeling. This is important for someone post MI who has damage to the myocardium. Some people take it for management of angina. Someone with severe aortic stenosis needs to have a lower pressure gradient across the aortic valve, which means lower systemic vascular resistance. People take antihypertensives for a variety of conditions, and many live with very low BPs. I once cared for a man with an EF of 10% who lived in the low 80s systolic. That was right where his cardiologist wanted him to be, and he was up walking around and living his life with that BP.
Someone with a BP of 86/52 still has a MAP >60, which is what is needed to perfuse the vital organs like the kidneys. Also you have to look at how the patient is tolerating that BP. Some people feel perfectly fine, while others might feel light headed or woozy with a pressure like that.
Now, I probably would go ahead and hold their dose of metoprolol with a BP like that, until it comes up above 90 systolic, unless they have been on the metoprolol for years and that's the BP trend that they live with, and they have a condition that warrants keeping them low. With someone like that, you could be doing harm by holding their med because you think their SBP is too low, just because it's 100, and you wouldn't want them to. If they normally run higher, like in the 110s-120s, and now they're at 86, you bet I'm calling the doc.
It's not black and white, and I do agree that MDs should write parameters for these kinds of meds, though I must admit that I do enjoy the critical thinking involved when there are none.

NightNurseRN · Jul 7, 2009

Sometimes I feel that some nurses are way too quick to call a doctor. We need to use our critical thinking skills and nursing judgement. Doctors do not need to be paged for every little thing, especially when the patient is asymptomatic.

guislander · Jul 7, 2009

It depends on the pt and the med and the reason they are getting the med. I remember having a young woman on our tele floor with cardiomyoapathy. the Drs WANTED her BP to be less than 90 SBP. In that case, yes I gave the meds. But If I feel this is a new thing or I don't feel comfortable I will call for parameters before giving a BP med. Sometimes the drs think I'm crazy or silly or whatever, but at least then I'm comfortable with the administration.

beachbutterfly · Jul 7, 2009

Thanks for your replies.In my first post I meant to say above 90 not below 90...sorry.Anyway I'm a new nurse and I'm just trying to be on the safe side and seek reassurance as well as quidance from more experienced as well as seasoned season nurses.I'm a big supporter and fan of critical thinking and nurses should not expect for the MD to hold their hands all the time and need to be able to use their own personal judgment in making patient's care decision.Just look at the ER nurses they do really use unofficial autonomy and are such a smart individuals and in many cases the doc is not even there.Anyway I'm just learning to swim and trying to survive in the complex world of medicine and I'm just wondering about different methods of safe practice.Please keep the responses coming...lets compare our own nursing practice it is never harmful to double check yourself.