VS parameters and antihypertensive meds

beachbutterfly · Jul 7, 2009

I will NOT..absolutely WILL NOT give ANY anti-hypertensives to a patient with a systolic B/P
I know it is so definitely crazy,I also prefer to hold the BP med if it is in low 100's yet majority if not all of the drug books state it is ok to give it as long as the BP is not

RedhairedNurse, BSN, RN · Jul 8, 2009

I will definitely hold a blood pressure med for a systolic of less than 100, and then call our hospitalist to get an order to cover me. It is our hospital policy that meds can be held at the nurses descretion, but the doctor must be notified and have an ordered received.

I will also hold a beta blocker for a HR of less than 60, then will call the hospitalist to get the order afterwards.

I get an order for everything related to meds, I work too hard to get my license so I'm going to work equally as hard to keep it!! Thank you.

FYI.......I'm not looking for a doctor to hold my hand. I'm in nursing, not in the business of practicing medicine as an MD, and if I believe a med needs to be held, I will hold it and then, as per hospital policy, will call for the order from the doctor who's business is to practice medicine.

Good luck to you!!

ChristyRN2009 · Jul 8, 2009

In general, I will hold for SBP

misswoosie · Jul 8, 2009

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.

Couldn't have said it better!

Need to consider

Current condition that lead to hospitilisation- I would not be too happy with a SBP of 100 in someone with acute stroke.

The med

The aim of the med (like you said beta blockers might be for AF rather than BP)

How long the patient has been on the med

How the current BP compares to their "normal"

BP trends - how does the BP usually respond to the drug?if pt has been on the drug for a week and SBP is usually around 100 anyway-why would you not give it?

Other obs eg HR,pulse,periph circulation,Temp- is there something causing the low BP other than the med eg sepsis,AF etc

Are their any symptoms -like you said dizziness,chest pain,

Might want to do a lying and standing BP in elderly patient-may be time for a change in meds-thinking falls risk.

I think this is called a nursing assessment.:icon_roll