What would you have done??

[Sun0408, ASN, RN]

from sun0408

registered user

years exp: not enough

join date: jun 2010

posts: 269

i have a quick question before i go to bed.. i worked a long 12 hour shift last night, short staffed in a icu.. i had a pt on a nipride gtt for bp control. she/he was also ordered 600mg labetalol tid.. bp was controlled over several hours so the gtt was turned down to 0.5mcg.. at about 5am hr went from 80's to 40's and 50's.. next dose of labetalol was due at 6am.. i held the labetalol and increased gtt to get hr back up.. oncoming shift came on and agreed, md rounds early so we were both waiting for him.. he was upset stating we should have stopped the gtt and gave the labetalol along with clonidine 0.3mg.. bp at that time was 114/75 hr 69 with the gtt running... what would you have done??

hx: htn, dsd..

urine output was good..

[detroitdano]

As silly as it is, this is why I call the doc when holding meds (aside from stool softeners!). You never know if they'll agree with your judgment. Most of the time they will, but CYA as they say.

[badness]

who the heck still uses nipride?

[flo136]

I still would have held the meds. Does the Dr want the patient to go into arrest by the morning? If your colleagues agree, and we are educated people, then I don't get the big deal.

Re:badness: we use Nipride every day here for our CABG's. Crazy. I hate it. And they stick it through syringe drivers, which is great when changing the syringe over. Huge BP swings.

[meandragonbrett]

who the heck still uses nipride?

It's mostly used in the peri-surgical CV population as it's much easier/quicker to titrate than Cardene is during a procedure.

[hodgieRN]

I would have held the labetolol for HR in the 40's. And asked for parameters for labetolol orders. Most Dr don't want it given if less than 60 or 55. The Dr could have used a whole list of meds to replace the beta-blocker..or lowered the dose and added hydralazine or something.