Criteria for Giving IV BP Meds?

So last night at work I was getting report on a pt from the ER and noticed their blood pressure was 200/100 when triaged. 6 hrs later when I was getting report on the floor the BP was 210/110 When I asked the nurse what she had given the pt to treat the BP her excuse was nothing, as due to the pt's vomiting the pt couldn't keep any PO meds down. I questioned why Hydralizine IV hadn't been given, the nurse seemed to not understand why you would give it if the systolic is less than 220. Pt ended up getting nothing for BP in the ER. The nurse taking care of the pt is a travel nurse new to my facility, so I'm curious, what is the criteria at other facilities are for giving IV BP meds?
You know? That is a good question, honestly. Coming from cardiac floors, I was used to treating generally anything over 160 sbp (unless suspect ischemic cva). In the ER, it is like pulling teeth to get a doc to order an IVP BP med. I'm not kidding. They don't really care in my ER unless it is 220 or higher. Now a fast HR they treat, or a low BP. Curious to hear the other answers.

I don't work in the ED, but the criteria for my unit is to treat with IVP or IVPB if systolic is over 160.

I can't say we have a hard & fast policy.That BP in triage ... in a patient actively vomiting ... would not necessarily worry me.That it remained elevated for 6 hours is another story, although your post seemed to indicate that the nausea/vomiting had not resolved and therefore could probably still account for the elevation. What was the patient's admitting dx?

Quote from NoviceRN10I don't work in the ED, but the criteria for my unit is to treat with IVP or IVPB if systolic is over 160.

Quote from AltraI can't say we have a hard & fast policy.That BP in triage ... in a patient actively vomiting ... would not necessarily worry me.That it remained elevated for 6 hours is another story, although your post seemed to indicate that the nausea/vomiting had not resolved and therefore could probably still account for the elevation. What was the patient's admitting dx?

Um.. Really? Why on EARTH wouldnt that be treated? Its on them if they stroke out. Bring that sucker down nice and slow, Clonidine/Labetelol/Vasotec... I work on a PCU, Persistent High BP is something we see every day. Start with a medium IVBP med to slowly bring that sucker down if they cant take PO. If it still isnt budging bring out the heavy guns. Ive seen some pretty unintelligent moves down in our ER.. Sending pt's up with FLUIDS going around 100/hr with CHF and BPs in the upper 180s... Its our job as the nurse to make sure the Dr isnt killing the patient :P GET THAT ORDER!

Quote from ThedreamerUm.. Really? Why on EARTH wouldnt that be treated? Its on them if they stroke out. Bring that sucker down nice and slow, Clonidine/Labetelol/Vasotec... I work on a PCU, Persistent High BP is something we see every day. Start with a medium IVBP med to slowly bring that sucker down if they cant take PO. If it still isnt budging bring out the heavy guns. Ive seen some pretty unintelligent moves down in our ER.. Sending pt's up with FLUIDS going around 100/hr with CHF and BPs in the upper 180s... Its our job as the nurse to make sure the Dr isnt killing the patient :P GET THAT ORDER!

Having recently dealt with a nasty stomach bug, I can say this ...Next time you're vomiting - see if you feel your heart pounding. What do you think your BP and HR are?

So call and get the order changed. Nurses are problem solvers as one of our many hats. True we dont know the entire situation but I see lazy nursing every day on my unit. As a patient advocate sometimes we need to "suggest" to the Dr what might be best for the situation.

Quote from AltraHaving recently dealt with a nasty stomach bug, I can say this ...Next time you're vomiting - see if you feel your heart pounding. What do you think you're BP and HR are?

Quote from ChristineNYes I get that. But I think that more of it was from the pt's kidney's failing than it was from vomiting or other secondary issues.

Yea, treating that underlying should paint a better picture to work with. Maybe some Zofran IV to help with the N+V, see if the BP comes down, check out what the CBC looks like, maybe get a BMP or CMP. Hopefully after that the BP comes down, VS get to a better norm and you can start replacing those lost fluids and electrolytes. <3