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Assessing the Safe Resumption of Antihypertensive Medications Following Total Hip or Knee Arthroplasty Surgery

Roach, Janey A.; George, Charles J.; John, Lawrence; Plocki, Regina

doi: 10.1097/NOR.0b013e3181ada7e4

PURPOSE This exploratory, retrospective study aimed at examining whether patients experience orthostatic hypotension unnecessarily when antihypertensive medication(s) is simultaneously resumed following total joint replacement surgery.

SAMPLE The study sample consisted of 285 patients who underwent either total knee or total hip surgery and had a dual medical diagnosis of hypertension requiring treatment with more than 1 type of antihypertensive medication.

METHOD Medical record reviews of all patients admitted to the orthopaedic unit from March 1, 2006, through June 30, 2006, at University of Pittsburgh Medical Center were analyzed to determine whether patients experienced any hypotensive event within 48 hr of their total joint replacement surgery following the resumption of their antihypertensive medications.

RESULTS Thirty-five percent of the patients experienced a hypotensive event following the resumption of their antihypertensive medications within the identified time frame. Among patients who had documented evidence of a hypotensive episode prior to the resumption of their antihypertensive medication, 42% of those experienced hypotension after postoperative medication administration versus 28% in patients without prior hypotensive episodes (p = .50).

CONCLUSIONS These findings indicated the need for clear nursing guidelines outlining time frames for the assessment and documentation of blood pressure reading prior to antihypertensive medication administration.

Janey A. Roach, MSN, RN, ONC, Faculty, St. Margaret School of Nursing, University of Pittsburgh Medical Center (UPMC) St. Margaret Hospital, Pittsburgh, PA.

Charles J. George, MS, Statistician, Senior Statistical Coordinator, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA.

Lawrence John, MD, Clinical Instructor in Family Medicine, School of Medicine, Department of Family Medicine, UPMC St. Margaret Hospital, University of Pittsburgh, Pittsburgh, PA.

Regina Plocki, BSN, RN, Staff Nurse, Unit 4 B Orthopaedics, UPMC St. Margaret Hospital, Pittsburgh, PA.

© 2009 National Association of Orthopaedic Nurses