Hold and report heart rate below 60 beats per minute or systolic BP below 90 mmHg.
Before you read
Test yourself first: 2 questions
Question 1 of 2
A client with hypertension is prescribed diltiazem. The nurse should question the order if the client also has which condition?
Answer: A. Diltiazem is a non-dihydropyridine calcium channel blocker with negative inotropic and chronotropic effects. It is contraindicated or used cautiously in clients with second- or third-degree heart block and in severe systolic heart failure because it can worsen these conditions. The nurse would question the order in a client with second-degree heart block. Mild hypertension, well-controlled diabetes, and seasonal allergies are not contraindications.
Question 2 of 2
A client with stable angina is prescribed a calcium channel blocker (diltiazem). Which assessment finding should the nurse report to the provider before administering the dose?
Answer: B. Diltiazem is a nondihydropyridine calcium channel blocker that slows AV conduction and lowers blood pressure and heart rate. A heart rate of 50 with a systolic pressure of 86 indicates bradycardia and hypotension, so the nurse should hold the dose and notify the provider. A normal blood pressure, a normal heart rate, or mild ankle edema would not warrant holding diltiazem in this scenario.
Keep the streak going with more questions like these, each with a full rationale.
What is diltiazem?
It slows AV node conduction, reduces heart rate, and relaxes vascular smooth muscle to lower blood pressure. Both IV and oral forms are used.
Key points to remember
- Slows AV nodal conduction and heart rate, making it effective for rate control in atrial fibrillation.
- Lowers blood pressure through arterial vasodilation and can cause bradycardia and hypotension.
- Should not be combined with IV beta blockers because of additive risk of profound bradycardia and heart block.
- Contraindicated in second- or third-degree heart block (without a pacemaker) and in cardiogenic shock.
- Grapefruit juice increases drug levels by inhibiting metabolism.
- Extended-release tablets must be swallowed whole, not crushed or chewed.
Signs & symptoms
- Bradycardia, hypotension, edema
- Dizziness, constipation, flushing
Nursing priorities
- Check apical heart rate and blood pressure before administration; hold and notify the provider if heart rate is below 60 or systolic BP is below 90 mmHg.
- Place the patient on continuous ECG monitoring during IV administration.
- Assess for signs of heart failure and peripheral edema with ongoing therapy.
- Teach patients to swallow extended-release forms whole and to avoid grapefruit.
Patient teaching
- Take your pulse as instructed and report a rate below 60 or feelings of fainting.
- Swallow extended-release tablets whole; do not crush, chew, or split them.
- Avoid grapefruit and grapefruit juice while on this medication.
- Rise slowly to prevent dizziness from low blood pressure.
- Do not stop the drug abruptly, as angina or rapid heart rate can rebound.
Red flags: report now
- Hold and report heart rate below 60 beats per minute or systolic BP below 90 mmHg.
- Report new heart block, severe bradycardia, syncope, or worsening heart failure.
- Never give concurrently with IV beta blockers due to the risk of cardiac standstill.
References
Clinical references for this topic
