I am wondering as to why the Doctors wants a patient's BP in the high range for a patient who was a post CVA? I was taking care of a patient who had a stroke (2nd one in 3 years) and her BP ranges anywhere between 168/98-198/117...I am a med-surg nurse and was floated to the Telemetry floor. I asked one of the regular Tele RN on that floor why and I was told that with post CVA patient it is actullay safe to have their BP on the high side..She said "I will feel safe if her BP is in 180/100 range". She said something about perfusion. I am still not clear about this, can someone give me a better explanation as to why. The patient has an order for Vasotec IVP PRN. When the Tele RN explianed it to me, she made me feel as if I am stupid for asking..excuse me, I don't have much exposure to this type of patients...so that's why I came to this site coz I know I'll get better response. And Oh, her MRI of the brain results didn't show any clots but swelling on the occipital region. Thank you very much.....oh, one more thing...since she was admitted, she's been hiccuping and the Doctor ordered THORAZINE....Why antipsychotic med?
May 22, '07
Keeping the BP up in post-CVA pts. ensures adequate perfusion to the damaged areas. The goal is to minimize the damage and this usually entails making sure the blood flow is OK.
Like in MI care, you are trying to reperfuse the damaged areas and maximize circulation to the collaterals. I just had a stroke class where they showed a graph showing that keeping the SBP in the 140-180 range reduced short and long term mortality and dependency, i.e. better outcomes.
Normally you're looking at blood flow in the range of 50-55ml/100g/min, the less blood flow you have you start getting ischemia, then infarction. This happens when you drop as low as 25ml/100g/min, so you can see how keeping the BP up will really help. As for Thorazine, it is used in cases of intractable hiccups (had to look in the drug guide for that though.
Hope this helps.
May 30, '07
With having baseline pressures that high (how long has she had HTN and are these high pressures her controlled pressures? Is she compliant with her meds at home?)...perfusion of the kidneys also comes into play.