[zuchRN]

I was just wondering what your thoughts are on BP post op. I work in stage one PACU. Some of our patients have low bp's for various reasons. The last 2 days, I have had 3 ortho nurses not want to take patients because of decreased bp, despite being within 20% of the pre-op level. One person was running 100/50 consistently with a preop bp of 110/60. Another person had a pre-op pressure of 138 and they were running 110. Is there something that I am missing???

[sharann]

You are not missing anything. I would guess that these ortho nurses are New grads or novice nurses. Experienced nurses know that you must assess the PATIENT and not the numbers! First off, those BP values are completely acceptable AND most people are nervous pre-op so theri baseline BP is high. Next, they need to look at how the patient is tolerating their vital signs. Haven't you ever had a patient with a low pulse, say of 40? The patient ALWAYS runs at 40. EKG pre-op shows Sinus brady. Do you call a code or give Atropine? Of course not. Its all in how the pts overall appearance is. Also, a spinal or epidural are known causes of low bp. They need re-education.
My final thought is that they are scared because if the BP drops, maybe the floor nurses are too busy to re-assess?

[sirI]

Originally Posted by sharann

You are not missing anything. I would guess that these ortho nurses are New grads or novice nurses. Experienced nurses know that you must assess the PATIENT and not the numbers! First off, those BP values are completely acceptable AND most people are nervous pre-op so theri baseline BP is high. Next, they need to look at how the patient is tolerating their vital signs. Haven't you ever had a patient with a low pulse, say of 40? The patient ALWAYS runs at 40. EKG pre-op shows Sinus brady. Do you call a code or give Atropine? Of course not. Its all in how the pts overall appearance is. Also, a spinal or epidural are known causes of low bp. They need re-education.
My final thought is that they are scared because if the BP drops, maybe the floor nurses are too busy to re-assess?

[StokoRN]

I don't see anything wrong the type pf BP variation that you are describing.
1st: +/- 20 % is a 2(out of possible 2) on the Aldrete Score used to screen pts for discharge from PACU.
2nd: If the patient is stable with those blood presures and is asymptomatic, then what's the problem.
3rd: (goes along with 2 above) If there are no others warning signs, such as tachycardia, restlessness, etc. than the pt sounds stable enough to transport.

If there is any doubt in a pts readiness for transfer to floor care, I like to get the anesthesiologist to clear the pt. That gives me an extra support in any discussions with the recieving nurse about the patients stabiliy

Many of our patients routinely run "low" blood pressures or heart rates. In an orthopedic setting I would ecpect to see older patients who may be on Beta Blockers, Ca channel blockers that can lower BP or Hr. I might also expect to find well conditioned athletes that would have "abnormal" vital signs. The patients overall condition shouldbe considered.



"your flag decal won't get you into heaven ,anymore. They're already over crowded from your dirty little war. Jeasus don't like killin, no matter whatthe reason for..." John Prine

[amnesia]

I don't see anything wrong with the vitals. Again we have to treat the pt. and not the vitals. If they are A&Ox3, follow commands and appear to be stable I don't see what the big fuss is about.