BP 200's/150's Appropriate for General Med/surg?

[KyPinkRN]

i am fairly new in nursing (in fact haven't even taken the nclex yet), but one of my colleagues had this evening an admission whose bp was consistently in the 200's/150's. to me that seems dangerously high and i would think require a higher level of care. this patient was said to have this problem quite often which logic tells me puts them at a great risk for a cva or aneurysm. any input is greatly appreciated.

thanks

[MikeyJ, RN]

That is dangerously high, but I wouldn't think it would constitute to be admitted to ICU or IMC... perhaps I am wrong though.

[rizzle]

Wow. A BP like that would constitute a hypertensive crisis and would probably need labetalol or a cardene gtt. That pt. definitely requires a higher level of care...

[Dolce, RN]

I've had patient's on med/surg with chest pain, BP 70s/30s, pt in trendelenburg, us drawing enzymes, hooking up portable EKG, O2 on, giving meds, starting new IVs and telling the R1 that patient really needs to transfer up. His response...well lets wait and see. Grrrrr. High acuity patients are not acceptable on a med/surg floor. It doesn't have to do with incompetent staff--med/surg nurses are very competent. But, when all of a nurse's time is spent in one patient's room all night then their other patients are being neglected. That is not okay.

[tanthalas]

200/150? Wouldn't the pt. be hearing pounding in their ears and major JVD?

[smk1, LPN]

yikes, off to a step down unit at the least inmho. I'd at least want to check what the rhythm looked like too so at least get on tele.

[UGAnurse414]

This was an issue recently on my med-surg floor. One of the nurses

received this pt whose BP in the ER had been 220/110's at points and the MD wanted to send her up to us anyway...as our charge nurse said "they're not really worried b/c her BP runs high anyway." So the patient gets to our floor in extreme pain and n/v...iv infiltrates...bp goes sky high again after getting labetolol, hydralazine, and other bp meds in the ER. Our charge nurse is still not all that concerned and neither is the MD!! So you had 3 LPN's in this patients room trying to get new IV access and get the pt calmed down all at the same time the charge nurse is up front working on "chart checks"! We finally had enough and got our nursing supervisor involved and after 4-5 hours of the high BP issue the patient was transferred to ICU, which is where she should have went in the first place and been on some type of drip to get that BP under control. I swear, I am surrounded by idiots at times!

[OC_An Khe]

It really depends on the individual patient and what treatment modalities are being ordered. Remember to treat the patient and not the number. Some patients can tolerate that level of BP and actually lowering it to aggressively in select patients can result in a relative hypotension.

[al7139, ASN, RN]

Hi there,

I work on a telemetry unit. I have been a nurse for about 10 months now, so I am still really new at this.

We are a unit that takes stable cardiac patients (i.e. angina, CHF, post cath +/- intervention, etc.). Often, our patients come to us for untreated hypertension, or a hypertensive crisis. In my short time as a nurse, I have seen patients come directly to us with B/P's in the low 200's or high 100's that are stable and do not require ICU or Stepdown status, either because of other related medical history (renal patients on HD, or diabetics) that makes this "normal" for them, or because the patient's MD feels that they need to be normalized very slowly via PO meds indstead of a titrated drip (again related to other pertinent medical issues). Usually these patients are asymptomatic, or have very mild symptoms.

On the other hand there are patients who need to go directly to ICU so they can be closely monitored because their hypertension is causing an unstable state (the patient is symptomatic, and the HTN is the cause).

Yes, I worry when I have a pt who is having hypertension, but if they are not unstable, I just make sure I follow the MD orders (usually there are PRN meds with parameters), and notify the MD of the B/P. Even if they do not give orders, at least I did what I needed to do to make the doctor aware, and I document EVERYTHING!!! (CYA) If it's a doctor I have a good working relationship with I will ask him what the rationale is for his treatment so I can get a better understanding of why the doctor wants to treat it this way instead of putting the pt on a drip or whatever.

Your original question of whether or not it is dangerously high, seems to me to be determined from patient to patient, since no two are alike. You have to look at the whole picture...things like if they are new onset, or a frequent flyer who is notoriously non compliant at home? Is their heart rhythm normal or are they experiencing an arrhythmia? Do they have a medical history that would predispose them to hypertension such as renal insufficiency or diabetes?

My personal rule is: If it's abnormal, I either treat as the doctor ordered, reassess, and if it's not fixed, call them for further orders, or notify the doc if I have no orders to follow ( and no, I don't care if it is 2am...tell me what to do, or if they don't give orders for treatment, I document it, and notify my team leader of the situation).

Hope this helps, sorry it's long winded.

Amy

[RN1989]

If we went merely by one number or complaint, EVERYONE would be in the unit.

The acuity of pt's is increasing. The pt's seen on a regular floor today are the pts that were in the unit years ago. And the pts that are now cared for in ICU are the pts that would have been dead years ago. If you are uncomfortable with certain pts being on the floor, then I suggest that you do research on these particular type of high acuity illnesses/symptoms. Knowledge is key in caring for these pts. When you learn as much as you can about a particular s/s, dx, etc. you will feel much more comfortable and capable caring for them in any capacity. You will also sound much more intelligent when you contact the doctor to report the abnormality. In fact, you may even be able to make suggestions to the doctor because you are so smart and studied and know all about the most current tx's for the problem.

[running_nurse]

i know when you look at the numbers it sounds horrible. i had a PACU patient (when one of the MEAN nurse managers was in charge) who came in with a BP around 200/150. our protocol is that we can't send patients up to the floor until BP within baseline. i asked the resident if we could treat it and he said "no this is his baseline." of course the nurse manager is flipping out at me and i knew the surgical floor would have an issue too. so after calling the resident again the ATTENDING showed up and refused to treat the BP as well. basically she said we weren't going to try to fix something that can't be fixed in the short PACU time. i had to go to another area of the PACU so the nurse manager took over this pt.....would be interesting to see what happened with that.....

[nrsang97, BSN, RN]

What was the pt diagnosis??