There was an elderly Pt running 190's/90's (manual BP), pulse WNL (SR c some PVC's), asymptomatic, no acute distress, neurologic check fine, at 2am. I called the MD about the BP, and he was a little perturbed, asking if this was a new development or chronic (possibly he was asking if the BP could have just waited until morning).
The answer to to that question was that she'd been at the hospital a few days for a bone fracture after a fall; the first day or so, BP's had been high but not crazy high (systolic BP's 150's - 170's, diastolic's
She was on BP meds at the hospital, but a couple of her home diuretics had fallen through the cracks...the way the MD wrote it, it looked like the Pt should actually have been getting those diuretics for a day or so now, but no one had done it, and I was a little timid about starting her back on without a clarification (MD had written to hold those meds while the Pt was NPO, but then the Pt got taken off NPO, and no one rewrote for or restarted the meds).
However, she did seem stable, neuro's fine; my question is, how high is too high? I get antsy about high BP's, thinking the Pt's going to stroke out...but what BP is really stroke range? Comoribidities on the Pt, btw, were DM and "borderline HTN," also hx ETOH abuse, cirrhosis, possible CHF, probable PVD, and risk for DVT.
For me, it was kind of one of those situations where I'm looking at it, thinking, "Err, the Pt will PROBABLY be ok in this situation...but what if she isn't?? I'll look back and beat myself up for not having done something."
(side note: darn you, allnurses.com, for keeping me up to 10:30 am!! i have to work tonight! I was just going to get on and post this one thing, and I got sidelined by the posts! growl)
Like everything else, it's relative. I agree with pretty much all the other good thoughts. And if it makes you feel better, I'd have also called, and I'm VERY conservative in my calls at night. (Not because I'm afraid to call the doctor, but because I don't think all that many things warrant a call in the middle of the night.) She was trending up, and this was a middle of the night, supposedly at a "relaxed/sleeping" time, so it concerns me more than a BP above their trend mid-afternoon. Throw in risk of DTs, I'd call.
wooh, BSN, RN
1 Article; 4,383 Posts
Like everything else, it's relative. I agree with pretty much all the other good thoughts. And if it makes you feel better, I'd have also called, and I'm VERY conservative in my calls at night. (Not because I'm afraid to call the doctor, but because I don't think all that many things warrant a call in the middle of the night.) She was trending up, and this was a middle of the night, supposedly at a "relaxed/sleeping" time, so it concerns me more than a BP above their trend mid-afternoon. Throw in risk of DTs, I'd call.