hypertensive emergency?

[conscientiousnurse]

">Today I had a student I was teaching who had a BP of 188/124. What would you have done in this situation? She says she recently saw the doctor and had a normal B.P., but is having problems with anxiety and has been prescribed med for anxiety, which she hasn't started yet and doesn't have with her. Also that she's being treated now for UTI. She said she had no symptoms with her B.P. except for feeling anxious and flushed. I was alarmed, and suggested she go home and either go to urgent care or call her doctor, but she wanted to stay till the end of the day. She didn't want to get her B.P. taken again at all, because it made her more anxious to do that. At the end of the day, I told her if it were me I'd either go some place that could take my B.P. or call my doctor. And I hinted that it could lead to a stroke. Every time I brought up the subject, though, she said I was making the anxiety worse. What approach would you have used, and do you think it's something a phone call to the M.D. or a trip to urgent care could've taken care of?

[conscientiousnurse]

I find this unsettling ... this talk of calling 911 as a "trick" to get the student to get immediate medical attention. But probably not as unsettling as the idea of asking an RN at the facility where these clinicals are being held to assume care of the student. This is completely inappropriate.

You are this student's academic instructor. Period.

It is unfortunate that the student felt the need to share other personal medical information with you. You have no business to know that. And as an adult whose mental status is not currently compromised ... neither you nor anyone else can "send" her anywhere ... it is HER decision whether or not to seek medical attention.

I wholeheartedly disagree with your perception of your role being to "take care of her in every other way while she's there". You are her instructor. Your relationship extends no further than the instructor-student exchange of information and evaluation of the student's learning process.

As an instructor, what report of an incidental finding of an elevated BP would you like to add to this student's academic record?

If you felt strongly about the BP you could have sent the student home, if it is in accordance with your school's policies to do so, as might be the case if a student was vomiting or febrile, for example. The school might have required medical clearance from the student's physician to be allowed to return, if it is their policy.

Thank you for this post. I found out today that I could send the student home, if I felt she was not able to fulfill her duties as a student at clinicals (which she would not, if it caused a stroke or other major problem). I would have done that, but still recommend to her that she call her doctor immediately. Of course, to judge whether she was in serious danger and may need to have an ambulance called so that she wouldn't die on the way driving home, wouldn't it be appropriate to ask if she had other symptoms? I'd hate to send a student home who refused to call her doctor, and then find out something terrible happen on the way when I was the one who sent her home.

Also, many of the posters here talk about documenting. If not in her academic record, where would I put this documentation? Just have my own documents in my house? To say that I sent such and such student home with a medical problem and recommended their calling their doctor immediately, where would I document this? We're a very small organization, I don't have my own personal office, and we have no health room.

I appreciate the post about using 911 as a trick. Really I don't think I would call 911 unless the situation was a lot worse than this, such as very worrisome symptoms with the B.P., that needed immediate care.