hypertensive emergency? - page 4

">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... Read More

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    "i also do not understand the relationship of you and the student. are you the school nurse? or a nursing instructor? is the student a minor or adult? what is the relationship and responsibility here? a school nurse has a different responsibility to intervene whereas a teacher with a student may not. just curious i guess as to why the student was so fearful and anxious. my mind wanders to possible abuse or threats.

    i know too that patients that tend to run extremely high pressures tolerate higher readings more than if was an acute onset. did the blood pressure cuff fit right? was the equipment calibrated correctly?
    "

    i am the instructor for these nursing assistant students, and she is an adult. as far as being normally high, she stated the contrary, that her b.p. is normal and was normal at last doctor visit, and that's she's not on b.p. meds.

    the cuff may have been slightly small for her, though i didn't measure it to her arm. i have no idea when the cuff was last calibrated, but it was one being used on the unit.

    another poster asked about intervening with only one reading. in this case, it was impossible to obtain any further readings, because she refused.

    i guess i'm tense about it because i am the teacher there and take care of her in every other way while she's there, so i would feel responsible somehow if she had a stroke or something and i hadn't done the right thing, such as giving her proper info on the reason why it's so important to contact a doctor, or insisting she go home, etc. what is the legal liability, i wonder, in such a situation? and would you recommend writing up some kind of report about this incident to put in her student records?

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    Those say that you have no responsibility or that her BP is not your business are being short-sighted. While this might be true if the patient was just your neighbor, for example, it is likely NOT true while you are acting as an agent of the school. I couldn't agree more with the post that counseled you to find out the school's policy and adhere to it strictly, as you may be putting them in a position of liability if you don't. The only thing I would add to that is to get the school's policy in writing so as to cover your own behind if it becomes necessary. I wouldn't rely on anything told to me verbally.
    NurseOnAMotorcycle likes this.
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    Liability is exactly why you have her report it to the doctor. Then it is out of your hands and into theirs. You could tell her she requires MD clearance to return to school.

    I once worked for a hospital risk management lawyer and i learned a lot. Very eye opening. The more you do the deeper you are in and the more liability you are getting yourself into.

    All that other stuff like repeat measurements and other advice is just establishing yourself as a care provider which you are not and do not want to do!
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    The op can recommend that she report to the doctor, but she can't force her to. However, the op can require that she leave if the school's policy allows it. That's why she needs to find out what the policy is.
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    Quote from conscientiousnurse
    That would be a good trick, to call the paramedics. But I'm not sure if that would violate the students' rights to call 911 without her permission? Another thing I could've done, since I was in the nursing home, would have been to talk it over with one of the other R.N.s there and see if the student would give permission for that R.N. to give her professional advice (maybe with a scary story thrown in about how a resident had a stroke with a high B.P. like that
    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.

    Quote from conscientiousnurse
    I was just reading something about this subject, and it made me think. It says that acute renal failure can be a cause or effect of elevated blood pressure. She says she has a UTI now which has been hard to treat. Hmm...could it be that something wrong with her kidneys now is causing her body to be unable to regulate B.P. and react so strongly to anxiety?
    I also still wonder whether it's appropriate in this case to send her to urgent care, or would they immediately send her to E.R.?
    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.

    Quote from conscientiousnurse
    I guess I'm tense about it because I am the teacher there and take care of her in every other way while she's there, so I would feel responsible somehow if she had a stroke or something and I hadn't done the right thing, such as giving her proper info on the reason why it's so important to contact a doctor, or insisting she go home, etc. What is the legal liability, I wonder, in such a situation? And would you recommend writing up some kind of report about this incident to put in her student records?
    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.
    KelRN215 likes this.
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    I agree with most of what Altra said about the student's choice being her own.

    As an instructor, you are acting almost as her NM/supervisor. Could you have sent her to employee health or something similar?
    Or as a teacher, set her down in a quiet office with a hot cup of tea for a while?

    Sticky business for sure. How far as a teacher should you go, how far as a medical professional? Certainly as a group of nursing instructors, explaining to her family why she went from school to the ED with an aneurysm would be a nightmare in itself.

    Either way I'd document the heck out of it and bring the situation up to the higher ups. My friends and I will be arguing this one for days.
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    Quote from Altra
    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.
    NurseOnAMotorcycle likes this.


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