Nsg care of hypotensive pt - page 2

I'm a new nurse, about 1/2 year experience and... I had a hypotensive pt the other day BP dropped very low, I called rapid response. My charge nurse told me today that there are certain things I... Read More

  1. by   EmmaG
    Quote from Blee O'Myacin
    I was told "YOU CAN'T DO THAT HERE!!!" by a very flustered, yet understanding nurse manager. We wound up sending that patient to the unit from where I was re-pulled and stayed with the patient for the rest of my shift. So it all worked out - but my point is this - find out what you are *supposed* to do, within what's acceptable on your unit.
    I was pulled to a med/surg unit and found one of my patients with a BS of 16. Not a typo--- sixteen. He had no IV access, and as the charge nurse stat paged the doc (no standing orders for low glucose either), I started a large gauge heplock. She hollered at me because 'WE DON'T HAVE AN ORDER TO STICK THAT PATIENT!' I told her I could pretty much guarantee we'd have one once the doc returned the page
  2. by   GrumpyRN63
    Quote from Emmanuel Goldstein
    I was pulled to a med/surg unit and found one of my patients with a BS of 16. Not a typo--- sixteen. He had no IV access, and as the charge nurse stat paged the doc (no standing orders for low glucose either), I started a large gauge heplock. She hollered at me because 'WE DON'T HAVE AN ORDER TO STICK THAT PATIENT!' I told her I could pretty much guarantee we'd have one once the doc returned the page
    She must also want you to get an order before calling a :trout:code
  3. by   GrumpyRN63
    I think it all depends on the whole picture, pt's age, dx, med hx etc. First and foremost recheck the BP, how does the pt look, tachycardic?,bradycardic? febrile? asymptomatic? dizzy? fluid status? Sometimes you need a cardiac intervention, sometimes position, lay flat, Have IVF running, openthe line, sometimes nothing, some pt;s will be perfectly healthy at 80/50 or even lower,you really need a better picture of what was going on w/this particular pt scenario
    Even if you 'jumped the gun',(and I don't know if you did or not) It was still much safer for the patient to go that route, than to have someone who ignored the hypotension in a sick pt leading to a bad outcome. As you gain experience, you'll get more comfortable with these types of issues. You may want to aska more experienced nurse (If available), or call a resident ( if available) first,

    If your gut tells you call rapid response, than call--better to have 10 men on death row than execute one innocent man... as in nursing--better to call 10 codes then send one pt to the morgue
  4. by   pagandeva2000
    I remember reading to lay them flat and to raise their legs.
  5. by   Crocuta
    Quote from meandragonbrett
    The latest literature does not support the use of trendelenburg or modified trendelenburg to treat hypotension and low cardiac output.
    Do you have some citations at hand?

    Thanks!
  6. by   gwenith
    I agree with those that say do not use trendelenberg positioning. Although the old saying "Head pale raise the tail, head red raise the head" is still OK - it simply means raise the legs but do not put the patient head down.

    http://209.85.173.104/search?q=cache...ient=firefox-a

    http://ajcc.aacnjournals.org/cgi/con...stract/6/3/172
  7. by   not now
    I recently had a patient with a BP of 70/40 manual. Couldn't take it on the other arm, he had a fresh faciotomy (sp?) from about mid forearm up most of his upper arm. I took his BP at 2100 for maintenance meds and it was 110 systolic so I gave them. When the CNA did midnight vitals was when the BP was 70/40 (not tachycardic, HR in the 60's). He felt fine but looked like crap. This was the first time I'd ever had him. Apparently his wound had been bleeding for three days, the AM nurse changed his dressing and when I came on he had a big puddle of blood under his arm (Yes, I showed it to the team lead). He said he felt fine.

    There was no IV. He was not only a very difficult stick but the two working IV's were pulled for being five days old. He got compartment syndrome from IV starts and the MD was worried about further problems. Rather than put in a central line the MD said he'd be fine without one and wanted the old IV's pulled.

    Anyway, I called rapid response after I put him flat. The ICU and house supervisor looked at me crazy because he wasn't in trendelenberg. (I wasn't gonna say anything about that since I'm new and that was not the place for debate. It helped while he was in it but about 30 minutes after the team left he was back at 68 systolic) Someone finally started an IV we got labs, bolused him and I ended up giving two units for a Hbg of 6.2.

    I'm still confused why he wasn't tachycardic.
  8. by   Valerie Salva
    Quote from Emmanuel Goldstein
    I was pulled to a med/surg unit and found one of my patients with a BS of 16. Not a typo--- sixteen. He had no IV access, and as the charge nurse stat paged the doc (no standing orders for low glucose either), I started a large gauge heplock. She hollered at me because 'WE DON'T HAVE AN ORDER TO STICK THAT PATIENT!' I told her I could pretty much guarantee we'd have one once the doc returned the page
    Man, what is a pt doing in the hospital without IV access, especially a diabetic pt?
    I agree with your actions- save the pt now and get an order later.
  9. by   CritterLover
    Quote from not now
    i recently had a patient with a bp of 70/40 manual. couldn't take it on the other arm, he had a fresh faciotomy (sp?) from about mid forearm up most of his upper arm. i took his bp at 2100 for maintenance meds and it was 110 systolic so i gave them.

    i'm still confused why he wasn't tachycardic.

    what meds did you give him?

    since you were checking the bp before giving them, i'm guessing that you might have given him a bp med?

    many bp meds will lower hr as well. beta blockers, clonidine, and norvasc are three common ones.

    beta blockers, especially, will prevent reflex tacycardia when bp drops.
  10. by   gwenith
    Quote from not now
    I recently had a patient with a BP of 70/40 manual. Couldn't take it on the other arm, he had a fresh faciotomy (sp?) from about mid forearm up most of his upper arm. I took his BP at 2100 for maintenance meds and it was 110 systolic so I gave them. When the CNA did midnight vitals was when the BP was 70/40 (not tachycardic, HR in the 60's). He felt fine but looked like crap. This was the first time I'd ever had him. Apparently his wound had been bleeding for three days, the AM nurse changed his dressing and when I came on he had a big puddle of blood under his arm (Yes, I showed it to the team lead). He said he felt fine.

    There was no IV. He was not only a very difficult stick but the two working IV's were pulled for being five days old. He got compartment syndrome from IV starts and the MD was worried about further problems. Rather than put in a central line the MD said he'd be fine without one and wanted the old IV's pulled.

    Anyway, I called rapid response after I put him flat. The ICU and house supervisor looked at me crazy because he wasn't in trendelenberg. (I wasn't gonna say anything about that since I'm new and that was not the place for debate. It helped while he was in it but about 30 minutes after the team left he was back at 68 systolic) Someone finally started an IV we got labs, bolused him and I ended up giving two units for a Hbg of 6.2.

    I'm still confused why he wasn't tachycardic.
    If he was on Beta Blockers he may not have been. Beta Blockes sometimes "mask" the symptoms of shock by preventing tachycardia.
  11. by   martymoose
    Quote from meandragonbrett
    The latest literature does not support the use of trendelenburg or modified trendelenburg to treat hypotension and low cardiac output.
    i guess i should have specified we only use mod. trendelenburg in a vagal response, and when we know the pt is not having neuro issues.
    Last edit by martymoose on Dec 28, '07 : Reason: didnt see quotes- oops

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