# Do you call the doctor at night for low B/P's on night shift? - page 2

B/P was 90/60. What would the B/P have to be before you would call the doctor on night shift? I work in the "skilled side" at the LTC. The doctor does not have orders or parameters in regards to... Read More

1. Quote from mappers
Why are you taking a BP at 1:00 am?
DON says all vitals on nights are to be done at 12 midnight so they usually turn in the v/s list between 12:30am and 1:00am
2. We didnt do a BP on nights unless there was a reason even our medicare pts they did temp pulse an O2
3. If you are uncertain, call the doc. Tell him why - Then ask for an order for parameters so you don't have to call him again - and say it in just that way.
4.  Equation: MAP = [(2 x diastolic)+systolic] / 3 Diastole counts twice as much as systole because 2/3 of the cardiac cycle is spent in diastole. An MAP of about 60 is necessary to perfuse coronary arteries, brain, kidneys. Usual range: 70-110 Don't have time, how hard is this. If you have a tool that is useful and takes all of 10-20 seconds (depending on your math skills) to do , why not use it. Takes way to much time is a euphemism for "i can't be bothered"
5. No - the sad thing in LTC is you have very little time to actually think. Over time you'll know when to call the doctor just by looking at the numbers AND your patient. The MAP will confirm what you'll already know. Whether you need to intervene immediately or whether this can wait. I don't think it's super necessary honestly. 15 years of nursing - don't use it even though I know how and can 'be bothered' myself. But that's just my 2 cents.
6. A BP of 90/60 is not usually considered a critical low BP unless there are other symptoms at play. If your patient is consistently 90/60 at night, chart the BP and leave it on report for morning. Perhaps the meds need to be adjusted, and the MD needs to know that. Does he need to know it in the middle of the night? Not really. He just needs to know before the next dose of HTN meds is due. Nursing is 24 hours. If the BP is lower than 90/60, you really need to assess the patient further. Is their usual BP on the low side? Is 80/50 their normal? Are they symptomatic? How is their pulse? Is it 72 and regular? Or are they tachycardic because their heart is trying compensate for a low BP? Anyway, you get the idea. And never be afraid to call the doc. So he calls the DON... it's still your license on the line and your assessment of your patient. I agree with those who said, give it right back to him. That's what he's there for.
7. First of all, I am quite surprised at everyone here for what is almost a complete lack of support for an RN in a nursing forum.

Second of all, the MD needs to be writing some parameters. They should be a standard on the order set for every patient that comes through the door. It can even be a standardized check off and sign at the bottom sheet that tells how frequently to do certain things and gives parameters.

Third, why doesn't the DON have a standard protocol binder with things like that in it, especially if this happens every time someone calls the MD at night?

I see several breakdowns in the system here. If I were you, I would want to recheck it myself on both arms and make sure the correct size cuff was being used. Calculating the MAP as someone else suggested is a great idea and can be done for single patients like this on an as needed basis. A quick assessment can also be very helpful in determining if you need to call the MD.

My last thought here is that the MD sounds a bit abusive to the nursing staff and that is not right. I would say that needs to be addressed at your facility. And he/she needs to write parameters if the MD doesn't want to be woken up at night.
8. I kind of feel like I'm missing something here. Unless the resident is displaying other symptoms, or this BP is part of a clear, rapid trend downwards, I don't get why you would call on this. A bp of 90/60, in and of itself, is nothing to call about. For some people, that's their normal range. It's not automatically a "red flag" BP.
9. Quote from BrandonLPN
A bp of 90/60, in and of itself, is nothing to call about. For some people, that's their normal range. It's not automatically a "red flag" BP.
Some of my eating disorder patients normally run so low, that I'm ecstatic when they break 90/60. Asymptomatic and fine otherwise; severe hypotension happens to be their baseline d/t their disease process.
10. Brewski -I'm curious what you mean by lack of support for an RN? The advice we are giving is support. Not sure what you are expecting. Not criticism really towards you, just wondering what you think we should say. If it's about the doctor - yes, the doctor shouldn't act that way and administration should support their nurses. Am I surprised? Heck no. Seen it too often. I call them if I need to and stay calm despite temper tantrums and other behaviors. And I always document accordingly. Its my license.
11. In my LTC we do vitals on 11-7 shift. All new admits get vs q shift x7 days, same for re admits. Incident reports q shift x3 days. Our LTC is skilled care. Most of our residents are post op hip, knees, etc and come to us 2 days after surgery. We also have some sub acute type residents on IV antibiotics round the clock or TPN. The average nursing home resident is sicker and sicker.

Yes...they need their sleep, I agree that is why unless they are not stable..I say take the VS when they are away or you are doing care. Most are up in the middle of the night for a bathroom run or prn med.

If this doctor doesn't want called for anything like this or other issues...he needs to write some paramaters and get some prns on the chart. Easy sollution to that problem.

As far as that BP..I wouldn't call unless there were other symptoms and this person has had a change of conditioin that you feel needs followed up on.
12. Quote from CapeCodMermaid
Why are you taking blood pressures at night?? People, especially sick people, need sleep.That said, I wouldn't call the doctor to tell him the bp was low if the patient were asymptomatic.
I know when I worked as a CNA, we had to take BPs q shift x3 for a resident who fell. It did not matter how they fell (even if they stood from their w/c and was assisted to the floor by an aide and had no apparent injury) the VS were done no matter what for those 3 shifts. If they were sleeping comfortably in bed with no distress, VS had to be taken because they fell 15 hours ago. If not, incident reports and write ups for the nurse and aide on duty that night.
13. Quote from CapeCodMermaid
Why are you taking blood pressures at night?? People, especially sick people, need sleep.That said, I wouldn't call the doctor to tell him the bp was low if the patient were asymptomatic.
And another thing....each month, every residents' VS and weight had to be taken within the first 5 days of the month. 1st and 2nd shift complained that it was unfair that they had to get these VS and weights and 3rd shift had none. So, each unit was divided into thirds--each shift was responsible for one third of the VS and weights each month. So one third of the residents was woken up at night to have a full set of VS and lifted out of bed so that their weight could be recorded. (I don't think we have a smiley for "the most incredibly stupid policy ever.")

As for the OP, since the resident is awake, check to see if they are symptomatic (i.e. are they alert, oriented at their baseline, not lightheaded--if they can tell you this), check the prior BPs, look at the other VS (for example, I would be quite concerned with this BP and a HR in the 130s, no so concerned with this BP and HR in the 60s), perhaps recheck the BP with the pt now awake. If all this 'checks out' I would not call the MD.