Do you call the doctor at night for low B/P's on night shift? - page 3
by Blackcat99 7,739 Views | 33 Comments
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 calling him in regards to the... Read More
- 3Dec 14, '12 by BrandonLPNI 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.
- 1Dec 14, '12 by Meriwhen Senior ModeratorQuote from BrandonLPNSome 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.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.
- 3Dec 14, '12 by withasmilelpnBrewski -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.
- 1Dec 14, '12 by michelle126In 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.
- 1Quote from CapeCodMermaidI 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.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.
- 1Quote from CapeCodMermaidAnd 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.")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.
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.
- 1Quote from OnlybyHisgraceRNI think what this person was saying is only calculate the MAP in the case where a BP is 'borderline.' Yes it would take too long to calculate every MAP, by calculating one or two takes approx. 10 seconds: mdcalc.com | Mean Arterial Pressure (MAP)We normally don't have monitors in LTC and many B/Ps are taken manually. We don't calculate the MAPs. Takes way to much time when you have 20-30 B/Ps to check in one shift.
To the OP. I would call the MD if the low reading is way out of the norm from the patients' baseline. If the patient is symptomatic, i.e. altered mental status.
- 2Dec 16, '12 by muffylpnDid not read all the comments. But many x's vs are taken at night. We seem to have established that. I have worked in both hospital 23 yrs and NH 16. I would never call a Dr. for that B/P ever unless s/s were noted. I would ALWAYS push fluids if I had an 80/50 and recheck in an hr. 70/40 would get a phone call but only after I did everything else. And this might have been mentioned but ( and I'm sorry) the Dr. does not seem to want phone calls if that's the B/P so why are you still calling him? ( it's just a question-not meant to sound rude)
- 0Dec 16, '12 by Blackcat99Quote from muffylpnThe RN supervisor from the other shift said I was suppose to call the doctor on night shift when patients have low B/P's like 90/60.Did not read all the comments. But many x's vs are taken at night. We seem to have established that. I have worked in both hospital 23 yrs and NH 16. I would never call a Dr. for that B/P ever unless s/s were noted. I would ALWAYS push fluids if I had an 80/50 and recheck in an hr. 70/40 would get a phone call but only after I did everything else. And this might have been mentioned but ( and I'm sorry) the Dr. does not seem to want phone calls if that's the B/P so why are you still calling him? ( it's just a question-not meant to sound rude)
- 4Dec 16, '12 by cherry_blossomQuote from Blackcat99When a doctor is on call, they are on call! Don't let them make you feel scared to call them. If that type of behavior from doctor continues, report them and DOCUMENT. If you feel something needs to be reported, then do it. This is that PT's life. I've been in similar situations and I just held my breath and called them. Now I serve as an on call member of the team, I get paid more too. At first I got goofy calls so I implemented a training that would give scenarios and, what are emergencies and what are not emergencies. This helped a lot.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 calling him in regards to the low B/P's. The first thing this doctor does when you call him at night is that he calls the DON at her home at night and reports you for calling him at night. However, the nurse from the 3-11 shift says you are suppose to call the doctor each time you get a low B/P on nights. In other words, I would be calling the doctor every night at 1am to report these low BP's. The DON would then be awakened every night at 1am when the doctor calls and reports me to the DON. Is it not normal to have a lower B/P when you are asleep at night?
Just remember that being on call is in that doctors job description. The doc is not staying on call out of the goodness in his/her heart. Lol. But good luck and stand up for yourself and the patient!