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

  1. 0 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?
  2. Visit  Blackcat99 profile page

    About Blackcat99

    From 'Florida'; Joined Jan '04; Posts: 3,080; Likes: 997.

    33 Comments so far...

  3. Visit  hogan4736 profile page
    6
    A one time BP should be looked at in context, along with symptomatic versus not...A single 'low' BP means nothing without qualifiers.
    psu_213, MoopleRN, loriangel14, and 3 others like this.
  4. Visit  CapeCodMermaid profile page
    7
    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.
    LTCangel, psu_213, MoopleRN, and 4 others like this.
  5. Visit  Mully profile page
    10
    A lot of long term care places take vitals at night. It's ridiculous.

    Do not call a doc for a BP of 90/60. Generally you need a MAP greater than 60 to perfuse vital organs. When you're sleeping, your organs such as your brain and heart don't need as much O2 anyways so it can be even less. 90/60 is a MAP of 70. If you don't know about mean arterial pressure, its a good tool to use, Google it. Anyways, I wouldn't even think about assessing a patient for anything greater than 80 systolic. Less than 80, think about the MAP. Map less than 60, retake the BP. When retaking it, check both arms, and assess pt for symptoms. Systolic less than 80, MAP less than 60 on both arms and pt showing some type of signs and symptoms... now you can begin to THINK about calling the doc. Hope this helps.

    P.S. Never be afraid to call the doc. There's a reason they get paid so much. If you're worried about your pt, ask others for their opinion, and if that doesn't help, call the doc. If they get mad, give it right back to them. Gone are the days of docs striking fear in the hearts of nurses. We're all in this together.
    LTCangel, DSkelton711, LoveToHike, and 7 others like this.
  6. Visit  Roseyposey profile page
    6
    If this person is running 90/60 every night, I absolutely would not call the doctor. Always assess your patient and consider their normal. Also, did they receive anti-hypertensives at bed time? Are they a small person? I assume they are just laying around in the bed, b/p is going to be lower.

    OTOH, if your "little voice" is telling you something is wrong - call the doc. I never hesitate to call my docs if I am uncomfortable with something - it is their patient!
    LoveToHike, Enthused RN, MoopleRN, and 3 others like this.
  7. Visit  mappers profile page
    2
    Why are you taking a BP at 1:00 am?
    Blackcat99 and loriangel14 like this.
  8. Visit  Sun0408 profile page
    6
    Famous words... Don't treat the monitor, treat the pt. I would not call the MD for that pressure, I would assess my pt. How are they, how are their other vitals, is this normal for this pt, did they receive BP meds at bedtime?? Does this pt run high,etc? All questions I would ask but typically with a MAP 60 or greater, I do not worry. I would continue to watch and report other issues. If its not an emergency, I would not call at 1am.
    LTCangel, psu_213, Enthused RN, and 3 others like this.
  9. Visit  BrandonLPN profile page
    4
    Definetly not for 90/60. Why would that, by itself, worry you? Of course, a lower than normal BP can be symptomatic of other things. Like sepsis or GI bleeding. But then they'd be presenting with other symptoms, like fever, tachycardia, bloody stools, whatever. And if that were the case, you wouldn't really be calling about the BP anyways, right?
    LTCangel, snorkzella, MoopleRN, and 1 other like this.
  10. Visit  OnlybyHisgraceRN profile page
    0
    Quote from Mully
    A lot of long term care places take vitals at night. It's ridiculous.

    Do not call a doc for a BP of 90/60. Generally you need a MAP greater than 60 to perfuse vital organs. When you're sleeping, your organs such as your brain and heart don't need as much O2 anyways so it can be even less. 90/60 is a MAP of 70. If you don't know about mean arterial pressure, its a good tool to use, Google it. Anyways, I wouldn't even think about assessing a patient for anything greater than 80 systolic. Less than 80, think about the MAP. Map less than 60, retake the BP. When retaking it, check both arms, and assess pt for symptoms. Systolic less than 80, MAP less than 60 on both arms and pt showing some type of signs and symptoms... now you can begin to THINK about calling the doc. Hope this helps.

    P.S. Never be afraid to call the doc. There's a reason they get paid so much. If you're worried about your pt, ask others for their opinion, and if that doesn't help, call the doc. If they get mad, give it right back to them. Gone are the days of docs striking fear in the hearts of nurses. We're all in this together.
    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.
  11. Visit  OnlybyHisgraceRN profile page
    0
    No matter what we say.... call the MD when it doubt. Never be afraid to get yelled at.
  12. Visit  Kooky Korky profile page
    5
    Quote from Blackcat99
    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?
    First, why doesn't this doctor write some parameters???

    Then, what does your DON have to say about this ridiculous situation?

    Lastly, what do the other nurses do?

    Oh, is the pt in distress? Are you doing routine VS at night? It's not unheard of for old people, thin people, sleeping people, people on BP meds, LOL to have lower BP? There's good advice earlier in this thread about MAP and about not fearing doctors.

    What time are you doing these VS? Usually, long-term VS are done monthly, but if you're on the skilled, presumably shorter stay, side, well, you will have to use good judgment. You can always RECHECK the BP after you get the pt moving, like flexing the hand and arm muscles.

    Even when VS are ordered around the clock, a prudent nurse might determine that sleep is more important at that particular moment.

    But your bosses need to protect you from this rude, unreasonable doctor. There's no reason, except to cover himself, that he isn't writing parameters for when to call at night re: sort of unusual VS. Obviously bad VS, pt in distress must be reported.

    It's your license. Protect it. But be reasonable. You will learn what "reasonable" is with time.
    Last edit by Kooky Korky on Dec 9, '12
    Mandylpn, gypsyd8, LoveToHike, and 2 others like this.
  13. Visit  Meriwhen profile page
    3
    Depends:

    Is this BP normal for the patient? Is it part of a trend?

    Any adverse signs/symptoms accompanying it?

    What are the other VS, particularly the pulse?

    What's the blood pressure and pulse when rechecked manually?

    Is the patient on known antihypertensives?

    Does the patient have known or suspected bleeding problems? Or known/suspected dehydration? Or other issues that may result in low BPs?

    Did the provider specify parameters for when they want to be notified (e.g., "call if below 90/60")?

    Assess the patient, find out what's going on, and take all of that into account when deciding whether to call. Sometimes a low BP doesn't necessarily signal a problem. Sometimes it does. You can't just consider a BP by itself when deciding to call...unless of course, it's critically low or parameters were written.

    Though to be honest...if you are ever uncertain, IMO it's better to call and risk the wrath of an irate doctor to protect both the patient and your license.
    LoveToHike, Blackcat99, and loriangel14 like this.
  14. Visit  sarahlee23 profile page
    0
    In addition to assessing the resident and checking whether the low blood pressure is normal or part of a trend, I also check with the CNA to see which arm was used for the blood pressure and have the blood pressure checked on the other arm. There are a couple residents at the facility I work at who have blood pressures around 90/60 in one arm. But if you check the blood pressure on the other arm, it's normal. And this is normal for those residents, which is why for those residents I make sure to chart which arm we got the blood pressure on.

    I've only worked for a year and a half, but I have not had to call the doctor about a low blood pressure during the night as the majority of the time it's normal for the resident. The rest of the time, there's something else going on, and fortunately the nurses there for days or PMs have had the doctor address it already.

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