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. 33 Comments so far...

  3. 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. 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. 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. 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. 2
    Why are you taking a BP at 1:00 am?
    Blackcat99 and loriangel14 like this.
  8. 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. 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. 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. 0
    No matter what we say.... call the MD when it doubt. Never be afraid to get yelled at.


Nursing Jobs in every specialty and state. Visit today and Create Job Alerts, Manage Your Resume, and Apply for Jobs.

A Big Thank You To Our Sponsors
Top