Published
Also I learned a little trick early on...if you can palpate a pulse in the radius...you are at LEAST 90 systolic...can't get diastolic though.
Use your other assessments as well...alert? Cap refill (for fingers they do have)? Pulse ox? Resp rate? Pulse rate? Talking? Moving? Headache? Dizziness? Skin color (red/pink/flushed/bluish)? and so on. AND continue these assessments after the med is given to make sure all is well. All these have to do with BP :) so use those as well...
You could also try to track down a thigh cuff.
His AKA's are very high up and he is very obese.
I appreciate the input from everyone. I wound up taking his BP below the PICC and the wife agreed. There was no documentation of a BP for three days. We're giving his albumin, lasix and other meds.
There was no documentation of a BP for three days. We're giving his albumin, lasix and other meds.
Yikes Tweety, sounds like a tough situation. I'm sure you appropriately documented the heck out of this one, and/or took it up the line to your manager ... giving meds affecting volume without knowing the BP. Just curious, did the pt.'s MD not question why there was no BP documented for 3 days?
As for the pt.'s wife ... knowing enough to know that a PICC calls for some reasonable precautions so as not to blow the line, but thinking that the correct approach was to simply not check BP ... not gonna go there.
Yikes Tweety, sounds like a tough situation. I'm sure you appropriately documented the heck out of this one, and/or took it up the line to your manager ... giving meds affecting volume without knowing the BP. Just curious, did the pt.'s MD not question why there was no BP documented for 3 days?As for the pt.'s wife ... knowing enough to know that a PICC calls for some reasonable precautions so as not to blow the line, but thinking that the correct approach was to simply not check BP ... not gonna go there.
When I approached the MD, I asked if she knew and she said yes the wife was refusing, I told her I wasn't comfortable with that, and the doc said "I definately am not either and I will talk to her." I'd better not say too much more in case she or someone else I work with reads this.
Tweety, BSN, RN
36,447 Posts
quick question while I'm at work. I have a patient who is a double aka amputee and right arm is totally injured with an external fixator. He has a picc in the left arm and his wife who is a nurse won't let us take a bp...at all. He's on meds that I'm very uncomfortable giving without knowing his bp. The picc is in the a/c. Can I take a bp in the wrist on the side with the PICC???