Blood Pressure Query

Nursing Students Student Assist

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I am a first time poster to this forum - so thanks in advance for any help offered.

I have a case scenario where I need to find a list of problem statements and then prioritise them. Basic outline is a gentleman with a history of Type 1 diabetes and hypertension has come on to the ward via Emergency with confusion for investigation.

On admittance to the ward his BP was 110/87. The assignment has 2 parts - and the 1st part has been completed - from this we have now been informed that our patient is hypoglycaemic and has been treated accordingly. His presenting symptoms now appear to have stabilised however I am unsure whether his BP is an issue. It is now to 105/65. (Also he takes an ACE inhibitor daily for his hypertension ) I understand that this may be an acceptable reading in some patients ( in this case we do not know the patient's usual BP) however I am querying whether the drop in diastolic is substantial enough to be of concern.

Different tutors seem to have differing opinions on whether this is a problem. My concern is that in Part A of the assignment one of the issues that I looked at was whether he may have suffered a head trauma based on his presenting symptoms. In the scenario he is still due to have a CT scan - and I am wondering if although he is hypoglycaemic, that there still could be something further going on for him beyond the hypo. Possibly a slow brain bleed from a trauma? Or stroke?

So does anyone think the drop in BP is an issue - or am I looking for problems where they do not exist.

Thanks for any help,

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The BP doesn't really really worry me. It is well within the range of normal. If you are looking for other causes of confusion in addition to possible head trauma, I work in a SNF/rehab facility and if we have an elderly patient that is confused or with increased confusion, one of the first things we do is dip a UA test strip to see if there might be a UTI. UTI's are surprisingly common cause of confusion and delirium in elderly patients.

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Thanks vdrapeau,

I had considered that in the first part of the assignment. In this section of the assignment after being treated for hypglycaemia he does not appear to have and abnormal signs and symptoms - the BP was the only one that was sticking out at me but only because of the drop - not the actual reading because as you said they are in the realm of normal reading. This gentleman is 50.

Thanks for your thoughts - I will move on and focus on the other problems I have identified!

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Specializes in Pedi.

What happens to blood pressure when someone has a "brain bleed" or increased ICP? Look up Cushing's triad.

I worked neurology/neurosurgery for many years and a BP of 105/65 is not an independent factor that would lead you to think "brain bleed." It is possible that someone could have had a syncopal episode from hypoglycemia and they are doing the head CT to look for something like a small bleed but that blood pressure doesn't worry me.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Welcome to AN! The largest online nursing community!

With a history of hypertension (HTN) I would consider holding the B/P meds and the systolic B/P is on the l;ow side. I would not intervene but I would be cautious to administer any anti-hypertensives. There is a consideration for cushings triade/cushings reflex....but that includes a widening of the pulse pressure....a symptom this patent does not exhibit.

Cushing reflex (also referred to as the vasopressor response, the Cushing effect, the Cushing reaction, the Cushing phenomenon, the Cushing response, or Cushing's Law) is a physiological nervous system response to increased intracranial pressure (ICP) that results in Cushing's triad of widening pulse pressure, irregular breathing, and a reduction of the heart rate.[1] It is usually seen in the terminal stages of acute head injury and may indicate imminent brain herniation. It can also be seen after the intravenous administration of epinephrine and similar drugs.[2] It was first described in detail by American neurosurgeon Harvey Cushing in 1901

But the patient can definitely be having a CVA with the history of Diabetes and HTN. What are the major complications of diabetes and HTN?

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