blood pressure spikes and drops, help please

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I am a relatively new new RN working at a LTC for vent dependent patients. Today, I had a patient with pneumonia, normally hypertensive with hypotension all shift (90s over 40s) for about 6 hours, all BP meds held, until she desaturated and stopped producing urine at which point she was sent the local ER. The paramedic that transferred her to the ER said that her BP during transport and upon arrival to ER was 146/82 and the ER nurse also found her to be hypertensive. Then later I talked to the ER and she was admitted to the ICU with sepsis. Is it possible for her BP to spike from hypotensive to hypertensive so rapidly? Within about 30 minutes from 98/48 to 146/82? Or did I make some type of mistake? Any help is greatly appreciated, can't stop questioning myself!

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Specializes in Emergency & Trauma/Adult ICU.

It does sound like this patient was septic. Even with the hypotension that accompanies sepsis, however, it is very possible for the patient's BP to temporarily increase with some stimulation -- i.e., being moved on/off the ambulance stretcher and onto the ED stretcher, and the stimulation of being assessed by several new providers (paramedics, ED MD and RNs, etc.)

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Specializes in ICU, Telemetry.

I work in ICU, and vent folks can throw their BP around like a baseball. Some become septic and the only sign (outside of labs) is a bout of hypotension in a normally hypertensive person. I don't know if they were on any IV fluids, but I would suspect that EMS probably started a line and gave them a bolus on the way in (fluid challenge to the anuria, also to bring up the BP). So they show up at the ER door with a respectable pressure. I've called the doc on someone circling the drain, and by the time he got there from the call room, the pt's looking much better due to bolusing, repositioning in trendelenburg, etc. Doc gets there and looks at me like I'm nuts, and I'm going, "but until the bolus, they looked bad, really..."

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I am a relatively new new RN working at a LTC for vent dependent patients. Today, I had a patient with pneumonia, normally hypertensive with hypotension all shift (90s over 40s) for about 6 hours, all BP meds held, until she desaturated and stopped producing urine at which point she was sent the local ER. The paramedic that transferred her to the ER said that her BP during transport and upon arrival to ER was 146/82 and the ER nurse also found her to be hypertensive. Then later I talked to the ER and she was admitted to the ICU with sepsis. Is it possible for her BP to spike from hypotensive to hypertensive so rapidly? Within about 30 minutes from 98/48 to 146/82? Or did I make some type of mistake? Any help is greatly appreciated, can't stop questioning myself!

Agree with the first 2 replies (only ones there, so if others show up before I get this up, nothing against them :D)..... would also ask- when you got the low BP, did you check it with a manual, or was it a dynamap? (might still have been correct- I just check manual B.Ps before sending someone out (then if the ED asks, you have that on your side :)).

If you have the info and trust it- go with what you believe is right for the patient. :) It's always better to check something out and have it be not as bad as expected, than to wait until it's too late to fix :up::twocents:

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Specializes in med-surg, dementia.

I agree with previous posters. Just had a patient not too long ago that had normal BP's and VS stable from time of admission (5 days) and one evening on my shift she experienced continuous BP decrease. I notified MD who ordered 911 send out. Sure enough, IV line was started by EMT, BP increased, but by the time they reached ED, pt was declared in septic shock. Thank God she reached ED when she did. Happy to report she is back on floor and doing well.

From what you are saying, it sounds as if you did the right thing in reporting to MD significant changes in BP. Usually when you have evidence of pt in decline and you feel unsure of pt stability, it's better to be safe than sorry and protect your pt from harm.

Also, keep in mind that pts on dialysis will exhibit significant drop in BP post dialysis due to fluid loss during the proceedure. Usually returns to normal w/in a 24-48 hour period.

Good job...

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[quote=xtxrn;5657147]Agree with the first 2 replies (only ones there, so if others show up before I get this up, nothing against them :D)..... would also ask- when you got the low BP, did you check it with a manual, or was it a dynamap? (might still have been correct- I just check manual B.Ps before sending someone out (then if the ED asks, you have that on your side :)).

If you have the info and trust it- go with what you believe is right for the patient. :) It's always better to check something out and have it be not as bad as expected, than to wait until it's too late to fix :up::twocents:

To be honest I only used the electronic BP cuff, I almost always check the BP manually for abnormal VS. At the time though I got slammed with problems: another pt that had developed bradycardia, dark red hematuria, and terrible labs that I had to send out, and another pt that had been spiking temps and having terrible diarrhea (almost positive it is C.diff). I had a total of 10 vent dependent pts this day. Not that I shouldn't have checked it manually but the hypotension seemed to fit in right with her other symptoms especially the anuria.

-Thanks

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Specializes in ICU, Telemetry.

10 vents?!?!

OMG, I think I need to go lay down. That's like my worst ICU nurse nightmare -- a unit full of vents and nobody shows up but me...

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