Let me first start by saying I am a new grad and know I have plenty to learn. I have NOT started my first position as a graduate nurse, I will begin that in August. I am currently working as a nursing assistant at a small facility where I have been for almost 2 years, I have been a nursing assistant in total for about 4 years and also worked in telemetry. My new job is at a different facility.
I work with at the most 3 other nurses on my shift. On a rare occasion we have pediatric patients. They are all post-surgical patients. I have a question concerning routine blood pressures on pediatric patients, I was taught as a general rule of thumb there is no need for routine BP on a patient under the age 8. A seasoned nurse insisted that I am wrong (she enjoys being a bully and everyone is usually wrong about everything ). Unfortunately, we do not have a policy on this at my facility. What is the age you use as a cut off or is there even one at all?
While BP changes in children are latent signs of decompensation they still need to be trended. Remember for pediatric pt's they hold their BP until they loose it. While it is most important to check additional signs/symptoms in concert BP is still always measured. Along with the recorded BP assess mental status/irritability, cap refill- central VS peripheral, skin temp-turgor-and color. And as was previously mentioned we are seeing more cases of pediatric hypertension. If you don't check you will never know. BP is a part of complete vital sign, and it is not age dependent.
I am a patient at a peds hospital, they have ALWAYS done routine bp's on me. Not sure if this helps I am not a nurse, this is just what I have noticed.
I totally agree with a4n6nurse. Children can effectively compensate for circulatory dysfunction (primarily by increasing heart rate, systemic vascular resistance, and venous tone), maintaining normal blood pressures despite significantly compromised tissue perfusion. Consequently, hypotension is a very late and ominous finding . The challenge for the clinician is to recognize children in shock early (before they develop hypotension), when they are more likely to respond favorably to treatment. This is true when a infant/child is critically ill. But in the Peds ER (where I work) and outpatient clinics, we take the BP in all children 3 yrs old and up (unless it's a very sick infant/child).
However, children, even very young babies, can have high blood pressure. The American Heart Association (AHA) recommends that all children age 3 and older have yearly blood pressure measurements, this is also supported by the American Academy of Pediatrics (AAP). Early detection of high blood pressure will improve health care of children.
I agree with the all kids, q4 or with other vitals.
I work on a cardiac floor in a children's hospital, so it's crucial on our floor. But I have seen many, many kids who could have been diagnosed way earlier than they were, and BP can be one part of the clue for some defects. So, I think a complete and thorough assessment will always include a BP.
depends in my hospital NICU if there 3:3 than we do one q12hrs unless otherwise indicated and of course if the bp is out of norm those who are 1:1 we take the quite frequently due to the fact that they are on a thousand meds. In our peds unit we take 1 blood pressure upon admit and really thats it. unless, of course we deem it necessary. good rule of them. I was taught that for any child ages 1-7 you can average their systolic bp as followed (age in yrs + 90) don't know if that is still the case since prehypertension came into play
8y and on-with scheduled VS unless otherwise ordered.
This of course changes if they are post-op then it is the same protcol as adults. Or if they have a condition that indicates more freq monitoring. i.e. VP shunt placement, cardiac issue etc. You use your clinical judgement.:wink2:
yes, you do monitor blood pressure. while a dropping BP is a late sign of decompensation (the kids tend to use other mechanisms to keep it up until the last possible minute) it is recommended that all ages get BP's while hospitalized and then routine screening at age 3 for outpatient. how often to get the bps? (on admit, q4, q12, etc and at what ages) would be on your hospital policy and your nursing judgement.
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
I work on a surgical peds floor that also gets medical overflow. Our hospital standard for vital signs in general is q4h along with our q4h assessments, unless stated otherwise, and this includes a BP. Now realistically, getting a good BP on a infant/toddler isn't going to happen. Also, in non-critical peds settings, BP is generally the last vital sign to go downhill when something bad is going on.
Specializes in Acute Med, Pediatric Hematology-Oncology.
At the hospital where I work, our norm is to do VS q4h, including BP. It doesn't matter how old the kid is. Of course, with small kids and babies, it's more difficult to get a BP reading so the majority of nurses try to get at least one accurate BP per shift if the pt. is asymptomatic.
I work on an oncology floor and a lot of the meds we give to our kids can affect their BP drastically. I've seen some incredibly high BP's on 3yrs old that needed interventions.
It is more difficult sometimes to get a good pressure on a baby/toddler, but that doesn't mean it's not part of normal vital signs. We definitely get kids who are out of the norm who aren't yet incredibly sick. For example, looking at my NICU experience, some of our early birds start having chronic hypertension when they're close to going home, and we treat this. Yes they fuss and yell when you try to do it, but that's when your creativity and comfort techniques come in. I've taken care of more than enough cardiac kids who went home from the newborn nursery "normal" and came back to the ER varying periods of time later (hours to months) only to be diagnosed with congenital cardiac defects. BPs might red flag this too. So there's just two of many scenarios where BP is helpful. Now I don't bat my eyelash at a difference of 10 or so points in a baby where I might for an adult. All that wiggling and fussing throws things off a bit. But the range and trends can be telling, and you don't get those if you're not taking blood pressure. :)
I am a pediatric nurse manager for home care and we do not routinely screen for Bp unless ordered by a MD. I do not, however, agree with this policy and am looking to change it. after much research, i have found several articles written by the AHA and AAP that indicate a need for routine screenings of neonates to adulthood. I agree with your preceptor in that a full assessment is needed especially after surgery. Peds can have hypotension related to anesthesia the same as adults.
I worked pediatrics for several years and our rule of thumb was full VS on admission to the floor, and then every four hours until discharge - physicians don't always cover that base. size appropriate cuffs should be available. if not, use an adult cuff on the kids' thighs or lower legs.
). Unfortunately, we do not have a policy on this at my facility. What is the age you use as a cut off or is there even one at all?
a4n6nurse
27 Posts
While BP changes in children are latent signs of decompensation they still need to be trended. Remember for pediatric pt's they hold their BP until they loose it. While it is most important to check additional signs/symptoms in concert BP is still always measured. Along with the recorded BP assess mental status/irritability, cap refill- central VS peripheral, skin temp-turgor-and color. And as was previously mentioned we are seeing more cases of pediatric hypertension. If you don't check you will never know. BP is a part of complete vital sign, and it is not age dependent.