BP 200's/150's Appropriate for General Med/surg?

KyPinkRN · Apr 9, 2008

This was an issue recently on my med-surg floor. One of the nurses
received this pt whose BP in the ER had been 220/110's at points and the MD wanted to send her up to us anyway...as our charge nurse said "they're not really worried b/c her BP runs high anyway." So the patient gets to our floor in extreme pain and n/v...iv infiltrates...bp goes sky high again after getting labetolol, hydralazine, and other bp meds in the ER. Our charge nurse is still not all that concerned and neither is the MD!! So you had 3 LPN's in this patients room trying to get new IV access and get the pt calmed down all at the same time the charge nurse is up front working on "chart checks"! We finally had enough and got our nursing supervisor involved and after 4-5 hours of the high BP issue the patient was transferred to ICU, which is where she should have went in the first place and been on some type of drip to get that BP under control. I swear, I am surrounded by idiots at times!

That was pretty much the same deal with this patient on our floor last night. I have a feeling if our charge nurse had suggested a higher level of care it would have been considered, but maybe not. This wasn't my patient but I think they had issues all evening as I didn't see much of the nurse who got this patient for the rest of the shift.

Penelope_Pitstop, BSN, RN · Apr 9, 2008

it depends, of course, on the patient. if this is a new finding, or if the patient is symptomatic, and the pt's medical team is not in-house, i'd say praise the lord for the rapid response team...

jess

Virgo_RN, BSN, RN · Apr 9, 2008

i am fairly new in nursing (in fact haven't even taken the nclex yet), but one of my colleagues had this evening an admission whose bp was consistently in the 200's/150's. to me that seems dangerously high and i would think require a higher level of care. this patient was said to have this problem quite often which logic tells me puts them at a great risk for a cva or aneurysm. any input is greatly appreciated.
thanks

a big consideration is whether the patient is symptomatic. also, is this a new, sudden onset, or does the patient live with high pressures? if the patient is otherwise stable, then they don't necessarily need to be in icu simply because their bp is high.

smk1, LPN · Apr 9, 2008

Still, what other assessments were done. WHat brought them into the ER if this is "normal" for the patient and why hospitalize at all. Something is requiring intervention. Was an ECG done, what about tele monitoring for a time other dx that could come into play. I know you need to treat the patient and not just the numbers but a BP of over 200/150 is way out of the normal range. If all they are going to do is give P.O. meds to slowly bring it down does this even truly require an admission at all? We probably need more info to truly decide where the patient should be, but I don't think it is unreasonable to expect a patient with a sky high BP to be on a unit with more monitoring equipment. Not necessarily ICU/CCU but at least get on Tele or a step down so the nurse to patient ratio is lower.

allnurses Guide · Apr 10, 2008

Mmmm, no not necessarily, not if the BP can be brought down ASAP with medication. If it doesn't come down, then yes that may require the patient to go to an ICU or Tele unit for closer monitoring.

But like has already been said, some patients live with and tolerate a high BP. I've had renal/dialysis patients who seem to live in the 190's/90's.

But yes, that's a dangerous level indeed if it's a new finding, or a finding in someone with a history of hypertension who had previously been well controlled. Treat with medication, transfer if medication isn't effective in a reasonable amount of time.