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Discussion

Consider normal or not?

Hi to allNurses! Nursing is really a difficult job especially when you are assessing your client then doing something if you assessed something is wrong. I'm just a newly grad and newly licenced nurse and I also got my first job in a tertiary hospital. Yesterday I was handling a paediatric client age of 6 with upper respiratory tract infection and was receiving a fluid replacement infusion which is hypertonic. When I took her BP, I got 120/90. So I immediately slow her infusion and listen for any adventitious breath sounds.

Since I am new, my initial action is to consult this to my superiors but I was shocked when they told me that "it is ok and there's nothing to be alarm of". :eek:

Do you think it is still normal considering the client is receiving a hypertonic solution? Thanks in advance:D

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I am only a nursing student, but I feel like that is not totally out of range. Normal of 120/80. I (having clinicals in a SNF) get BP's of 140/60 120/palp (i think that is where you dont hear a beat all the way down right?) and my teacher has never been to concerned.

  • Author
I am only a nursing student, but I feel like that is not totally out of range. Normal of 120/80.

120/80 is normal for adult but for a 6 year old client?

Well what hypertonic solution was it? D10, D51/2ns, D5LR, D51/2NS+20K, 3%NS. There are alot of hypertonic solutions. For example lets say you need to pull fluid into the vessels but don't want to overload the patient, you may give a hypertonic saline solution... must be careful with hypertonic saline especially with people with very low sodium levels. Lets say you want to rehydrate a patient, you may give D51/2NS. This is a hypertonic solution which turns hypotonic when it hits the bloodstream and the dextrose is absorbed. Lets say you are keeping a patient NPO but want to keep their metabolism up and give their body something to go on.... Maybe a D5LR.... replaces all electrolytes in the balance found in the body and throws them some sugar. Lots of reasons. :)

The diastolic is out of range, but given that it is peds I would wonder first was the pt screaming, playing, etc when the BP was taken? Sometimes it can be very difficult to get an accurate BP on a child. In your case, since you assessed the lung sounds and they were benign, I would have just rechecked the pt's BP a few min later, making sure that the child was calm and an accurate sized BP cuff was being used. If it was still high then I would let the doctor know.

  • Author
The diastolic is out of range, but given that it is peds I would wonder first was the pt screaming, playing, etc when the BP was taken? Sometimes it can be very difficult to get an accurate BP on a child. In your case, since you assessed the lung sounds and they were benign, I would have just rechecked the pt's BP a few min later, making sure that the child was calm and an accurate sized BP cuff was being used. If it was still high then I would let the doctor know.

I agree. I rechecked if for 4 TIMES and still getting the same Blood pressure. For me both diastolic and systolic blood pressure are out of range. I used the standard cuff for pedia.:confused:

BTW the IVF was 5%Dextrose in 0.9 NAcl.

I agree. I rechecked if for 4 TIMES and still getting the same Blood pressure. For me both diastolic and systolic blood pressure are out of range. I used the standard cuff for pedia.:confused:

BTW the IVF was 5%Dextrose in 0.9 NAcl.

Hmm Everywhere I've worked there has been like 4 different sizes of ped sizes (infant/toddler, schoolage, adult, etc). Seeing how the pt isn't in for dehydration, you could have always looked at the pt's I&O's and if the pt was having good intake you could have seen about getting the IV fluids dc'ed.

  • Author
Hmm Everywhere I've worked there has been like 4 different sizes of ped sizes (infant/toddler, schoolage, adult, etc). Seeing how the pt isn't in for dehydration, you could have always looked at the pt's I&O's and if the pt was having good intake you could have seen about getting the IV fluids dc'ed.

Yeah, I was thinking to DC it but since im jez new I only slow it to make it sure then consult it to my superiors.:cool:

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