Could this be construed as "abuse"?

[Pat_Pat RN]

I have a patient in my LTC setting that has dementia and is confused at all times.

She complains that the B/P cuff hurts her arm. She begins complaining almost immediatly when it starts inflating, 60 or so. Using a manual cuff gets the same results. Is this something to worry about? I would hate for her to tell someone that "they hurt me" or something like that. Not that I think she would, I don't think she can remember for more than a few minutes.

Any suggestions?

[chrisrn24]

My mom actually was having her BP checked a few months ago and cried out in pain. She never complains about stuff so I know it hurts.

I have a lady at work who is severely contracted and I can't get a BP on her ever. I feel it's cruel. Other nurses do it but I won't.

Unless it's terribly necessary - unstable BP - ask your facility to have a care conference. Maybe BP meds could be d/c.

[Pat_Pat RN]

Does she have stable BP or does she have problems with hypertension or hypotension? Is she on BP meds? If her BP is normal and she is on no meds, maybe you can tell the doctor and get an order to only check BP weekly or PRN. If she has dementia, does she have a POA? Maybe the POA could refuse BPs on the patient's behalf so you would be covered in not checking them.

Not on B/P meds. The reason for the B/P checks is her Medicare charting. She has a POA, I've never talked to this person.

[Pat_Pat RN]

Out of curiosity, does this patient complain when receiving other aspects of care? Does she let others assist with bathing etc? I am wondering if she has a "touching" issue. There are some people out there who do not like to be touched, and if the touch is painful all the moreso. At our LTC facility even those patients on B/P meds usually had their b/p checked twice a week, not daily. Unless the meds are being changed there really is no reason to take it every day. I know as a nurse it is just normal to take the b/p before giving any med, but if the b/p has been stable and there are no changes see if your facility policy can be changed. Also, is there any psych follow-up for this patient? We use to contract out for counseling services for our dementia patients who were exhibiting behavior issues. It often did help them and it helped the staff provide better care by the counselor providing options for the nurses.

Yes, EVERYTHING "hurts". She is one that grabs and pinches, etc. when the Aides are moving her, getting her up, bathing, etc.

No thought of a psych consult.

[Pat_Pat RN]

Has she recently started complaining about the BP cuff? Is it only on one arm?

She is new to this unit, it has been going on since she got here. I've used both arms.

[Pat_Pat RN]

Why are we even taking multiple blood pressures per day on a demented LTC resident? It's their home. These residents don't need shiftly blood pressure checks unless they're symptomatic or a change in condition is occurring.

Think about it. If you were at home, in stable condition with chronic health issues such as HTN, and took Clonidine three times per day for routine BP control, are you going to check your own blood pressure three times daily, every day? Most people in the community with HTN simply take the medicine.

When I worked in LTC, residents received a full head-to-toe assessment once a week. The major exceptions were the short term patients over in the skilled Medicare rehab wing. Since Medicare skilled charting requires a set of vitals once every 24 hours, these patients received daily vital sign checks.

I definitely wouldn't take a demented LTC resident's BP several times daily. She's not in the acute care hospital where this action would be required and prudent. She's a LTC resident in stable condition with a chronic ongoing health issue and a predictable outcome. Unless there's a dramatic change in her usual condition, or unless her BP medications have parameters with each dose, I'd leave her alone.

Not sure where the "multiple per day" came from. I never said multiple. Once per day for Medicare charting. No B/P DX or meds.

As to what you are saying about taking vitals the way I would at home, I agree. Seems to me that it's overkill to check the [whatever] EVERY TIME we give a pill to someone that could POSSIBLY effect SOMETHING.

[TheCommuter, BSN, RN]

Not sure where the "multiple per day" came from. I never said multiple. Once per day for Medicare charting. No B/P DX or meds.

Thank you for the clarification. In this event, since Medicare is her payor source, the BP checks are going to have to continue in order for the facility to be reimbursed. Therefore, I really see no solution to this complex problem.

Since everything hurts this little old lady, perhaps a popliteal BP will hurt a little less? This situation is going to necessitate some creativity and ideas outside the box. Good luck!

[annie.rn]

Is it possible to get one of the little wrist BP machines designed for use at home? I used one when I did home hospice and they worked well with much less pressure to the extremity. They also work well when the patient's arm is very tiny or the pt. was contracted. My mother had Alzheimer's and would also cry out when her BP was taken w/ the automatic brachial machine but would tolerate the portable wrist BP device. I would tell her that it was a "bracelet" and would speak gently to her while it took her BP. Sounds like it might be a long shot w/ your pt. but maybe worth a try?

[morte, LPN, LVN]

maybe it isn't pain at all, but that she is feeling violated by touch she can no longer understand.

[Karou]

I found my dementia patients generally didn't like being touched and viewed most contact as painful or caused them to get agitated. When I worked in LTC I used an electronic wrist BP cuff. My patients liked it better. Instead of having to move their arms around I could maneuver the cuff around them easier. It isn't as tender of an area so when it inflated, it "hurt" less.

Temporal thermometers also agitated less than oral or axillary. If I got a funky reading temporal I would check oral though.

[toomuchbaloney]

Yes, EVERYTHING "hurts". She is one that grabs and pinches, etc. when the Aides are moving her, getting her up, bathing, etc.

No thought of a psych consult.

Does she receive any pain medication at all?

[Morainey, BSN, RN]

No, I would not describe that as abuse. Some things are uncomfortable. Of course, I would rule out some kind of musculoskeletal issue but really it's (hopefully) not going to be on her arm for any extended amount of time. It also hurts to get your finger pricked for blood sugar checks, and to have blood drawn, and I would not describe that as abuse, rather a necessary discomfort that comes as a result of those procedures.

[Pat_Pat RN]

Does she receive any pain medication at all?

Norco 10/325 4x/day.