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?

[Pat_Pat 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.

Great reply, thanks.

[LDrounette]

As for the worry about her saying "they hurt me"...........document, document, document. And care plan it. That should keep you out of trouble with the State for any complaints about that. As for it hurting, I would investigate why. Has she historically had a low pain tolerance? I think the cuff hurts too, especially once they get around 180, I almost can't stand it. Maybe it's just that now all she can say is it hurts and doesn't understand any longer that it's normal to hurt a little.

[LDrounette]

I agree. It could be "it hurts" or "ouch" is the only sentiment she can recall to express, depending on her degree of dementia.

[Been there,done that, ASN, RN]

Understand your concern. The cuff pressure does hurt . ( recently experienced it).

Cover yourself with a note in the chart describing the situation. Copy and paste it each day she verbalizes the complaint... and move on.

[Sixtyseven]

However, doesn't the resident, demented or not, have the right to refuse? Unless the resident is in an acute situation, I would not force it, just document "resident refused". It's her right.

[Finbarr]

Its up to you to reassure your patient during the procedure of taking a BP. If we took everything on board for a law suit, we would not be able to do our job. There would be no nurses anywhere in the world. Do your job and stop putting the fear of God into the rest of us. The patients vitals have to be taken......Fact. Base line obs have to be done......Fact. Without baseline obs we cannot do our job.

[prmenrs, RN]

I think you should try a wrist cuff. Upper arm cuffs do hurt sometimes. @ least it would be worth a shot.

[Wendysplace68]

it will depend on whether her Dementia is severe enough for her to be considered an capable person (who can make decisions). I believe taking someones blood pressure is part of routine medical treatment and falls under duty of care...if she is considered capable (generally they don't refuse to have their blood pressure taken, I have never had someone refuse to have their blood pressure taken). Then I guess the Dr could explain to her why it is so important to have it taken....

[Wendysplace68]

Sometimes people with dementia are worse in the evening...maybe she is better in the morning after breakfast?? or maybe she thinks someone is a relative and they will have better luck....

[maelstrom143]

Procedures are a necessity and a pain; unfortunate, but true. Without a baseline, we would fail to notice when a patient starts heading south. Vital signs are one of the things we are required to do to ensure patient safety. Demented or not, many of these patients have meds on board and they affect VS. Find something she enjoys (i.e., if you let me do this real quick, I promise to not bother you for an hour - works great with a lot of acute care patients, too ) and then make a verbal contract with her. Let her know if she breathes in and out and does not move it will finish faster and you will be able to stop pestering her so much. Worst case scenario, come back later when she might be calmer. One learns to work around inconveniences and make verbal contracts that might allow the patient to feel a small measure of control. They may not always honor the contract, but it never hurts to try

[firstinfamily, RN]

I agree with most of the posts above. The patient should not need to have her/his blood pressure checked 3 times a day. As stated in other posts, this is a chronic health condition for her and unless there are symptoms of hypotension(faint, sleepy, low urine output) there is no indication to take her blood pressures. The policy of your facility should be changed if there is a requirement of daily blood pressures for these patients. We were doing them biweekly. When was the last time the automatic cuff machine was checked and calibrated?? I find most LTC facilities use these on a daily basis for multiple pts but no one ever seems to think about when the machine was last calibrated. They do need routine maintenance, not just when they are broken!! The input about having a care plan meeting also makes a lot of sense. In the care plan it can be brought out how the patient resists having the b/p taken, and what options there are. Using a wrist b/p cuff may help. These are suppose to be as accurate as the arm cuffs according to research articles and less painful. Good luck, keep us posted!!

[MunoRN, RN]

If she's refusing the procedure then yes, from a legal standpoint it is assault. If she isn't capable of refusing then there is a legal process that must take place to legally remove decision making capacity and if that is granted then a proxy is appointed. The proxy must then consent to any procedure which the patient is refusing.