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?

[MunoRN, RN]

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.

Of course you can still do your job without vitals. The whole point of nursing is to take into account the patient's goals and what they want (and don't want) done. They absolutely do not "have to be done", a patient retains the right to their refuse assessments/treatments. The final decision is the patient's, and it's up to nurses to make sure anyone who feels something "has to be done" against the expressed wishes of the patient or their proxy gets nowhere near the patient.

[Tenebrae, 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.

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.

For the non Americans here, what does it mean "for medicare charting"?

[Tenebrae, BSN, RN]

If its a requirement of the funder, I would tend to document "Mrs X, reports that she finds it very painful to have her BP taken on either arm" any time you have to do her blood pressure. somewhat a case of protecting your butt. It also documents a clear history for this lady

And again not under standing the connection to her funding, however is it possible to negotiate with them the clinical appropriateness of a daily blood pressure on an elderly lady who obviously finds the procedure painful and distressing and perhaps look at a weekly BP

But no I wouldnt construe that as abuse.

[FranEMTnurse, CNA, LPN, EMT-I]

If she has fibromyalgia, she would tell you that the BP cuff hurts her. I have it, and the only way the nurse can get a BP reading on me without hurting me is to put it on my lower arm.

[Paws2people]

Can you take it on her leg instead? Or try a counting technique. Have her count along with you till its done.

[MunoRN, RN]

If its a requirement of the funder, I would tend to document "Mrs X, reports that she finds it very painful to have her BP taken on either arm" any time you have to do her blood pressure. somewhat a case of protecting your butt. It also documents a clear history for this lady

And again not under standing the connection to her funding, however is it possible to negotiate with them the clinical appropriateness of a daily blood pressure on an elderly lady who obviously finds the procedure painful and distressing and perhaps look at a weekly BP

But no I wouldnt construe that as abuse.

What do you mean by "if it's a requirement of the funder"?

[Tenebrae, BSN, RN]

In NZ, we provide nursing care as per our patients requirements its not dictated by insurance companies, district health boards ACC.

The poster mentioned having to take BP related to medicare requirements I'm still trying to figure out what means whether thats related to a funder or what

[MunoRN, RN]

In the US all patients, regardless of payer, have a legal right to refuse treatments or assessments. The only exception is for patient who have lost their rights to make medical decisions through a legal process.

[Tenebrae, BSN, RN]

So can someone explain for me why medicare would want to know the BP of a long term care patient

[orange_dolphin]

Every patient I have who has poor muscle tone in their triceps and loose flapping skin folds complains of serious pain and some bruising. I'm guessing the skin folds cause a pinching-type pain. I always offer to take the BP in the wrist instead, and I document that the pt could not tolerate getting it taken on the arm. I had one patient refuse to let me pump above 140, which would give an incorrect reading if she has BP higher than that. I refuse to take it incorrectly and will offer it in the wrist.