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Elevated BP

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KeeperOfTheIceRN has 4 years experience as a ADN.

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First occurrence here. 

Had a student come in asking to have their BP checked as they had told their mom they felt a little shakey and had a "very slight" headache. Per mom's request, they came to me to have it checked. First BP was 144/83 second BP was 148/105. BP's taken 15 minutes apart. HR WNL. Student denies feeling anxious or any other complaints. Mom wants them to have it rechecked in about 30 minutes to see where it's at at that point. Since the student is essentially asymptomatic at this time, I feel comfortable sending them to lunch until I need to reassess them. They know to return sooner if anything changes. Plan is to refer MD visit if next BP is still elevated as it will have been an hour at a sustained elevated BP

I'm curious to know how many kiddos you have had with an elevated BP and what you have done for them? I've checked a few here and there but they have always come back normal. This was a first for a student to pop up with an elevated BP for me since being in a school. Oh, and I should mention student is in 9th grade. 

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SaltineQueen works as a School Nurse.

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Could they be dehydrated?  That could be the culprit along with the headache.  Anxiety?  Meds?   I've never had one come back elevated that I've checked but I think you're doing what I'd do.

 

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KeeperOfTheIceRN has 4 years experience as a ADN.

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5 minutes ago, SaltineQueen said:

Could they be dehydrated?  That could be the culprit along with the headache.  Anxiety?  Meds?   I've never had one come back elevated that I've checked but I think you're doing what I'd do.

 

Those were my same questions as well. Student said they didn't feel anxious or nervous about anything. Student doesn't take any meds. They were going to lunch so I made sure they had enough food/drink to help with any headache/shakiness that might be hunger related. This was the first one I've had come back elevated as well. Glad to hear that this is likely the same path you'd take as well! 

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ruby_jane has 10 years experience as a BSN, RN.

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30 minute recheck is what I'd do. Overweight? Just got done running? Just had a major test? Any ADHD meds (or caffiene-containing Monsters)?

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SaltineQueen works as a School Nurse.

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7 minutes ago, ruby_jane said:

30 minute recheck is what I'd do. Overweight? Just got done running? Just had a major test? Any ADHD meds (or caffiene-containing Monsters)?

Ooh...good thought with the energy drinks.  I don't have many of my K-3ers drinking them throughout the day.  🤣

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KeeperOfTheIceRN has 4 years experience as a ADN.

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11 minutes ago, ruby_jane said:

30 minute recheck is what I'd do. Overweight? Just got done running? Just had a major test? Any ADHD meds (or caffiene-containing Monsters)?

THEY LITERALLY JUST ADMITTED TO DRINKING ONE EARLIER TODAY!!!! Good thought!!! I didn't even go that route as their HR was normal but it will definitely be on my list 'o questions from now on. We had a good convo on why to avoid them and student seemed to be cool with not drinking more (at least for now!). 

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UrbanHealthRN has 8 years experience as a BSN, RN and works as a RN.

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41 minutes ago, KeeperOfTheIceRN said:

THEY LITERALLY JUST ADMITTED TO DRINKING ONE EARLIER TODAY!!!! Good thought!!! I didn't even go that route as their HR was normal but it will definitely be on my list 'o questions from now on. We had a good convo on why to avoid them and student seemed to be cool with not drinking more (at least for now!). 

Wow, that's scary. Makes me wonder if the energy drinks are just that bad, or if the kid actually has an underlying BP issue that comes out with poor food and drink choices. Very interesting!

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KeeperOfTheIceRN has 4 years experience as a ADN.

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6 minutes ago, UrbanHealthRN said:

Wow, that's scary. Makes me wonder if the energy drinks are just that bad, or if the kid actually has an underlying BP issue that comes out with poor food and drink choices. Very interesting!

I really feel they are just that bad for you. But that also doesn't mean this student can't have an underlying issue either. So, they'll be on my radar from now on and if/when they come see me again, my assessment will be a little more in depth for sure. 

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Mavnurse17 has 2 years experience.

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I came from a cardiovascular floor, where MD's were typically okay with SBP's up to 160 (as long as they're asymptomatic).  I tend to follow the same guideline in my clinic-- if SBP is 140's-160's and they're asymptomatic (and have no known underlying cardiac condition), I usually recheck, ask all the pertinent questions, and if still high I'll usually say "your BP is on the high side, when's the last time you went for a check up?"  I'm in a HS so I feel like it's easier than ES or MS to go this route.  If they are symptomatic, I call parent to pick up and recommend medical treatment, and if it's bad enough I'll call EMS.  

We're taught in nursing school the "perfect range" for BP's, but being on that cardiac floor really taught me to critically think by looking at the clinical picture of the patient/student. 

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On 5/3/2019 at 5:29 PM, Mavnurse17 said:

I came from a cardiovascular floor, where MD's were typically okay with SBP's up to 160 (as long as they're asymptomatic).  I tend to follow the same guideline in my clinic-- if SBP is 140's-160's and they're asymptomatic (and have no known underlying cardiac condition), I usually recheck, ask all the pertinent questions, and if still high I'll usually say "your BP is on the high side, when's the last time you went for a check up?"  I'm in a HS so I feel like it's easier than ES or MS to go this route.  If they are symptomatic, I call parent to pick up and recommend medical treatment, and if it's bad enough I'll call EMS.  

We're taught in nursing school the "perfect range" for BP's, but being on that cardiac floor really taught me to critically think by looking at the clinical picture of the patient/student. 

What would you say was a safe range for the diastolic to watch and recheck or send on out? 

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Mavnurse17 has 2 years experience.

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@SmallTownNurseSWL

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What would you say was a safe range for the diastolic to watch and recheck or send on out?

Diastolic is tricky I think because while it's still unhealthy for the DBP to be high, it doesn't usually cause as many symptoms as a high SBP does.  Our cardiac docs had us give a PRN if diastolic was at or above 90, so I'm okay if diastolic is in the low 90's.  Anything above 95 is like, ehh.  I've called a parent for pickup and referral to PCP before because the student's BP was 140/110; she was symptomatic but not enough to have to call EMS for.  If the student hadn't been symptomatic, I certainly would've called mom to give a heads up and provide plenty of education to student.  So of course, make sure you're focusing on how the student is doing regardless of the number!  😊

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