hi im a new memeber as you may be aware i need to clarify what most of you would do in my position. approx back in 1999 i was an assistant nurse that was taking blood pressures in the evening and this elderly patient said " oh i wouldn't bother love as i am waiting to go home as if he was discharged. as i was doing bps anyone i said never mind i'll still do it, but as i continued to take it he started laughing quite heartily and i noticed his bp cam up a little high. i looked back at his previous bp readings and found approx 2-3 weekd previous he had another high one that almost matched this one and as it was approx 10-20 higher on the diastolic than usual i thought oh its because he was laughing. looking back i now know i was a bit nieave and as the patient was going home i suppose i did not take the reading as that seriou; also bearing in mind i was not very experienced and untrained in observation readings, except for what was learnt on the ward! on my ward which was surgical the nursing auxillaries are not given any special training regarding observation readings! as i am now half trained i now know that maybe i should have taken it again , although it is possible in my view still that laughing heavily could push your bp up by atleast 20 on the systolic. would you agree? also what is the position in your workplace as to discharged patients waiting at their bedside to go home, would you bother to still take their bp? thanks for your interest. tara
Feb 5, '03
please could someone give some sort of reply to mu questions about patient discharge protocal? It would be nice to know other nursing views on this. thanks tara
Feb 5, '03
As long as the patient is on the unit, I'd do it - until he walks out the door he's still your responsibilty. Rides have funny ways of not showing up and people who are supposed to go home have been known to croak while waiting to do so.
Feb 5, '03
Yes, laughing can cause a person's BP to go up. To get an accurate pt's BP it is best if the pt. is relaxed, sitting down, and not talking with their arm elevated at heart level. When I get a pt that has a high BP I recheck them after about 5 minutes and document in their chart. If the BP is still high I would discuss my findings with a clinician.
Feb 5, '03
thanks is it also the same protocal on your ward that you should take the patients bp untill they have left the ward, although they say they are waiting to go home, they have already been discharged?. please answer honestly what you would do if you were not aware or did not think to ask about what the situation would be for this matter, thanks for listening tara (now 2nd year student nurse)
Feb 5, '03
Take the vital signs as ordered until the patient goes home.
Feb 6, '03
as an assistant nurse working on a chaotic understaffed ward and not sure of what the protocals are and seeing this example before i felt this was upto the nurse if she wanted to take it or not! i know this now sounds ludicrous but i was very timid and as i did decide to take it anyway as I normally would have regardless through my own good will I am probably more concerned with the fact i think the bp was 10-20 higher than usual, but as the patients was laughing I thought well it would put it up that bit extra, which i do believe still. But as I was vertually untrined in observation, disgusting really isn't it, i did not think to redo his bp! and now feel guilty that approx 2 weeks aft leaving hospital the man died of a heart attack. Neverthe less with my training well on the way realistion hit me of the past events and guilt then set in.
Feb 6, '03
If you can still see the patient they are still your responsibility. If you choose to take their BP or not you have to be ready to give the rationale behind your decision. As a new person it is easier to defend taking the BP than not so that is what I woud have chosen, even if you could see his ride pulling up.
Yes laughing can affect BP, and depending on what it was and his diagnosis it could be reportable, or you could write (laughing) beside the reading. You can take the BP again later, but if laughing brings it up to a frightening level remember that he is very likely to laugh again at sometime in the future. Will he survive the joke?? That's another judgement call on your part.
Seriously though- it probably wasn't a big deal, docs know that readings will change based on what the pt is doing at the time, and take that into consideration when deciding to let them go home. For example, if a BP drops and pt passes out every time they sit up they won't be discharged, even if it is perfectly normal when they are sitting quietly. Usually if the pt is asymptomatic, and they go back to the norm when the activity is over, they are fine.
Feb 7, '03
We have to take a set of discharge vitals. If the vitals haven't been taken in a while, then we take them right before they are to leave.
Occasionally this has caused a hold up in d/c as we have discovered temps or or high bps much to the dismay of the patients being dishcharged.
But just because a patient has been d/c'd from the hospital, it is still your responsibility that you d/c them with stable vital signs. You'll never know unless you take them.
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