High Blood Pressure At End Of Life?????

[tencat]

I am SOOO stumped. I have a patient who is end-stage congestive heart failure with +2 edema in both lower legs and some ascites. Patient is already mottling on feet and elbows, breathing is wet and kind of 'hiccup' breathing (I'm sure there is a real name for it, but I am having cerebral flatulence at the moment :imbar) with lots of rattling in the throat. Oxygen level is at 67% on 10 L/min oxygen. Patient is dusky and fingers are grey. Patient is not able to open eyes or follow commands, but does respond with moans if someone talks with her. She's appears to be in the active phase of dying. So.....blood pressure is 142/60. What the......? I took it three times, and got nearly the same result each time. Usually blood pressure drops significantly at this point. What would be causing that? Help me out you guys! It's driving me NUTS.

[KenCCRN]

I am SOOO stumped. I have a patient who is end-stage congestive heart failure with +2 edema in both lower legs and some ascites. Patient is already mottling on feet and elbows, breathing is wet and kind of 'hiccup' breathing (I'm sure there is a real name for it, but I am having cerebral flatulence at the moment :imbar) with lots of rattling in the throat. Oxygen level is at 67% on 10 L/min oxygen. Patient is dusky and fingers are grey. Patient is not able to open eyes or follow commands, but does respond with moans if someone talks with her. She's appears to be in the active phase of dying. So.....blood pressure is 142/60. What the......? I took it three times, and got nearly the same result each time. Usually blood pressure drops significantly at this point. What would be causing that? Help me out you guys! It's driving me NUTS.

Thats not unusual...when a patient is in CHF, Congestive Heart Failure the left ventricle which is the pump is failing and is working hard to push against the resistance of all that fluid. Hence, Blood pressure is up..once you start a nitroglycerine drip and reduce the preload and afterload it eases the workload of the heart by dilating and sort of taking the nozzle off the garden hose...and allowing the blood and fluid to pass more easily while also lowering blood pressure. So basically, the blood pressure is up to move the blood/fluid out of the left ventricle. Its working hard and the pressure will be up until the heart goes into complete failure.

Ken

[tencat]

Thanks so much for all of your help guys!

[MrsMommaRN]

No words of wisdom, just wanted to say, YOU GUYS ROCK! What a wealth of info! Thanks!