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Discussion

High BP

Patient, 80 year old female...fall with numerous facial brusing..one large by right eye, temple, and forehead. Fell a week ago while in assited living. CT shows nothing abnormal. Thru out week becomes increasingly confused, blood pressure sores to almost 200/140. ER send to LTC. PT keeps her for a long period of time, then family comes in and takes her for a walk, etc...when I finally get a chance where she is in her room, her BP is 150/118. I give her a pain med and tell everyone they have to leave the room a little while so this lilttle lady can rest (Doctor in building and aware of my findings). She needs to rest...therapy doesn't like this because they have a schedule to keep. 15 minutes later, therapy tries again to go into room. I hear OT telling CNA resident BP low...I redirect and say nooooo her bp is high and she needs to rest. Within one a one half hours BP goes down 130/78 and pain better. Who has priority here.....? I wanted to tell them, if she strokes then there will be no therapy for anyone.

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Nursing always takes priority. Although you may have a fight on your hands. Sounds like she is being skilled and without PT and OT getting to work with her, her MDS level can drop and NH gets less money. Stand your ground. It's your license. And CYA in the chart. I've seen DON/Administrator push OT/PT to work with residents anyway.

:clown: You are absolutely right. I work in a free standing rehabilitation facility and I face this every day. The therapists are so concerned to meet their scheduled " units " that the acutual medical condition of the pt is ignored. I am happy you stood your ground on this one. When this happens to me, I often get a order for either no therapy this day or an order for bedside therapy if pt can tolerate. This often satisifes all parties involved and the pt is able to rest up :)

the facility will likely say their $$ take priority.

but we all know that medical status always (always, always) does.

yes, document your proverbial butt off, including concerns you've shared w/others.

leslie

You can't treat them if they're dead. So BP takes priority.

What part of the ABCs is rehab? You don't get up and do PT/OT with people that are that hypertensive.

I'm really glad that you sent the family out as well. Most of the time family are helpful to patients/residents but there are those families that are not. I feel so bad for the patients that get absolutely no rest.

  • Author

Thanks you all....it makes me feel a bit better when I have you all to agree with me. It just burns my *ss when I try to get them to understand....I NEED TO PATIENT! Heck, they will even say "and so do I"...I am not about to have a battle, but I will be damned if they take a patient with a bp like she had, and then expect her to do therapy. What the heck is wrong with them. I understand the MDS..and money part...but crap. Today, I was trying to admit a patient, getting the chart together and all, and therapy came up and took it right from under my nose. Slowed down my admission big time.

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