Hypertension

[kanashe]

:redbeathe A patient had just finished a MRI of the knee. She felt a little dizzy after the test. A MRI support associate brought her to the nurses station for an evaulation. My co-worker took her blood pressure with an automatic machine. It was 180/100, P-76. Dizziness had resolved, and she felt fine. No history of hypertension. She had been to the doctors several times in the past month and had her B/P taken with no mention of hypertension.

She rested for about 20 mins and her pressure was retaken. She still felt fine. This time it was 150/110. My co-worker called me over to convince this patient to go the ER for treatment. I couldn't. I told the patient that the descision was up to her. I strongly suggested she follow up with her primary doctor and gave her some tips on diet and exercise. I did not feel this pressure was worthy of an ER visit. My co-worker was obviously perturbed with me. She told the woman she could drop dead with a stroke at any moment with a pressure that high. Then she escorted the woman to triage where they told her to take a seat out side.

Any comments on this? Should I have been a little more aggresive in coaxing the woman to ER?

Thanks

[XB9S, BSN, MSN, EdD, RN, APN]

I run a clinic and can often get patients with undiagnosed hypertension coming in. We are quite lucky and have clear guidence about management of hypertensive patients so I follow this.

It states that immediate referral is needed if the BP is above 180/110 and we do this on 2 consequetive readings. If they do not fall into this catagory then we refer to the GP with a letter and followup phonecall.

here are the guidelines we follow (bear in mind I work in the UK but the principles are the same.

We are very lucky because we have lots of clinical Guidelines from NICE that support us with various treatments.

[nitenurse02]

I would have been a litle concerned over a pressure that high. but as you said it was up to her. I would have checked a manual pressure too. sometimes the machines just aren't very accurate

[Virgo_RN, BSN, RN]

Without having been there, it sounds like your colleague may have been overreacting, and that advising the patient to follow up with her primary care physician was probably appropriate advice.