hypertensive emergency?

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">Today I had a student I was teaching who had a BP of 188/124. What would you have done in this situation? She says she recently saw the doctor and had a normal B.P., but is having problems with anxiety and has been prescribed med for anxiety, which she hasn't started yet and doesn't have with her. Also that she's being treated now for UTI. She said she had no symptoms with her B.P. except for feeling anxious and flushed. I was alarmed, and suggested she go home and either go to urgent care or call her doctor, but she wanted to stay till the end of the day. She didn't want to get her B.P. taken again at all, because it made her more anxious to do that. At the end of the day, I told her if it were me I'd either go some place that could take my B.P. or call my doctor. And I hinted that it could lead to a stroke. Every time I brought up the subject, though, she said I was making the anxiety worse. What approach would you have used, and do you think it's something a phone call to the M.D. or a trip to urgent care could've taken care of?

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I was hoping some of you urgent care nurses or office nurse could help me with this question. Or is it more appropriate to put on the emergency nursing forum?

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Specializes in Education, FP, LNC, Forensics, ED, OB.

Moved to General Nursing where you might get a better response. :)

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I don't know the right answer. I do think I would have sent her home. I keep thinking "What if she had stroked in front of me?" Then I think about it as a parent. As an instructor you have certain responsibilities, similar to a parent. You have to do the right thing. if it had been my daughter you were teaching and she had a B/P that high and you responded as an ER nurse might rather than an instructor... That was my thinking.

You might have come to some agreement later about how to make up the time, if that was an anxiety producing piece. She could do some research about kidney disease in lieu of time missed.

As I say, I don't know the right answer. For me the right answer would be to present her with reality that a B/P that high will not be tolerated. It is too dangerous for her and those around her. How long would you keep your job if she blew out her brains from that pressure? How would you feel about yourself not intervening before catastrophe?

I pray she does get the message about how dangerous it is.

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Specializes in ICU.

I would have sent her home. She needs to start her anti-anxiety meds. I am normally a 11/60 kind of chick, but when I am in a time of very high anxiety or pain, I go up to 160/90. If it is anxiety, I take a xanax and my BP comes down. If it's pain, I take something for pain.

I treat the underlying condition.

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Specializes in ICU.

110/60, that is.

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Specializes in Cardiac.
I would have sent her home. She needs to start her anti-anxiety meds. I am normally a 11/60 kind of chick, but when I am in a time of very high anxiety or pain, I go up to 160/90. If it is anxiety, I take a xanax and my BP comes down. If it's pain, I take something for pain.

I treat the underlying condition.

BP of 11/60?! DANG, you're mellow! lol

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Specializes in ICU.

xanax is wonder drug:)

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Specializes in PACU.

Sounds like what my BP probably was as a student early on. Thank goodness I never checked it. Catecholamine surge for the win.

I'd encourage her to call her PCP's office immediately and provide information regarding the importance of getting it under control. Otherwise, she's a grown woman and can make her own decisions.

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Thanks for the comments! She didn't want to go home even though I told her I wouldn't count her down for going home early, and said another student was her ride home also. I should have probably encouraged both students to go. But what if she still declined the offer? And is this something I should've encouraged sending her to E.R. instead of just home?

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Specializes in cardiology/oncology/MICU.

We had clinical instructors that were not nearly as nice as you sound. There is a lot of fear generated by nursing school.

What if I miss too many hours and fail. We had people go out in the last semester for that. I think it owuld have been wise to have her leave early whether she wanted to or not, reassuring her that you would not count the time against her. What if the administrators of your program found out? I think ours would have counted the time against us. How pitiful! Don't worry, I am sure she is fine. Was that a manual pressure?

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And is this something I should've encouraged sending her to E.R. instead of just home?

The ER doesn't sound like a bad idea, but with that it depends on the competency of the ER doctor as to what he/she would do next. I don't mean that rude, but my wife (who has since been placed on hypertension medicine) passed out at work once and had a BP of 210/180 when the paramedics arrived. She was transported emergency status to the local ER where the doctor proceeded to try to explain to me and her that her high BP was only because she was in an ER. I never could explain to this moron that she had been transported BECAUSE OF the high BP. We ultimately had to request a different doctor and file a formal complaint with the hospital oversight board.

Anyway, I think you were right in having concern for her. I would also check with my school (and maybe the legal personnel at said school), and get their take on it. Some schools will not allow students who have an illness or a potential emergency problem to stay on campus if for no other reason than liability. You might want to explain to her also that you don't really want to have to teach the other students how to work with a stroke victim with her as the patient.

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