If this was your patient what would you do?

[azalight90]

Hi

i was on placement. I took a patients obs all but blood pressure was normal.

He he felt cold but had a temperature was 36.5

however his blood pressure was systolic 199 diastolic 70

the blood pressure was normally high at 160 170 systolic and diastolic not much difference.

what would you have done. The patients nurse just bleeped for the doctor to come see him. Think that was good but what would you have done?

Thanks

[akulahawkRN, ADN, RN, EMT-P]

More assessment... not enough info yet.

[malamud69, BSN, RN]

Reassess. ..especially the BP...both arms...legs if need be...need much more info.

[azalight90]

What other assessment would you do? I can't remember the other obs sorry.

[akulahawkRN, ADN, RN, EMT-P]

When I said "more assessment" I actually meant "more assessment" so I would have done a head to toe assessment to be reasonably certain that I'm not being distracted by something else and then a focused assessment on the presenting problems. Due to elevated BP, I'd certainly check that in other extremities as well.

Let me show you what you've got...

Patient complaining of chills/cold.

Pt obs: BP 190's/70's, temp 36.5 and normal BP 160's/70's.

Chills, normal temp, and hypertensive over baseline. Nothing else.

I'm a Paramedic and an RN. Everything I do is driven by my assessments. Without knowing more info, there's no way I can tell you exactly what I would do beyond what I stated above: Head to Toe and then do focused assessments from there.

[azalight90]

Was it wrong to just call the doctor? I have never ever seen uk nurses use a stethoscope by the way

[Esme12, ASN, BSN, RN]

Was it wrong to just call the doctor? I have never ever seen uk nurses use a stethoscope by the way

Really? How interesting. We use them here in the US all the time. How did you take the blood pressure if you didn't use a stethoscope?

NO it isn't wrong to call the MD. That is a high B/P. I would look for other causes. Is this normal for the patient? What other medical history is going on? I would take the B/P in both arms. Are they in pain? Do they have a headache? Are they any neurological symptoms present? How does the patient feel?

[azalight90]

99% of blood pressure is taken by machine also takes pulse and sats.

There re was no pain at all. The only problem was his he felt temperature wise. However he was on oxygen and had no voice box..

[nurseprnRN, BSN, RN]

You can call the MD, but s/he is probably going to ask you for a lot more information than you shared with us here. Pain, diet, appetite, bowel/bladder, level of alertness, any specific observations related to whatever he as admitted with, recent labs and imaging; here we'd also be listening to lung sounds, palpating the abdomen, taking peripheral pulses and skin temp, maybe doing a mini-mental exam. I find it hard to believe that nurses in the UK don't use stethoscopes even if they do, like many places here, rely on (sometimes unreliable) machines to take BPs and sats.

[mrsboots87]

I also find it hard to believe that UK nurses dont use stethoscopes. How do you listen to lungs and bowel sounds? Theres a lot to be learned from lung and bowel sounds. How do you assess the thrush and bruit of a dialysis fistula? How do you double check that very high BP? What if the machine was malfunctioning and a manual BP was more in the patients normal range?

No stethoscope. That's just crazy talk. Especially for this patient. Since his BP is so high and is normally elevated, CHF should be monitored for. But as other posters said, there is a lot more assessment needed before speaking to the physician because a high BP alone is not enough info for the nurse to recommend anything or the physician to order anything.

[mrsboots87]

Also with that high BP, after assessing, the orders should be checked to see if there are any PRN orders for antihypertensive meds to use in situations like this one. And did anyone check for edema? Or what about IV fluids, were they running at what was ordered, or maybe high? How were his distal pulses? These are more things the doctor will want to know.

[CTnewgrad826]

What was the patient doing before the BP was taken? During? Did they just sit down after walking back from the bathroom? Were they shivering from being cold? Agitated or anxious at all? Simple movements can increase BP temporarily. If asymptotic I would've rechecked the BP in 20 minutes. If still high then I would contact the MD.