Low diastolic = 911?

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schroeders_piano

schroeders_piano, RN

Has 19 years experience. 186 Posts

I haven't seen this mentioned yet. How high did you pump your cuff up to? Maybe the 120 was the diastolic reading. I've taken care of many patients with pressures of 200's/ 110's-130's. Which that would then be an emergency.

Penelope_Pitstop

Penelope_Pitstop, BSN, RN

Has 13 years experience. 2,365 Posts

I haven't seen this mentioned yet. How high did you pump your cuff up to? Maybe the 120 was the diastolic reading. I've taken care of many patients with pressures of 200's/ 110's-130's. Which that would then be an emergency.

Very good point! I hadn't even thought of that!

silentRN

silentRN

559 Posts

From the book House of Gods...you have to learn to buff your charts.

Scarlette Wings

Scarlette Wings

Specializes in M/S, ICU, ICP. Has 27 years experience. 358 Posts

hello. i am an rn still in the "new grad" category (less than 1 year nursing experience) who was recently hired on as a weekend supervisor at a ltc facility. it is a great facility and so far the job had not been too bad until this past weekend, when i was asked to put aside my administrative duties to cover for a nurse that had quit. i would actually have enjoyed doing the actual nursing work, if i had known what the heck i was doing! due to my unfamiliarity with the patients and procedures on top of still doing alot of management/administrative stuff, it took me until about 2pm on both days to get all of the "morning" meds done. that's a whole other vent though.

my question is this, is there an urgent significance to low diastolic blood pressure? i received a phone call from the adon because i had documented a blood pressure with only the systolic because i had not been able to obtain the diastolic. the patient was non-symptomatic and the systolic was within normal range at 122. i have worked in ems before and we quite often had difficulty obtaining a full reading due to riding in an ambulance or whatever and many times would document a bp as systolic/palp. now i realize that it might seem i was being lazy but i had tried several times to get a good reading and ended up taking one on her leg. i didn't really think anything of it until i got the phone call and the adon said she "fixed" the documentation so i would not be liable if anything should happen to this patient in the near future and it came to light that i did not get her further evaluation for an "unobtainable diastolic". as far as i know, low diastolic (with a normal systolic) is not urgent but can cause damage over long-term...and there's no way of knowing if her diastolic was low or i just couldn't hear it because i was taking it in her leg. (had never done that before) u

sorry to babble about such a silly question but i'm really not understanding this. i would appreciate if someone could enlighten me! thank you!

i am a little concerned about the way the adon "fixed" the charting.:eek: wonder what else this adon "fixes". had a daughter work for a don that fixed a few things and i begged her to leave that place. thank god she did. the state closed them!

i do not think that you were being lazy. i hope that you have learned several new things.

1) dont jump in over your head just because they are short staffed due to someone quitting. that is their problem. that person may have had a real good reason to quit. never jump in and try to cover or work in an area you are not comfortable with or have little experience or training. that is your license and they...the adon who fixes things, the doctor, or the ones in authority over you when it comes to a law suit....will hang you out to dry in a heartbeat! i have seen too much in the last 25 years. believe me, you are on your own when it comes to th whisper of the word l-a-w-y-e-r. always have your own legal coverage and malpractice imho.

2) always chart what you yourself get and if you do not hear a diastolic say so, or if you palpate it, document it. do not freak out if the patient is non symptomatic, but do check the patients baseline vital signs for what that patient normally runs. i have had pts where a 80/40 is their normal. on the other hand, a pt who normally has an 180/90 and drops to 80/? i would double check.... but that comes with experience.

personally i think that the adon should be thankful you stepped in to help when he/she could have but didn't, and that adon could have used this as an opportunity to realize more education is needed, not chastisement. i think i would scout out a different place to work myself.

Woodenpug

Woodenpug, BSN

Specializes in MPCU. 734 Posts

Got so excited by the method of reading a b/p, that I missed the essential fact: No one should "fix" the chart. Mea culpa.

indigonurse

216 Posts

Generally speaking anything abnormal needs to be reported to the MD.

JLForever

JLForever

30 Posts

Thanks for all the input everyone! I definitely did feel "in over my head" that day. In hindsight I should have refused to take over for the nurse who had quit. However they did tell me in the beginning that I would be asked to work a cart occasionally. I had gone through a little orientation working their carts about a year ago, then worked in a hospital setting for several months, then ended up back in LTC (related to scheduling needs). So when they didn't offer any orientation or training for working a hall I figured I would probably remember what to do and be ok. So not true! I just felt lost and it took so long to get all the meds out and deal with management issues that came up. One patient was so upset about gettng her meds late that she refused to take her meds or allow us to check her blood sugar until the next shift started.

Next time I have difficulty getting the diastolic I will document all the x's I tried, patient being a-symptomatic, etc. I will also get another nurse to try. Doppler would be great but there is very little equipment in this place. I had to scrounge around for a BP cuff so we could take BP's prior to giving meds. I'm going to be discussing with my husband whether it's a good idea for me to keep working at this facility. I accepted the position because I want to stay home during the week with my kids and work a couple weekends a month as a nurse to supplement my income. At a hospital I could not dictate my schedule that way! I am just not sure the risk is worth it because it is pretty scary how things are done there at times.

As for her "fixing" it, she told me she took the entire nurse's note out and wrote a new one. I was so confused by the whole thing I didn't really respond to that. I will definitely be checking her chart when I come into work on Saturday! I'm also going to tell them that I do not feel comfortable covering for any nurses unless I get more orientation working a cart. Finding the time to attend additional orientation will be tough since I not only care for my children during the week I also babysit a little girl part-time. But we'll see.

Thanks again for all the input and information.