Nsg care of hypotensive pt

meandragonbrett · Dec 23, 2007

Modified Trendeleburg and you also could have paged the physician to get an order for a fluid bolus (but that's basically the same thing as calling rapid response.) How hypotensive was the patient? Did they recently receive any meds? If so, what? Where they tachycardic? Febrile?

Christie RN2006 · Dec 23, 2007

How low did their BP go? Did they have a change in mental status? Were they laying on a side? If a patient is laying on their side and you take their bp on the arm that is highest, sometimes you will get a false low. Did they receive any pain medication or medications to lower their bp? In the ICU, if the patient has a rapid drop in bp with no explained cause, we generally lower the head of the bed and give them a fluid bolus (by our policy). Then we call the doc and let them know what is going on, what we did, etc.

martymoose, BSN, RN · Dec 23, 2007

hi how low was the bp? was the pt symptomatic? were they septic, maybe new meds? dry? vagal response? was hr low too?hr too high?, arrythmia? all these things can factor in. all these things you will learn over time as they happen more often. fluid bolus and trendelenburg position of bed(pt tipped on their head, feet up bed slanted) help, depending on situation. if they are bad chf though, you wouldnt want much of a bolus.( you should still have an order for this)

your charge nurse and floor situation dont sound very supportive for you. you did the right thing by calling in a respose team- depending on how hypotn they were.keep asking here- ill try to help- i work on intervent cardiology floor, but we get everything else too. the learning curve stinks, but the only way to learn is to ask questions like you are. i work with nurses who have been there 20 years and they still ask questions or opinions. dont be afraid to ask and insist on answers. especially since this prob was you r first situation in this. good luck!

meandragonbrett · Dec 23, 2007

The latest literature does not support the use of trendelenburg or modified trendelenburg to treat hypotension and low cardiac output.

socalpca · Dec 23, 2007

I have the same questions as all the previous posters about meds and how low the BP actually got. Was the low BP taken by machine? If so did you confirm that reading with a manual reading? Did you take it on the other arm as well? Was the pt on IV fluids? What was the diet status? Any sings of active bleeding? Vomiting? Diarrhea?

For me, I would get a full set of vitals including manual BP, mental status, skin color, cap refill and then bring my charge nurse into the room to also assess the pt. From there, the two of us would decide between calling the MD or calling a rapid response.

Poochee · Dec 24, 2007

Low arterial pressure (low BP) may be a sign of severe disease and requires urgent medical attention.

When arterial pressure and blood flow decrease beyond a certain point, the perfusion of the brain becomes critically decreased (i.e., the blood supply is not sufficient), causing lightheadedness, dizziness, weakness and fainting.

The treatment for hypotension depends on its cause. Asymptomatic hypotension in HEALTHY people usually does not require treatment. Severe hypotension needs to be aggressively treated because reduced blood flow to critical organs including the brain, heart and kidneys may cause organ failure and can ultimately lead to death

Sometimes less is more.

leslie :-D · Dec 24, 2007

The latest literature does not support the use of trendelenburg or modified trendelenburg to treat hypotension and low cardiac output.

it has worked for my pts.

not always, but many times.

leslie

anonymurse · Dec 24, 2007

What meandragonbrett said. The evidence even shows Trendeleburg can be bad.

What poochie said. Tissue perfusion is the name of the game.

A few things seem like proper anticipatory responses. First, make sure the right size BP cuff is being used. Check anything that could cause a vagal response and correct. Hold meds that ought to be held.

If you smell BP trending down, make sure that pt has adequate IV access. A 22 ga. will only pass 31 mL/min, but an 16 ga. will get you 180. But the main thing is to flush that pup and see if it's patent. If access is in the hand, you might want to start a second site.

Also, atropine is wonderful stuff. Can't say enough for it!

FlyingScot, RN · Dec 24, 2007

it has worked for my pts.
not always, but many times.leslie

That may be so but it also decreases the patient's ability to breathe and increases intrathoracic pressure causing a subsequent decrease in venous return which may or may not worsen the situation. In addition a sudden decrease in BP can be associated with some types of neuro pathology which may be seriously increased when you drop the patient's head. It's better to lay them flat.

leslie :-D · Dec 24, 2007

That may be so but it also decreases the patient's ability to breathe and increases intrathoracic pressure causing a subsequent decrease in venous return which may or may not worsen the situation. In addition a sudden decrease in BP can be associated with some types of neuro pathology which may be seriously increased when you drop the patient's head. It's better to lay them flat.

my bad...

let me clarify.

i always lay them flat-

never do trendelenberg.

agree about affecting intrathoracic pressure.

dang, i feel suffocated whenever i see trendelenberg.

leslie

FlyingScot, RN · Dec 24, 2007

[quote=earle58;2563280 i feel suffocated whenever i see trendelenberg.

leslie

It makes my head hurt just looking at them.