patient discharge protocal

please could someone give some sort of reply to mu questions about patient discharge protocal? It would be nice to know other nursing views on this. thanks tara

Hi,

Yes, laughing can cause a person's BP to go up. To get an accurate pt's BP it is best if the pt. is relaxed, sitting down, and not talking with their arm elevated at heart level. When I get a pt that has a high BP I recheck them after about 5 minutes and document in their chart. If the BP is still high I would discuss my findings with a clinician.

Sincerely,

Purple_RN

thanks is it also the same protocal on your ward that you should take the patients bp untill they have left the ward, although they say they are waiting to go home, they have already been discharged?. please answer honestly what you would do if you were not aware or did not think to ask about what the situation would be for this matter, thanks for listening tara (now 2nd year student nurse)

Take the vital signs as ordered until the patient goes home.

as an assistant nurse working on a chaotic understaffed ward and not sure of what the protocals are and seeing this example before i felt this was upto the nurse if she wanted to take it or not! i know this now sounds ludicrous but i was very timid and as i did decide to take it anyway as I normally would have regardless through my own good will I am probably more concerned with the fact i think the bp was 10-20 higher than usual, but as the patients was laughing I thought well it would put it up that bit extra, which i do believe still. But as I was vertually untrined in observation, disgusting really isn't it, i did not think to redo his bp! and now feel guilty that approx 2 weeks aft leaving hospital the man died of a heart attack. Neverthe less with my training well on the way realistion hit me of the past events and guilt then set in.

If you can still see the patient they are still your responsibility. If you choose to take their BP or not you have to be ready to give the rationale behind your decision. As a new person it is easier to defend taking the BP than not so that is what I woud have chosen, even if you could see his ride pulling up.

Yes laughing can affect BP, and depending on what it was and his diagnosis it could be reportable, or you could write (laughing) beside the reading. You can take the BP again later, but if laughing brings it up to a frightening level remember that he is very likely to laugh again at sometime in the future. Will he survive the joke?? That's another judgement call on your part.

Seriously though- it probably wasn't a big deal, docs know that readings will change based on what the pt is doing at the time, and take that into consideration when deciding to let them go home. For example, if a BP drops and pt passes out every time they sit up they won't be discharged, even if it is perfectly normal when they are sitting quietly. Usually if the pt is asymptomatic, and they go back to the norm when the activity is over, they are fine.

We have to take a set of discharge vitals. If the vitals haven't been taken in a while, then we take them right before they are to leave.

Occasionally this has caused a hold up in d/c as we have discovered temps or or high bps much to the dismay of the patients being dishcharged.

But just because a patient has been d/c'd from the hospital, it is still your responsibility that you d/c them with stable vital signs. You'll never know unless you take them.