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Post Cva And Blood Pressure

Nurses   (5,802 Views 12 Comments)
by KulRN KulRN (Member)

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I am wondering as to why the Doctors wants a patient's BP in the high range for a patient who was a post CVA? I was taking care of a patient who had a stroke (2nd one in 3 years) and her BP ranges anywhere between 168/98-198/117...I am a med-surg nurse and was floated to the Telemetry floor. I asked one of the regular Tele RN on that floor why and I was told that with post CVA patient it is actullay safe to have their BP on the high side..She said "I will feel safe if her BP is in 180/100 range". She said something about perfusion. I am still not clear about this, can someone give me a better explanation as to why. The patient has an order for Vasotec IVP PRN. When the Tele RN explianed it to me, she made me feel as if I am stupid for asking..excuse me, I don't have much exposure to this type of patients...so that's why I came to this site coz I know I'll get better response. And Oh, her MRI of the brain results didn't show any clots but swelling on the occipital region. Thank you very much.....oh, one more thing...since she was admitted, she's been hiccuping and the Doctor ordered THORAZINE....Why antipsychotic med?

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Post CVA the brain needs all the help it can get to prevent any more cells from dying. The higher the BP, the more blood getting to the brain.

Think about a garden hose: when the water pressure is low, what comes out the other end (the brain end) is a trickle. The higher the water pressure, the more water coming out the end.

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k3immigrant specializes in critical care.

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higher BP at least greater that SBP of 140 for ischemic stroke is indicated for as mentioned better perfusion but for hemorrhagic stroke, it's the opposite, you want a lower BP.

Thorazine is not just an antipsychotic, it's used for treatment of hiccups in adults and also nausea.

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Beary-nice has 18 years experience and specializes in Almost everywhere.

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Promotion of perfusion is correct. With a CVA, brain tissue is damaged and can swell resulting in increased intracranial pressure. So as Tazzi said, promotion perfusion keeps more brain cells from dying. Because you are telling me that there was swelling in the occipital region, I am thinking increased ICP. The way to promote cerebral perfusion is to keep blood pressure higher.

I think the formula is MAP-ICP=CPP. Normal ICP should be

The blood pressure in your post of 198/117 would give you a MAP of 144, so if your ICP was pretty high say 74, you would maintain CPP at 70.

I don't know if that makes sense. I kinda like the garden hose thing.

Thorazine is used for intractable hiccups, which I would think that they would not want this patient hiccuping, vomiting etc...it increases ICP.

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Beary-nice has 18 years experience and specializes in Almost everywhere.

514 Posts; 8,205 Profile Views

higher BP at least greater that SBP of 140 for ischemic stroke is indicated for as mentioned better perfusion but for hemorrhagic stroke, it's the opposite, you want a lower BP.

Thorazine is not just an antipsychotic, it's used for treatment of hiccups in adults and also nausea.

Agree with this, would not want a higher BP if the stroke was hemorrhagic.

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NurseCherlove has 3 years experience and specializes in Med/Surg; Psych; Tele.

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But here is what I would like to know...since clots eventually resolve/reabsorb, etc., how long would you want to maintain an elevated BP for a recent ischemic CVA?

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maryloufu has 4 years experience and specializes in PCU, Home Health.

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KulRN-- I too had this same question when we had a stroke patient on the floor. The only answer I got was 'they just like them to have a higher blood pressure.' One of the nurses said 'he already survived a stroke, what are you worried about.' Well I called at 8 am on a saturday to the doc and he was not happy with me- but I learned that he is cool with a b/p up to 220/100 ish- which kind of freaked me out. IT is a perfusion thing. Just remember how you felt asking this 'dumb question' when another nurse comes along and asks something that you think everybody knows.

Also on the Thorazine thing- I had a pt with chest trauma with intractable hiccups- a range dose of thorazine was given- I gave the low range- the hiccups stopped for about 30 minutes- then here they come back. Dang! I gave the rest of the dose- which silenced them for 30 minutes- and here they were back. Thank goodness the guy was sleeping from pain meds.

Nurse Cher- I would think that the pt would have frequent CT scans to check on the clot. (but that is a guess)

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Promotion of perfusion is correct. With a CVA, brain tissue is damaged and can swell resulting in increased intracranial pressure. So as Tazzi said, promotion perfusion keeps more brain cells from dying. Because you are telling me that there was swelling in the occipital region, I am thinking increased ICP. The way to promote cerebral perfusion is to keep blood pressure higher.

I think the formula is MAP-ICP=CPP. Normal ICP should be

The blood pressure in your post of 198/117 would give you a MAP of 144, so if your ICP was pretty high say 74, you would maintain CPP at 70.

I don't know if that makes sense. I kinda like the garden hose thing.

Thorazine is used for intractable hiccups, which I would think that they would not want this patient hiccuping, vomiting etc...it increases ICP.

Thanks for the reply...before I received this patient, she stayed in PCU for about a week....there was no documentation in her record that shows they did ICP or even an arterial line monitoring. She basically stayed there for closed monitoring then got transferred. Even the neurologist didn't say anything about ICP...This patient neuro status is intact, she only has weakness onto her left side but is otherwise A/O X4. Now, I'm kind of suspecting that she probably has cerebral hypertension...of course not for me to diagnose....and with the thorazine, I too noticed that it only helps control the hiccups but only for a short while.

Thanks for all those who responded.....Maybe I'll use the "hose thing" next time I work with a patient with similar diagnoses.

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Roy Fokker is a BSN, RN and specializes in ER/Trauma.

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Has anyone ever seen Thorazine work for hiccups? I have seen it used numerous times, and never have seen it work.
Thorazine has always worked when we give it on our floor....

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Roy Fokker is a BSN, RN and specializes in ER/Trauma.

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Think about a garden hose: when the water pressure is low, what comes out the other end (the brain end) is a trickle. The higher the water pressure, the more water coming out the end.
That's assuming constriction/dilation doesn't occur.

e.g. Vasodilation, though it causes a drop in pressure, increases blood flow to an area.

Ergo, higher pressures doesn't necessarily always equal to higher perfusion.

Maybe I read your response incorrectly? :confused:

cheers,

Roy (post 8 hours on the road and probably a wee bit gorky right now :bugeyes: )

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