mcd24RN

[quote=xtxrn;5657147]Agree with the first 2 replies (only ones there, so if others show up before I get this up, nothing against them )..... would also ask- when you got the low BP, did you check it with a manual, or was it a dynamap? (might still have been correct- I just check manual B.Ps before sending someone out (then if the ED asks, you have that on your side :)). If you have the info and trust it- go with what you believe is right for the patient. :) It's always better to check something out and have it be not as bad as expected, than to wait until it's too late to fix To be honest I only used the electronic BP cuff, I almost always check the BP manually for abnormal VS. At the time though I got slammed with problems: another pt that had developed bradycardia, dark red hematuria, and terrible labs that I had to send out, and another pt that had been spiking temps and having terrible diarrhea (almost positive it is C.diff). I had a total of 10 vent dependent pts this day. Not that I shouldn't have checked it manually but the hypotension seemed to fit in right with her other symptoms especially the anuria. -Thanks

I also work in LTC but with ventilator dependent patients. We get critical labs all the time and they are always called in to us directly, and the lab has to verify and document who they reported the critical value to. Our lab aso labels values with CH for critically high and CL for critically low. At our facility it is almost impossible to overlook a crtical lab and assume it is similar elsewhere. What can get tricky is determining what labs that are out of rang but not critical warrant notifying the MD. This comes with experience and if you are in doubt I would always call to cover yourself. I have been reemed out by a few MDs about labs when I first started but just don't let it bother you if it happens. They are getting paid to care for the pts, even if they're on call, is how I look at it. Better safe than sorry.

I am a relatively new new RN working at a LTC for vent dependent patients. Today, I had a patient with pneumonia, normally hypertensive with hypotension all shift (90s over 40s) for about 6 hours, all BP meds held, until she desaturated and stopped producing urine at which point she was sent the local ER. The paramedic that transferred her to the ER said that her BP during transport and upon arrival to ER was 146/82 and the ER nurse also found her to be hypertensive. Then later I talked to the ER and she was admitted to the ICU with sepsis. Is it possible for her BP to spike from hypotensive to hypertensive so rapidly? Within about 30 minutes from 98/48 to 146/82? Or did I make some type of mistake? Any help is greatly appreciated, can't stop questioning myself!

I figured I would post this question in the critical care section because Critical Care nurses may have more experience with my question. I am a relatively new new RN working at a LTC for vent dependent patients. Today, I had a patient with pneumonia, normally hypertensive with hypotension all shift (90s over 40s) for about 6 hours, all BP meds held, until she desaturated and stopped producing urine at which point she was sent the local ER. The paramedic that transferred her to the ER said that her BP during transport and upon arrival to ER was 146/82 and the ER nurse also found her to be hypertensive. Then later I talked to the ER and she was admitted to the ICU with sepsis. Is it possible for her BP to spike from hypotensive to hypertensive so rapidly? Within about 30 minutes from 98/48 to 146/82? Or did I make some type of mistake? Any help is greatly appreciated, can't stop questioning myself!