Protocol for blood pressure?

Altra, BSN, RN · Apr 22, 2015

I'm uncertain exactly what you're asking. The 4 items you listed seem like a very basic part of health history/assessment and I would be surprised to hear of any medical specialty that does not include those items in the process of normal history-gathering. Do you normally obtain vitals on patients when they present for appointments? I could potentially see this being omitted for office visits in certain specialty areas, in which case I would suggest clarification of the BP requirement - is your parent system now mandating that vitals be obtained?

BrandonLPN, LPN · Apr 23, 2015

I'm not understanding. What do you mean by a protocol for high BP? Do you mean a protocol for treating a high BP reading there on site at the doctor's office?

Is that something that's done? Hypertension is generally a chronic condition. I don't see why trying to treat a high reading on site like that would be necessary or even desirable. If the situation is such that the patient is having some sort of acute hypertensive crisis that needs to be treated immediately.... wouldn't you just call an ambulance? (Or, like I said, maybe I'm misunderstanding the scenario here)

MunoRN, RN · Apr 24, 2015

While a protocol would be wise if the person obtaining and evaluating the BP is an MA, it's not necessary if the person is an RN. That's the whole point of employing RN's; they are legally allowed to employ their required clinical judgement skills.

**canoehead, BSN, RN** · Apr 25, 2015

If someone has hypertension that you are concerned about, just mention it to the doc they will be seeing and wait for new orders.

BrandonLPN, LPN · Apr 25, 2015

While a protocol would be wise if the person obtaining and evaluating the BP is an MA, it's not necessary if the person is an RN. That's the whole point of employing RN's; they are legally allowed to employ their required clinical judgement skills.

But.... is hypertension usually treated on-the-spot in a doctor's office setting? I'm still not understanding the point of a HTN protocol for patients in this case.

jadelpn, LPN, EMT-B · Apr 25, 2015

I get it, if you get a high blood pressure reading, then you are curious as to what to do with that information. You need to inform the MD, and document that you did so.

If there's a licensed nurse who works in the office, then you also need to advise, and document that you did so.

There are offices that will send a patient to the ER if their blood pressure is sky high and they are symptomatic. Other times, patients are re-educated by the licensed nurse or the MD on high blood pressure being a chronic condition, and they need to monitor it, take their meds, and NO they are not "cured" when the meds need to be refilled--they need to refill the meds, and take them. (and you would be amazed at the amount of people that do not refill meds and believe themselves "cured")

The important thing to remember is to let the MD or RN/LPN know of any findings that are critical. If the patient is symptomatic, then it is of great importance to let them know immediately.

BrandonLPN, LPN · Apr 25, 2015

I wish the OP would return and clarify the question. I'm still baffled by what a BP treatment protocol would be in a PCP clinic setting.

jadelpn, LPN, EMT-B · Apr 25, 2015

I wish the OP would return and clarify the question. I'm still baffled by what a BP treatment protocol would be in a PCP clinic setting.

If you are taking a blood pressure as part of the MD visit, and it is critically high, then you need to do something with that information. Often, if it is part of a yearly, then discussion needs to be had with the MD regarding options for treatment of HTN, monitoring, that type of thing. And the MA needs to be sure that they point it out to the MD/LPN/RN. AND document it--very important.

Sometimes, patient's present with a c/c of headache, weakness, and they have a BP through the roof. The protocol is usually if they are symptomatic, they need to be transported to the ED for acute HTN treatment.

In other words, how can we be sure that the patient with the BP of 210/180 and a screaming headache and feeling a bit "off" isn't sent home with a migraine prescription, no one but the MA aware of said BP, and they stroke out in the parking lot.

Usually, interventions in the ED are quicker than what oral meds may or may not be able to be given in a PCP setting. However, if the patient is asymptomatic, then they need to be given a HTN med, and strict follow up....

Altra, BSN, RN · Apr 25, 2015

I wish the OP would return and clarify the question. I'm still baffled by what a BP treatment protocol would be in a PCP clinic setting.

Agree - OP's question is really not answerable without some clarification.

OP did note this is a specialty provider's office, not a PCP. From the wording, I wonder if they did not routinely obtain vitals until this recent change in process.

hotflashion, BSN, RN · Apr 30, 2015

OP here, I'm sorry to post and run, that wasn't my intention. I've never worked in a Dr's office before and it is a specialty office, not primary care and certainly not a cardiology office. It is relatively recent that the practice has been taking BP on its patients, though this was instituted before I was hired. We are so busy that I basically run in the door in the morning and we don't stop running until we're out the door an hour late in the evening.

Assuming for this post that a patient exhibits a "high" BP reading, denies symptoms and exhibits no signs, what do you do? And, do you use the American Heart Association's category definitions for normal, pre-HTN, HTN Stage 1, HTN Stage 2, and HTN Crisis?

I want to know what you do in your office, I'm not asking anyone to tell me what I should do in my office. Does this help?

Seaofclouds, BSN, RN · Apr 30, 2015

When I worked at a doctor's office, we would simply report it to the doctor along with any symptoms the patient was having. Most times, they would have us recheck it toward the end of the appointment to see if it came down. As far as using the AHA definitions, we had no reason to do that as that was for the doctor to decide as it is a medical diagnosis, not a nursing one. It's good to know the information, but nurses are not the ones that make the call to say the patient is in that stage.