what to do when your pt has high bp?

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I currently work at a wound care clinic, and we frequently have patients who have elevated blood pressure readings. (we take vitals for every pt we see during visit) Yesterday i had a patient with one reading 180/108! i am a brand new lvn, so when asking my coworker (also lvn, worked at the clinic 2 years) she went into the room and asked the pt if he felt dizzy or light headed? the pt said no, and my co worker just said OK. your free to go. and that was it! im thinking, dizzy and lightheadedness might be from hypotension and not hyper..... but this assessment didn't seem sufficient to me? working at a clinic, theres not much we can do besides inform the PCP im thinking, at what point would you send to er? or straight to dr office? what would you do? thanks! :) i feel like i have so much to learn still :/

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Specializes in Hospice.

Is there a NP or MD available? If so I would report it to one of them.

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Specializes in Primary Care.

Has this patient been coming for a while? I would take a second value to confirm a high blood pressure, then I would compare it to previous values for the patient and ask them if they normally run that high. I have taken care of a few patients whose blood pressures were concerning, but because it's their norm nothing was done. If it is not their norm, I would call the doctor.

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Specializes in Hospice.

I agree that one should recheck BP, however, 180/108 is not normal. If they generally run high they should be advised to make an appt with their physician. Maybe it's time for med adjusting, or maybe it's just White Coat Syndrome. Either way it's for the physician to determine.

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It is a tough situation, all the advice has been good. Re-take it at least 3 times over 15 minutes or something in that ball park. Educate the patient, write their BP down, or print out their trend, give it to the patient and tell them show their PCP what their BP was. Maybe you could fax it to their PCP?

If it's consistently high......I have no idea......you can't force a patient to go to the ER......I honestly don't know what a nurses liability would be? Call their PCP and maybe they would call you back 3 - 4 hours later?

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Specializes in Reproductive & Public Health.

We run into this at my clinic too. If it was that high even after repeating it, I would not let that patient leave without consulting with the clinic's provider and making appropriate provisions for follow up, which might mean sending pt to ER or getting an urgent appt with a GP. If the patient was unable/unwilling to stay while I figured it out, I would document the hell out of that encounter. No way would they just get asked a couple questions about sx and then be allowed to walk out the door. Many people do not have PCPs and your clinic might be the only medical care they receive on a regular basis.

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Specializes in Cardiac, Home Health, Primary Care.

1. Recheck

2. Ask questions (Did you take your meds this morning? Start anything new? Anything OTC? Consider pain to an extent as well)

3. Get them in with their PCP if at all possible. If symptomatic send to ER so they can get it down quickly with further work up.

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An isolated BP reading of 180/108 without any symptoms is not a reason to send to the ER. However, this definitely warrants a phone call to the patient's primary care provider to get them an appointment as soon as possible.

A BP reading of >/= 180 systolic or >/= 110 diastolic accompanied by symptoms such as vision changes, headache, confusion, chest pain, shortness of breath, back pain, new peripheral edema, etc. should be evaluated immediately in the ER.

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An isolated BP reading of 180/108 without any symptoms is not a reason to send to the ER. However, this definitely warrants a phone call to the patient's primary care provider to get them an appointment as soon as possible.

A BP reading of >/= 180 systolic or >/= 110 diastolic accompanied by symptoms such as vision changes, headache, confusion, chest pain, shortness of breath, back pain, new peripheral edema, etc. should be evaluated immediately in the ER.

This is right on. I'm and ER attending and completely agree with this. There are many people that run around with SBP's of 180 and even greater and really don't know about it. A simple reading of 180/108 is not normal but it is not an emergency. I get this all the time in the ER from nurses, patients, and even other physicians. Asymptomatic hypertension is not a medical emergency. Someone with hypertension and having acute weakness, difficulty speaking, or changes in mental status needs to go to the ER. If someone feels normal they do not need to be seen. I question a headache and maybe they should be seen but it would take a full exam to decide if it was an emergency (so I guess send them).

Hypertension itself is a chronic disease unless acute changes or findings. My treatment in the ER is mostly IV antihypertensives and is normally done in hypertensive urgency/emergency. If someone walks into the ED with chronic hypertension and no new symptoms I will do more harm by acutely lowering the BP. This needs to be done slowly in a clinic with good follow up which is not what an ER can do.

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