Should I call the doctor for a BP of 175/72?

[moonshawdow]

I always thought it was to call doctors if over 180?  Am I wrong and giving my patient bad care? 

[gratefultobeanurse16, BSN, RN]

It depends. if the patient is symptomatic (I.e blurry vision, headache) yes I would notify physician and treat bp with PRN medications. 

Usually if the patient is asymptomatic and is known to have high bp then I would first see if they received there scheduled po bp meds. I typically will give them there po medication and recheck within 1 hour. if there home meds are ineffective then I would send them a page to let them know that home bp medications ineffective. 

Sometimes there are PRN hydralazine orders for patients that usually have parameters to give if sbp greater than 160,165, etc or dbp greater than 110. 

 

[MelEpiRN]

Not enough info...are there listed parameters? PRNs if above a certain number? Unit standards?

[Tacocat, ASN, RN]

Are there parameters? Anything PRN available? Documented hx HTN? Is the pt having sx? Did you get that BP on a manual BP check or did you use a vitals machine? 

[Sour Lemon]

I agree with all of the above. I'd also make sure to address pain, agitation, etc.

[moonshawdow]

2 hours ago, gratefultobeanurse16 said:

It depends. if the patient is symptomatic (I.e blurry vision, headache) yes I would notify physician and treat bp with PRN medications. 

Usually if the patient is asymptomatic and is known to have high bp then I would first see if they received there scheduled po bp meds. I typically will give them there po medication and recheck within 1 hour. if there home meds are ineffective then I would send them a page to let them know that home bp medications ineffective. 

Sometimes there are PRN hydralazine orders for patients that usually have parameters to give if sbp greater than 160,165, etc or dbp greater than 110. 

 

This was 330 am vitals went to recheck but pt was sleeping so didn't retake.  pt was asymptomatic. No PRN orders but had been given 2 nights before a one time dose of PRN hydralazine. He had morning lisinapril due at 8am so just passed on to morning shift. I feel now I should not of just passed it on and called the doctor but usually there is a policy to only call them if it is over 180 but im new to this hospitals policy. Was I completely wrong for holding off? Would like to be better for the future if I was wrong? ....

[Tacocat, ASN, RN]

45 minutes ago, moonshawdow said:

This was 330 am vitals went to recheck but pt was sleeping so didn't retake.  

You need to do a little research on your patient. Check the vitals flowsheet and see what his usual BPs are. Does he usually run in the 170s at night? What were his BPs during the day? Familiarize yourself with the patient's baseline and diagnoses.

If the BP was elevated I would have done the recheck, sleeping or not. Somebody woke him up to take the BP to begin with, didn't they? I get not wanting to wake him but sometimes you have to. It's part of your assessment. If they tell you to kick rocks, "patient refused vitals reassessment."

If your initial set of vitals was on one of those electronic BP machines, go in and do a manual personally to confirm. You can tell the patient the machine said their BP was high and you want to make sure it's correct. Sometimes those machines give screwy readings. 

[gratefultobeanurse16, BSN, RN]

47 minutes ago, moonshawdow said:

This was 330 am vitals went to recheck but pt was sleeping so didn't retake.  pt was asymptomatic. No PRN orders but had been given 2 nights before a one time dose of PRN hydralazine. He had morning lisinapril due at 8am so just passed on to morning shift. I feel now I should not of just passed it on and called the doctor but usually there is a policy to only call them if it is over 180 but im new to this hospitals policy. Was I completely wrong for holding off? Would like to be better for the future if I was wrong? ....

I know working night shift there can be some reluctance to wake patients up but if you need to reassess a blood pressure wake them up. If you get push back from patients kindly remind them they are in the hospital! if they refuse document it as refusal and notify md.  Since there were no PRN blood pressure meds ordered it would have been best to reach out to the physician at that point to see if they would like to address sbp 172 or get something ordered for PRN with order parameters. I hate to say that you were "wrong". But I will gently put this as you could have been more proactive in this situation. If you did not want to wake them to recheck it can be viewed as you either being lazy or timid.  I would say for future reference always go with you gut feeling. Reassess and wake them up.  Also, if you are unsure of something or when to page doctor ask your charge or a nurse that's been on your unit for some time. And no you are not a bad nurse! You care because if you didn't you would not have thought twice about this. we have all done been down that road where we wish we would have done more or handled something differently or whatever. But look at it as a learning experience and move on. 

 

I hope this helps and again this response is out of love! Take care ?

[Tacocat, ASN, RN]

The thing about passing on to the morning shift because has an 8AM lisinopril due is the timing. If you passed it on to the day shift, it doesn't sound like it was checked again.

Your patient has an elevated BP at 3AM while sleeping and isn't going to be medicated for four hours. A lot can happen between your 3AM vitals check and the 7AM vitals check. Maybe the first 0330 check was a false reading and he was fine. Maybe his BP continues to climb and hits 190 by 7AM and now you've thrown the dayshift nurse a new headache to monitor. 

A lot of nursing comes down to CYA. 

[moonshawdow]

You are right it. I did go to the charge nurse and ask the policy if it was to call for over 180 or 170 she said 180 just like every other hospital I have worked out but your right I was taking the lazy way out and should have just called anyways. Thanks for your helpful kind response. 

[MunoRN, RN]

You were correct not to call since with the exception of a specific, small group of hospitalized patients this BP should not be treated.

We overtreat hypertension in hospitalized patients and this worsens outcomes, it doesn't improve them, much of this overtreatment is driven by nurses who aren't aware of current best practice recommendations pushing for inappropriate anti-hypertensive treatment.

[Workitinurfava, BSN, RN]

Try to get parameters for the BP of this patient especially if it is a continous thing. Is this a machine BP or a manual BP?,  sometimes it can make the difference. I would get orthostatic bp.