What the heck is this doctor thinking? Actually not thinking!

jnette, ASN, EMT-I · Feb 22, 2007

Wow, Dutch, that's outrageous. :stone

You did the right thing by telling the pt. to SEVERELY limit sodium intake (give him some handouts on hi-sodium foods to avoid!) and by calling the doc, etc.

I really don't know WHAT this doc is (not) thinking! I imagine he has been following this pt. for some time? Is there sth. he knows about this pt.'s hx. that you all don't?

I'd be tempted to ask him WHY this is not a concern. What have you got to lose?

P_RN, ADN, RN · Feb 22, 2007

How old is the patient? Has she been known to be noncompliant before? That's not a good doctor patient situation.

muffie, RN · Feb 22, 2007

wowee

Cattitude · Feb 22, 2007

you asked this doc to do something. he chose to do nothing. still, you are doing your job and he is not.

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[color=#483d8b]i may have called the doc and told him about the bp and that i would either send the pt. to him or to the er, which did he prefer? that would have kind of prodded him into doing something.

[color=#483d8b]now i know this is tougher for your cases as they have just come home from the hospital, but really, the dr. needs to do something.

[color=#483d8b]a person with no hx. of htn certainly does not need to not be treated and be told to eat all the salt they want.

[color=#483d8b]has the pt. ever been treated by a cardiologist before? if so, maybe they could make an appt? it wouldn't have to be the primary following up on this right?

caldje · Feb 22, 2007

Without more information I cant honestly say the doc isnt doing what he's supposed to. We have to remember that there are many things we dont know. For example, the vast majority of hypertension is not sensitive to salt intake AND low sodium can actually increase the risk of renal complications when on certain meds. Like I said, a full case presentation of this patient, leaving nothing out, and I think we might find that the doc is not being "bad." Give the guy a break, you wouldnt want someone treating you like you're treating him.

Cattitude · Feb 22, 2007

without more information i cant honestly say the doc isnt doing what he's supposed to. we have to remember that there are many things we dont know. for example, the vast majority of hypertension is not sensitive to salt intake and low sodium can actually increase the risk of renal complications when on certain meds. like i said, a full case presentation of this patient, leaving nothing out, and i think we might find that the doc is not being "bad." give the guy a break, you wouldnt want someone treating you like you're treating him.

isn't is something like only 30% of hypertensive people are salt sensitive? but still that was a high bp and on several occasions. you would think the doc would at least have said, "let's hold off on giving any meds right now because blah blah blah" give the poor nurse something!!!!

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DutchgirlRN, ASN, RN · Feb 22, 2007

Wow, Dutch, that's outrageous. :stone
I'd be tempted to ask him WHY this is not a concern. What have you got to lose?

Thanks jnette, I think that's a very good idea! I better ask my DON first if that's ok.

DutchgirlRN, ASN, RN · Feb 22, 2007

[color=#483d8b]i may have called the doc and told him about the bp and that i would either send the pt. to him or to the er, which did he prefer?

that's what i did and he said no need to come in and certainly no need for the er. :uhoh21:

twinmommy+2, ADN, BSN, MSN · Feb 22, 2007

isn't is something like only 30% of hypertensive people are salt sensitive? but still that was a high bp and on several occasions. you would think the doc would at least have said, "let's hold off on giving any meds right now because blah blah blah" give the poor nurse something!!!!
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even if only 30% of the general population are salt sensitive, it would be prudent to eliminate it as the source wouldn't it? and say if this person were a minority such as african american or native american, doesn't that percentage go up for those populations?

but on the other hand was he showing other symptoms? dizzyness, spots before the eyes, headache? perhaps the dr. was worried about adding a new med and having the pt plumet too much?

just wanted to advocate for both sides here.

DutchgirlRN, ASN, RN · Feb 22, 2007

Without more information I cant honestly say the doc isnt doing what he's supposed to. We have to remember that there are many things we dont know. For example, the vast majority of hypertension is not sensitive to salt intake AND low sodium can actually increase the risk of renal complications when on certain meds. Like I said, a full case presentation of this patient, leaving nothing out, and I think we might find that the doc is not being "bad."

Dangerously high BP is all the clinical information I need to know. This has been going on for a week. What more info does this doc need? What if this were your elderly Dad/Mom? I'd be having a fit. I would have already taken them to the ER after the first severely elevated set of orthostatics and fired the doctor.

Give the guy a break, you wouldnt want someone treating you like you're treating him.

Just how am I treating him badly? I followed his order to keep him informed of the BP's. I wasn't rude in any way. I asked if the pt needed to come in or go to the ER. My concern was for my patient. I never treated the doctor badly. The fact that I think he's totally incompetent is something he'll never hear from me. I know my limits.

Lets review the basics of hypertension:

HTN is the silent killer... high blood pressure left uncontrolled, causes fatal heart attacks, sudden cardiac death and strokes. If you have high blood pressure, the increased pressure of blood flowing through your arteries can cause a variety of problems, including arteriosclerosis, an aneurysm, kidney failure, damage to the heart such as coronary artery disease, heart failure and an enlarged left heart. Just like your heart, your brain depends on a nourishing blood supply to function properly and survive. High blood pressure can cause several problems, including: Brain bleed, transient ischemic attacks, dementia due to the extensive narrowing of the arteries that supply blood to the brain. The kidneys are responsible for filtering and excreting excess fluid and waste from the blood. These processes are highly dependent on blood vessels. HTN compromises both the vessels leading in and out of the kidneys. HTN is the leading cause of kidney failure.

HTN damages the eyes. The tiny delicate blood vessels that supply blood to the eyes are vulnerable to the damage of high blood pressure.

In some patients the blood pressure rises so quickly and severely that it constitutes a medical emergency requiring immediate treatment.

DutchgirlRN, ASN, RN · Feb 22, 2007

But on the other hand was he showing other symptoms? Dizzyness, spots before the eyes, headache?

Dizziness yes, Syncope yes, Falling yes, Headaches yes. He/She has CNA's 24/7 who can take the BP at any time. I doubt a small dose of Lopressor would plummet this patient. Something is obviously causing the sudden severe hypertension and I feel like this pt should be back in the hospital for extensive testing to find the cause. Sorry I totally disagree with this doctor. My documentation is complete so he's not going to blame any of this on me.