What to do you do if a pt has really high blood pressure

[changeofpaceRN]

in a LTC facility on the 11-7 shift? Sorry, new nurse here and it shows! At what point do you consider the BP to bee too high for comfort and act on it? The other night, my co-worker on the opposite wing has a reading of 289/80 and she did nothing. I was wondering what others would do in this case because I often have that wing at night.

[SuesquatchRN, BSN, RN]

Good Lord.

In the absence of standing orders for this patient I would call the charge nurse. If I were the charge nurse I'd call the doctor.

[kiszi, RN]

I too worked 11-7 in LTC. A lot of times, it's difficult to figure out what to call the Dr. about at 3am. I can't say a specific number I would go by for a high BP. First thing I would do is look at the pt's baseline. I've had pt's that would often run up to the low 200's systolic. That can wait till morning. But if there's someone who normally runs, say 100's over 50's and all of a sudden they're 210/90, yep, call the doc. In your case.. yikes! 289/80? Definitely get the on-call MD on the phone. That's what they're on call for. Just make sure to have the chart in front of you when they call you back. Be ready with recent BP's, current meds, diagnoses, etc. The dr. will be a lot nicer about getting a call at 0300 if you get right to the point and give them the info they need!

Hope this helps.

[TheCommuter, BSN, RN]

I know that no medical advice is allowed to be given, so I'm simply going to indicate what I would do if I were in that very same situation.

I would have obtained Clonidine 0.4mg from someone's PRN supply and, if no allergies are noted, I would have swallowed it. Also, I would never document that I took the drug anywhere, because that would open an ugly can of worms...

Additionally, I would see a doctor within the next few days after the incident, tell him or her what occurred, how I dealt with it, and allow him or her to proceed from there.

[SuesquatchRN, BSN, RN]

I know that no medical advice is allowed to be given, so I'm simply going to indicate what I would do if I were in that very same situation.

I would have obtained Clonidine 0.4mg from someone's PRN supply and, if no allergies are noted, I would have swallowed it. Also, I would never document that I took the drug anywhere, because that would open an ugly can of worms...

Additionally, I would see a doctor within the next few days after the incident, tell him or her what occurred, how I dealt with it, and allow him or her to proceed from there.

HA!

.....

[TheCommuter, BSN, RN]

I too worked 11-7 in LTC. A lot of times, it's difficult to figure out what to call the Dr. about at 3am. I can't say a specific number I would go by for a high BP. First thing I would do is look at the pt's baseline. I've had pt's that would often run up to the low 200's systolic. That can wait till morning. But if there's someone who normally runs, say 100's over 50's and all of a sudden they're 210/90, yep, call the doc. In your case.. yikes! 289/80? Definitely get the on-call MD on the phone. That's what they're on call for. Just make sure to have the chart in front of you when they call you back. Be ready with recent BP's, current meds, diagnoses, etc. The dr. will be a lot nicer about getting a call at 0300 if you get right to the point and give them the info they need!

Hope this helps.

Good Lord.

In the absence of standing orders for this patient I would call the charge nurse. If I were the charge nurse I'd call the doctor.

The OP's coworker had the high BP reading during the night shift at work, not a patient at the facility. Therefore, calling the on-call doctor for the coworker's change in condition would be fruitless.

EDITED: Forget it! Maybe I'm misunderstanding the OP after all!!!

[SuesquatchRN, BSN, RN]

The OP's coworker had the high BP reading during the night shift at work, not a patient at the facility. Therefore, calling the on-call doctor for the coworker's change in condition would be fruitless.

I read the OP to mean that the coworker's resident had that reading.

But as I've said before, I've been wrong.

If it were me I'd hijack some metoprolol.

[SuesquatchRN, BSN, RN]

Cross post!

[TheCommuter, BSN, RN]

I read the OP to mean that the coworker's resident had that reading.

But as I've said before, I've been wrong.

If it were me I'd hijack some metoprolol.

Yep, I think I misunderstood the OP after reading the post again. I think he or she was referring to her coworker's patient after all.

However, I would not sit around and do nothing about a high BP, because guess whose license will be disciplined if the patient has a CVA or aneurysm?

Call the on-call physician and document his or her response to cover your A**. Also, immediately attempt to follow through with any telephone order the doctor happens to give. As always, document meticulously.

[SuesquatchRN, BSN, RN]

Oh, I would indeed contact that doc!

No, I was wondering why you'd take clonidine for a high BP instead of Lopressor? I meant for me. I sure ain't prescribing.

[TheCommuter, BSN, RN]

Oh, I would indeed contact that doc!

No, I was wondering why you'd take clonidine for a high BP instead of Lopressor? I meant for me. I sure ain't prescribing.

When I worked at the psychiatric hospital, clonidine was the drug of choice to QUICKLY lower an elevated BP.

Lopressor, on the other hand, tends to be slightly longer acting, and can reduce the heart rate. Even if the BP is 280/90, the pulse can be 59. While we'd like to lower the BP, we don't want that pulse to decrease too much lower.

[SuesquatchRN, BSN, RN]

When I worked at the psychiatric hospital, clonidine was the drug of choice to QUICKLY lower an elevated BP.

Lopressor, on the other hand, tends to be slightly longer acting, and can reduce the heart rate. Even if the BP is 280/90, the pulse can be 59. While we'd like to lower the BP, we don't want that pulse to decrease too much lower.

Huh. Interesting.

I know ED's use IV Lopressor.

Thanks.