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

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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.

Specializes in Travel Nursing, ICU, tele, etc.

If indeed we are talking about a patient with pressure of 289/80, I would first of all let the house sup in on the issue. And then I would do a thorough assessment before I (absolutely) called the Doc.

For instance, does the pt have any pain w that pressure, do both arms, get a different manometer and cuff (is it the right size). A pressure of 289 sounds like it was from one of the automated cuffs which can be notoriously inaccurate especially on the elderly, many of who have some degree of PVD. (often LTC facilities can't afford the kind the hospitals have and employees bring in their own to speed up their assessments..I have seen it done..and I have done it myself..it is ok if you verify the accuracy with a reliable correlation from another source). Does the pt have a fever? Could this be early sepsis? Many LTC can easily develop urosepsis which has an insidious presentation.

I would have to bet money on the fact that the 289 has some significant degree of inaccuracy attached to it. Hypertensive crisis are based on the diastolic pressures. It could be though that the pt is severely dehydrated along with some sympathetic stimulation.

Do that assessment and then call the Doc. Personally I would NOT hijack someone's else's meds unless the med was actually ordered by the Doc in an emergent situation only.

Good questions, though, as a new nurse, when in doubt, run it by a more experienced nurse, and if you don't have one available and you still aren't sure, then CALL THE DOC...often these doctors are in a group and the on-call Physician is receiving calls from hospitals as well as LTC facilities (and even directly from pt's at home) so calling them in the middle of the night does not mean you are waking them up. Be the pt's advocate first....the Doc can advocate for him/herself.

Good luck!!;););)

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Thanks for the responses.. sorry my post didn't make sense and I just noticed many spelling errors :-( I was talking about a patient on her wing. I guess I better not post until I get more sleep! The reading of 289/80 was done with one of those wrist machines. The nurse went down and manually did it herself and it was still about that range. I was just really suprised because she has been a nurse in the LTC area for over 15+ years and I guess a bad role-model!

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Oh and another thing. How would I get baseline vitals when we don't do vitals on everyone? We only do vitals on those who need it for ins charting or for incidents. Taking vitals from when he was admitted to the facility 3 months ago wouldn't be accurate. I'd hate for the doctor to ask that since he is one of those who never gets charted on :-/

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Specializes in Travel Nursing, ICU, tele, etc.

You are asking some really great questions for someone who is a new nurse!!

The pressures you have from his admission would be considered his baseline. Also, by the type of medications that he is on, the on-call Doc would have some sense of his history, if you don't have a very complete one available to you in the chart.

If you are working with a nurse (or nurses) who aren't very strong and who aren't good role models, you will have to trust your own judgment, which sounds to me that it is very sound! I always advocate for erring on the side of caution...if you call someone and it turns out to be a minor issue, so what? The Doctor will live. On the other hand....(you get the picture!)

Keep asking these great questions, thank God those patients have you.

;););)

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Specializes in Community Health, Med-Surg, Home Health.

I would have definitely did complete vitals, obtained a baseline, and informed the charge nurse because she may be aware of how this protocol is supposed to play out. Of course, calling the doctor is in order, but I would just be sure that I know if the patient is symptomatic. And, yeah, I would have copped some clonidine just in case. We give clonidine frequently in my clinic for hypertension; it can bring the pressure down nicely. But, I have noticed that if the patient is suffering from rebound hypertension from missing a few doses, I have seen 0.2 mg of clonidine act like nothing but a sourball piece of candy. And, document, document, document all of the information you gathered, who you spoke to, and how long it took for them to respond.

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