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Discussion

What Would you Do!!!

If your client had a BP of 79/33.....74/42.....92/62.....Pulses 57...62... and 60, what would you do....If you called the provider and was told to use the parameters of 92/41 on average?

Featured Replies

  • Experts

If you called the provider and reported these BPs, well what did the provider instruct you to do? It seems the provider would have told you what action to take if they thought the BPs were something to be concerned about. If they didn't tell you to do something about it, then I would continue to monitor the BP. I would certainly take care in ambulating the patient and would instruct the patient to take care in changing position, to prevent falls. I can't off hand, think of anything else. Perhaps someone else can help with this.

  • Author

well what did the provider instruct you to do? It seems the provider would have told you what action to take if they thought the BPs were something to be concerned about. If they didn't tell you to do something about it, then I would continue to monitor the BP

as stated above........the provider and was told to use the parameters of 92/41 on average?

  • Experts

huh? I would have asked them to explain themselves. Because I can't get anything from that answer. I know I'm dense, but I don't think I'm that dense. Hope the patient is ok.

If your client had a BP of 79/33.....74/42.....92/62.....Pulses 57...62... and 60, what would you do....If you called the provider and was told to use the parameters of 92/41 on average?

Just wondering, was the pt symptomatic with the low bp and hr? What meds and history? Also does the provider mean to not call unless they fall below the parameters?

  • Author

Yes pt was asymptomatic and yes provider does not want to be called unless bp and hr falls below those parameters.

Hi,

I'd just continue to monitor, and notify doc if BP falls below stated parameters, and/or pt becomes symptomatic. Some people seem to live in these ranges, but I'm sure glad I don't! :uhoh3:

Best,

Sue

I beleive that if the pt was symptomatic I would call EMS and have the pt transported to the ER. I think you have to go with your instinct. I had a similar situation and the provider told me that due to the pt's severe pvd that I was probably incorrect and that if I could palpate a pulse that the bp had to be above 90/50. I disagreed and asked if the pt would be better suited for hospice since she had a DNR order in place. A week later the pt was transferred to hospice. It sounds like the pt had fallen below his parameters.

  • Experts

I have hypertension and take meds that keep my BP low. My usual readings are around 95/55. I am one of those people whose BP spikes as I am waking up in the morning ... so, to avoid spikes that are dangerously high, I have to take meds that drive it down pretty low the rest of the time.

You can't make a clinical judgment about a particular patient unless you know that patient's history and usual pattern. That's not only true of BP's, it's true of most parameters. You have to know their usual levels, their trends, and what else is going on with them. That's why they call it "judgment." It's not just following an A,B,C protocol.

  • Author

You can't make a clinical judgment about a particular patient unless you know that patient's history and usual pattern. .....

He is new and the provider had no more history than I did, which was a couple of readings from the past.

This is a tough one because of even nurses on this forum posting that they have had similar situations and some of them have low bp.

I thought the kidneys aren't perfusing in SBP below 40. Danger!

If this wasn't normal for the patient I'd be looking for a fluid bolus- 500cc say, and watch for changes.

If the patient was symptomatic and the bp was below the parameter don't we have to do something besides just monitor? I also believe you have to know the patient's history but you also have to react when there is something wrong. I also have low bp around 90/50 but I am not dizzy. Also how is the provider setting parameters if he/she has a limited history and doesn't know the patient's trends? What symptoms was the patient having and was there someone present to educate on how to react if the situation continued to decline? Also, you are talking about a patient you were seeing in there home correct?

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