When to react to an abnormal reading

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I am a new grad on step down/cardiac unit. Most of our pts are in for AMI, Angina, Stroke, Chest pains, etc. I know basics, but I finding when it comes to blood pressure, heart rate and rhythms I do not know when I need to call the doctor or observe. One night I had a pt's b/p bounce up and down all night and charge not concerned. I have b/p's in 190s systolic and 100's diastolic[ Pt's who converted to AFib; Heart rates in the 120-140's and charge nurse look me like whats the problem? What am I missing? I need some general guidelines to go by.

Specializes in Cardiac step-down, PICC/Midline insertion.

I'm a new nurse too and I have had some issues with the same thing. At first, calling the doctors was scary because I am always worried that they'll think I'm just a dumb nurse and it's silly that I'm calling them. I've got over that pretty quick. If you have a real concern about the patient, call them. You're just doing your job. If I were a doctor, I would rather the nurse call then not call, because then I'd just know even more about what's going on with the patient. Of course most of them do not think like nurses and they can get ugly on the phone. Just take it with a smile. At least you'll know for sure in your mind that the patient is ok. And you chart that you called the doctor and what he said about it. Then if something does happen...it's on him not you.

It takes experience...I am learning as well. If I have a concern, I always ask a charge nurse or more experienced staff nurse what they think and sort of "screen" my potential doctor calls through them first. A BP of 190/100 is too high for anyone. If you get a crazy reading like that...recheck it, preferrably manually. There may have been a problem with the cuff. Machines lie sometimes.

I always call a Dr if the rhythm changes and is sustained. One run or 2 of afib or tachycardia is not a big deal, it's if it stays sustained. If they're in afib and the rate is sustained at a high rate I would call the Dr. Everytime I have called for this they ordered something to control the rate...IV dig or an amio bolus or something. But then again you always have to take in consideration what's going on with the pt...if they're in pain or distress, that could be the cause, so give them pain medicine or some xanax or something first, that way you don't end up hanging a $300 drip like cardizem or something.

Then keep in mind too if they're on anticoagulants or not. If not and they're in a fast afib, calling the Dr. is a must so they don't potentially throw a clot and stroke.

I call the Dr for my own peace of mind more than anything sometimes. I don't care if they get mad. Let them. It's their patient too.

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