"No more blood pressures..."

Yes, you read it correctly...no more blood pressures.  That was an order I received from a doctor the other night.  I had a patient whose blood pressure at 8 pm was 198/92 and her heart rate was 115.  She was sleeping & had already received pain medication, so I knew it wasn't her activity or pain level that was messing with her vital signs.  So I call her doctor...tell him the details, he orders Lopressor 25 mg.  I give her that, let her sleep for a couple of hours & recheck it around 11 pm.  Her heart rate is good...in the 70's, her blood pressure is now 202/90.  I recheck it...same reading.  I call the doctor again, he orders a Catapres patch & says "Do not take any more blood pressures tonight."  Huh???  You don't want me to recheck her blood pressure?  "No, NO MORE blood pressures on this patient tonight.  Hold them until the morning."  Nice doctor, isn't it?  He just didn't want to be bothered again.  Sorry, I didn't follow his order...I did recheck it around 4 am vitals, it was still elevated, but a little better 185/77.  I definitely made sure to document his exact words. I wasn't going to get in trouble for not reporting a high blood pressure on a patient whose normal bp doesn't run that high.  Obviously something was going on with her.  Granted she was 95 yrs old & a DNR, but that doesn't mean I want her dying on my shift.  So far I have not had any patients die on me, I would like to keep this trend going.

My other patients were ok...I felt like I was working in a psych ward in a nursing home.  I think dementia has to be one of the saddest conditions I've ever seen...simply because nothing you say or do will affect the way your patient is behaving - however, that didn't stop me from trying to reason with my patient.  :)  She would not stop yelling out...she was calling her daughter's name, then the name of the woman that takes care of her at the nursing home, then she was pleading for water - which I gave her often & finally it was "helpppppppp meeeeeeeee."  All night long.....didn't matter how much Haldol or Ativan I gave her, the results were the same.  She did not sleep for one second.  She was in restraints because she would attempt to get out of bed, pull out her foley, pull out her IV.  By the end of the shift, I also was resorting to saying "helppppppp meeeee." 

In addition to those two patients, I had two combative males that required a sitter.  Did I also mention that on this floor....it was just me & one other nurse?  That's it.  I handled these guys fine......one wanted his sleeping pill & pain medicine, once he got that, he was cooperative & the other one just wanted to be left alone so he could sleep.  Not a problem.......sweet dreams.

I got my 5th patient around midnight...a woman that had checked herself out AMA two days earlier.  Not a wise decision when you have a DVT (blood clot).  She was pleasant as can be...I had no complaints. 

I'm not feeling too good today...not sure if it's the weather or pms or if I'm fighting off some kind of cold or flu.  I just feel blahhhh.  Luckily I'm not scheduled to work until Sunday.  I go back to a full-time schedule for a few weeks.  I don't like feeling blah.  Maybe some chocolate chip cookies & milk will make things better, right????

Hope everyone had a wonderful Thanksgiving & got lots of Christmas shopping accomplished!