My shift was filled with 3/5 pts requiring interventions for SBP > 150
Go figure their BP's were ok ALL DAY LONG! Now I get onto shift and these BPs are incredibly out of whack.
Several phone calls later and ppl's BPs are semi back to where I wouldn't shit my pants because they're sooooo high.
It was amusing when I took my one guy's BP and found it to be 170/100ish and so I went looking for the on-call doc - turns out he was on the next door unit so I took my MAR and went to him....
What had happened was that my pt's IV went interstitial last night and family decided they didn't want access anymore and the discussion was to make the pt DNR - but not palliative.... well the IV access was because my pt couldn't control his own BP due to pontine myelinolysis and so required IV hydralazine - but without that access it was changed to G-tube.... well the doc's in all their wisdom decided to leave the dosage the same even though the route was now different..... now it was catching up with my pt! On-call doc was familiar with the guy and said he didn't much care that it was elevated and to just give him his next scheduled dose of hydralazine - which wasn't actually due for another 3 hrs. Ya not happening without an actual order. So since the guy was moaning (he was also nonverbal and non responsive except to pain) off I went to grab him some morphine - hey it's going to lower the BP so it's helpful in two ways! Then I also gave himt he hydralazine when I was supposed to and an hour later it was 149/90 - well at least it was moving in the right direction!
At least it's no longer my problem! Tomorrow is another day though!
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