Laying supine reduces the amount of gravity the blood has to pump against to perfuse the upper extremities (arms, shoulders, brain, etc. Having said that, a drop from 200/180 to 159/80 with just a postural change seems excessive. The resident, if he really was insinuating that you re not assessing the pt well, needs to be corrected--the nurses and the physicians are not COMMUNICATING well. What needs to happen is that a patient who is known to have hypertension problems needs to have more precise focused cardiovascular assessments done that include not just the BP, but the posture at which it was taken (standing, high fowler s/low fowler s, supine, etc), the time it was taken (BP can peak naturally in the afternoon) the medications the person has been taking (did he skip his daily morning ramipril? Did he take double the dose of metoprolol?), the person s presentation (sad? angry? anxious?) and other things such as HR, pain levels, MAP, etc. Don t let those short-coats (or even the long-coats) trash your nursing practice! Just fight back with a high volume of precise assessment info!!
from one who has has strokes your patient was having a tia and the clots disloged so you were right to but your patient in the postion and do not blame yourself for what you did was right. the dr show have him or her checked for tias.and be on the heart monitor
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