Question

The nurse obtains the patient vital signs. The blood pressure reading is 150/95. The patient, asks is that ok? Is that high? What is the most appropriate response from the nurse?

Answer 1

The nurse obtains the patient vital signs. The blood pressure reading is 150/95. The patient, asks is that ok? Is that high? What is the most appropriate response from the nurse?

Nurse should include following points in her communication with the patient:

1. Th appropriate response from nurse should be that your reading of 150/ 95 is higher than normal range of 120/80 but this is a single, one-time measurement and is not sufficient to confirm diagnosis hypertension. We need to take more readings of your blood pressure to diagnose hypertension.

2. Secondly diagnostic criteria for hypertension was previously 140/ 90 but the criteria have been now updated to 130/80. According to updated guidelines by Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (2017) -

· Normal BP is defined as <120/<80 mm Hg;

· elevated BP 120-129/<80 mm Hg;

· hypertension stage 1 is 130-139 or 80-89 mm Hg,

· and hypertension stage 2 is ≥140 or ≥90 mm Hg.

· Hypertensive crisis: Top number over 180 and/or bottom number over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.

3. On an average based on two or more readings obtained on two or more different occasions to estimate the individual’s level of BP.

4. Since your blood pressure is definitely above the normal range and falls in diagnostic criteria for hypertension, still you cannot be diagnosed as hypertensive on the basis of single reading.

5. Blood pressure is not static or never remains same. There are many factors which can affect blood pressure reading and they need to be considered while interpreting the results like age, time of the day, intake of tea, coffee or drugs, positioning of person during measurement as well as level of physical activity.

6. We need to observe your blood pressure for two or more times.

7. You need not to visit a clinic or need health professional for this measurement. You can do it at your home using automated blood pressure monitoring device or home - based blood pressure monitoring device.

8. Home blood pressure monitoring will help to reveal “white-coat hypertension,” which occurs when pressure is elevated in a medical setting but not in everyday life.

9. Home readings can also identify “masked hypertension,” when pressure is normal in a medical setting but elevated at home, thus necessitating treatment with lifestyle and possibly medications.

10. I will demonstrate you how to measure blood pressure and if you have any doubt please feel free to ask me. Later I will ask you to demonstrate the procedure of measurement to me to confirm your ability to carry on measurement.

11. Please write down the details about time of measurement, reading obtained, your intake of meals, tea or coffee time, position, device used when you measure blood pressure at home.

12. Once you are done report back with the results. Based on results we may need to go for some diagnostic tests if required.

13. Please feel free to call or come back in case you find any difficulty.