Previous section | Next section

Post‐procedural considerations

Immediate care

Abnormal blood pressure results should be notified to medical or senior nursing staff (NICE [142]). As the treatment will depend on what is causing the abnormality, and its severity, it is important that practitioners try to ascertain any possible causes of the physiological change in blood pressure (Brown and Cadogan [31]). Hypovolaemia will require fluid replacement and, if persistent, inotropes or vasopressors and other cardiovascular drugs may be necessary (Bunce and Ray [33]). If hypertension is evident it may be transient, for example related to anxiety or pain, in which case it is important to address that issue and monitor the blood pressure until it resolves (Bickley [18]). However, if the patient is diagnosed as having hypertension, they might require medication to control their condition (NICE [132]). To determine the cause of the altered blood pressure, more information will be required, including:
  • a comprehensive medical history from the patient
  • a full set of observations
  • an ECG
  • urinalysis including protein, leucocytes, blood and the osmolality of the urine
  • blood tests for full blood count, urea, creatinine and electrolytes, and fasting blood tests for glucose and lipids
  • a chest X‐ray or further radiological investigations (if required)
  • a septic screen including blood cultures, sputum specimen, and swabs of any wounds or potential sites of infection (if required)
  • current fluid balance (Adam et al. [2], Bickley [18], Blows [21], Sprigings and Chambers [189], Wilkinson et al. [215]).

Ongoing care

If the patient is hypertensive and in primary care, they will require at least monthly blood pressure measurements and more frequent measurement if it is accelerated hypertension or there are any further concerns (NICE [132]). Additionally, it will be necessary to give lifestyle advice on eating healthily and smoking cessation, if relevant (NICE [132]).
If the patient has orthostatic hypotension, they should be advised to change position slowly so their baroreceptors and sympathetic nervous system have time to adapt their blood pressure to each stage (Marieb and Hoehn [110]).

Documentation

As well as accurately recording the blood pressure measurement, it is important to record:
  • the position the patient was in
  • the arm used – and, if both arms were used initially, the pressure of each
  • arm circumference and cuff size used
  • whether there is an auscultatory gap
  • whether there were any difficulties in obtaining a reading, such as the absence of stage 5 of the Korotkoff sounds
  • the state of the patient, for example whether they were in pain, frightened and so on
  • any medication they are on and when they last took it (Bickley [18], NICE [132], RCP [172]).
When documenting what medication the patient is taking, it is important to include not only cardiovascular medication but also other medication that might affect their blood pressure, including tricyclic antidepressants, neuroleptic agents, contraceptives, decongestants and non‐steroidal anti‐inflammatory drugs (Bickley [18], Bunce and Ray [33], Wilkinson et al. [215]).
Previous section | Next section