8pm: Patient's blood pressure is high in the 170s. He has been anxious and up and down to the bathroom frequently. I decide to give him a little time to calm down and recheck.
9pm: Patient has calmed down and is resting in bed. Blood pressure is now in the 180s. I page the doctor, who says she isn't concerned and puts in orders for IV meds if it goes up above 190.
11pm: Blood pressure is now in the 190s. I give IV labetalol.
12am: Blood pressure is still in the 190s. I give IV hydralazine.
1am: Blood pressure is still in the 190s and now he has a severe throbbing headache and a sudden onset episode of nausea. I can't give any more blood pressure meds. I page the doctor and tell her the patients BP readings and symptoms. She tells me to give more labetalol, I tell her I can't give more meds on this floor and if she wants more, the patient will have to transfer. Doctor says we'll just wait until the morning and consult the hospitalist.
2am: I have told my charge nurse about this and she has reached out to a couple other resource nurses we have for backup. Charge nurse pages the doctor herself and tells her we need transfer orders to get this patient to a higher level of care because he is extremely hypertensive and symptomatic and not responding to medication. Doctor grumbles but puts in the transfer orders.
3am: I take the patient downstairs where he can get stronger blood pressure meds and closer monitoring than I am able to do on my floor.
New nurses: if something doesn't feel right, if the doctor doesn't respond the way you think they should, follow your gut and ask for help. And always, always chart to cover your ass!
