Before
I became a nurse, I worked as a Medical Assistant at a local women’s clinic in
Pittsburgh, PA. I worked in the lab and drew blood on about 50-60 people a day.
It was inevitable that out of the 50-60 people, at least one of them would
start to drop their pressure and pass out.
When
I became a nurse, the same sort of thing happened but sometimes it wasn’t
because I was drawing their blood – sometimes it was because they had a massive
GI bleed, were septic, or severely dehydrated.
What would be your initial independent nursing intervention if your
patient passed out? Pick one.
1.
Drop his head lower then his body.
2.
Keep his head level but lift his legs higher.
For
many, many years I’ve listened to nursing instructors and myself tell students
that if your patient drops his blood pressure, to immediately lower the
head of the bed.
What’s the rationale?
It’s
because when your blood pressure drops, your cardiac output drops. When your
cardiac output drops, you may not be able to adequately supply your vital
organs with the oxygen and nutrients they need. Hence, you lower the patient’s
head to allow gravity to help perfuse the brain (the most important vital
organ).
While
lowering the head down to flat may be a good thing, I’ve seen some nurses put a
patient’s head lower than their body (Trendelenburg). And that’s NOT a good
thing.
Why?
When
you lower someone’s head below the rest of their body, this increases pressure
(due to gravity) to the major vessels in the heart AND compresses the lungs,
thereby interfering with cardiovascular circulation and respirations. These effects can further compromise
cardiac output making the situation worse.
So,
if you choose option 2, you are correct.
If your patient drops his pressure:
Put his head
flat and raise his legs - you don’t need to perfuse your legs to survive
anyways!
That’s
exactly what we did when I was a Medical Assistant. We’d lower the person to
the floor and lift their legs on top of a garbage can. We even kept a pillow in
the lab so that we didn’t have to put their head on the cold floor.
Oh…
just in case you recently went through ACLS or BLS training…of COURSE you will
call for help and follow your algorithm! That just goes without saying.
I hope this clinical practice tips helps. Would love your comments or suggestions for other blog posts. As I've mentioned before...I do take requests!
Thanks for choosing to become a nurse. I'm cheering for your success!
Renee
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