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Would You Try To Break (Or Change) This Nurse Habit?


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DD was sick last week with strep and what we think was scarlet fever (yeah, I know. But the little one dd babysits had been diagnosed with it a few days before). Her heart rate (I have my new nifty pulse/o2 meter) was all over the map but mostly above 100 and even flashed up to 185.... and laying down, too.

When I took her in to see the doctor, I mentioned to the nurse that she'd get a better picture of what was going on if she took a laying and standing bp and hr. She looked at me and proceeded to take a sitting bp and hr. Whatever.

The following evening we went to the ER per the doctors after hours recommendation because of a really, really bad raw throat and the need to drink, etc. They took bp and hr in all 3 positions without me saying anything. Of course, it looked really good after pushing in 30mg of midodrine in 7 hours prior to the ER visit. They gave her an IV anyway which helped keep her hydrated overnight.

Would you insist that the nurse take different measurements? DOES it make a difference in a doctors evaluation? How do you do that gracefully?

Dealing with POTS/OI/NMH.... I think it's easier to unhook an eel from your fishing line.

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Anytime over the years I've had the "poor man's TTT", the various physicians actually took my vitals from sitting to standing. I'd bet the nurse is not familiar with all this, and probably has no clue about it. I tend to not worry how much the nurse knows if I am going to be seen by the doctor anyway. If for any reason a nurse was my only provider, then it would be a different story.

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If she's in a doctor's office, there is a good chance she's not even a RN, so she maybe clueless. I would mention to the doctor and have him/her put it in the chart as part of the protocol of the office visit when she comes in if you want it documented.

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Normally if sitting/standing BP/HR is needed it is requested by the doctor. For a patient presenting with symptoms of strep it would not be a part of the nurses initial evaluation for most patients.

Brye

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Brye, If her heart rate was bouncing in the 100's...... 120 to 185 while lying down with fever, etc., is that not something the doctor would use to evaluate her? Illness does cause POTS, etc. to kick up a notch. I'd think it would be a reasonable bit of data to get a more complete picture on how she's doing.

I understand that for most patients, this information isn't needed. Are you saying that its not something the nurse should be asked to do but I should ask the doctor to check it?

Thanks for the feedback.

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Not something I would ask the nurse (if it is a nurse) to do on an initial vital check for someone with strep symptoms. Maybe they would check if there were increased fainting or dizziness. I would hold off and discuss my concerns with the doctor so he/she could decide what vitals he needs. That's the person who's making the diagnosis and decides what data they need. I guess though it would depend on if you're confident the doctor your seeing will do a complete and thorough exam. A doctor has checked my sitting/standing vitals, never a nurse/tech when checking in. That's just what I would do. I've been sick before and it does definitely exacerbate the POTS so I would expect a faster HR. The treatment for strep is the same though whether my POTS is exacerbated or not. Oh, and as others have said a lot of times it is a tech/cna. Have they even been trained in orthostatic vitals. If you wait til you get to see the doctor the doctor may check or at least maybe a RN.

Anyway. Hope all is better and she's on the road to recover.

Brye

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That is so true, it's like a new normal that's never normal. It's so hard to figure out what not to worry about and what you need to see a doctor for. I feel blessed to have a doctor who has been helpful in treating my POTS. I Always better to err on the side of caution and see a doctor if you're worried about it. Glad she's recovered.

Brye

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