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August 2011, Volume 41 Number 8 , p 72 - 72


  • Michael W. Day MSN, RN, CCRN


DURING PATIENT ROUNDS, one of your patients has a BP of 196/122 displayed on the automatic noninvasive BP monitor. Mr. H, 69 years old, was just admitted to your surgical unit following a laparoscopic cholecystectomy. He has a long-standing history of hypertension.Mr. H is complaining of shortness of breath. He's pale, diaphoretic, dyspneic, tachypneic, and tachycardic. You auscultate pulmonary crackles bilaterally; his SpO2 is 92% on supplemental oxygen at 2 L/minute via nasal cannula. His wife tells you he stopped taking his antihypertensive medications (metoprolol and furosemide) about a week before surgery because he didn't want his BP to get too low while he was in the hospital. You immediately obtain a manual BP of 190/122 in both arms, initiate a Rapid Response Team (RRT) alert, and continue to assess and support Mr. H's ABCs until the RRT arrives.Mr. H's severe elevation in BP (>180/120), associated with signs and symptoms of target organ dysfunction (possible acute left ventricular

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