Case Study: Blood Pressure Drop
Posted by York RN on January 29, 2010
Taking care of a patient in their 40′s in with nausea/vomiting/diarrhea x1 day and stomach pain for 3 days. The physician ordered CBC, Chem 7, LFTs and an abdominal XRay. Blood work came back completely normal. XRay came back normal according to the radiologist, but the bowel looked bloated.
Patient has a history of Crohn’s, and it was decided that the patient had an exacerbation of the disease.
On arrival BP was 102/69; SAT 96% on room air; resp rate 18; pulse 101, afebrile.
Patient was prescribed morphine for pain. I gave 2mg morphine and the patient’s blood pressure dropped to 98/75.
Other drugs included antibiotics, antiemetic and pantoprazole.
Patient’s pain continued, and I gave two more separate doses of 2mg of morphine, spaced about an hour apart. Each time I administered the drug her blood pressure dropped.
The patient’s lowest reading recorded was 79/45. The patient was ordered another 500cc bolus of NS that was draining at the end of shift and her blood pressure was on the rise again.
The patient had no urine output since time of admission. No edema. Lungs clear. No vomiting since time of admission except just before end of shift and vomited less than 2cc of bright red blood. Her hemoglobin was normal.
I know morphine can drop blood pressure. But was there another explanation for the patient’s BP drop?
I’ll update this case study in about a week.
