Reverse Orthostatic Hypotension

Okay, I said there would be a quiz or two.

Here's a REALLY tough one to start out with. (Nursing students, don't feel bad if you don't get this one.)



Patient's vitals (each was taken after being in said position for approximately 5 min.)

Pulse did not change posturally.



1. Supine 55/30

2. Seated 91/62

3. Standing 104/72

4. Supine 60/29



Now I know there is orthostatic hypotension, but what is this?! I've googled, asked doctors, hoped the patient would come back with an answer, but I'm still waiting. Maybe I'll never know. But this is just one of those things that leaves you thinking "What is going on here!" Equipment failure and human error have been ruled out as this pattern is consistent on various automatic and manual cuffs, with at least 5 different medical professionals.



Hint (maybe): Patient presented a month ago in SVT. Put on Lopressor. Patient "felt awful at night" on it, and pulse sitting at rest was in the 60's on a QUARTER of a 25 mg tablet. Normal pulse for patient was in the 90's prior to this. Second episode of SVT, back on Lopressor.



That is just so weird. I can't find ANYTHING that says Lopressor lowers BP more when patient is supine.

Welcome

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Intersting phone calls of the day:

1. I can't find my Demerol. Can you call it in? (Patient is not on Demerol but I guess that doesn't stop them!)

2. Pharmacist. Patient is requesting that we refill Demerol. Patient demands that the pharmacist call.

3. Kind old lady - my blood sugar was 483 before breakfast, and 582 before lunch. I'm sorry to bother you, I was just a little worried....(Yeah, I was too!)

Pain scales:
Patient did not understand numeric rating. Rated pain as 10 in areas he felt no pain. Tried explaining pain scale. Tried smiley face scale. Patient said "none of those is making the face I'm making". Okay, tried to explain what each pain would correspond with. Patient said "Can't I just say I have no pain so I don't have to answer this?" Ended up telling the doctor that the patient stated he was in pain, seemed to me to be in pain (holding abdomen, guarding over lower right quadrant), but did not rate pain.

Now this one had me baffled:
Me: Asking if the patient had pain
Mathless: Yes, my knee
Me: Asking to rate pain on 1-10 scale
Mathless: negative 2.385
(Huh?)
I explained that negative numbers were not what I was asking for.
Mathless: okay, how about 7.297595860403858395786894949589454874878458745898459845989458945874857485748574637348589493977777777777777777777788888888888888888999999999999999999999944444444444444422222222.............etc.
I really don't think we need it THAT precise. And how pain can go from -2 to 7 is also unbelievable