Information to provide the doctor

Q. With respect to Jean’s blood pressure what information do you think would be most useful to provide the doctor?

1. Does she have a family history of stroke? – No – this is not immediately relevant to cause of stroke or low BP.

2. Is Jean dehydrated? – Yes – Jean was found lying on the floor and could well have become dehydrated prior to admission in hospital with resultant hypovolaemia and hypotension. Dehydration associated with hypotension results in decreased cerebral perfusion and potentially worse stroke outcome.

3. Does Jean have any chest pain? – Yes – because the causes of chest pain might contribute to low blood pressure, such as acute myocardial infarction or pulmonary embolism. Check if the patient has had an ECG or a history of angina. Hypotension results in decreased cerebral perfusion and potentially worse stroke outcome.

4. Does she have a high blood cholesterol? – No – although a risk factor for stroke, in Jean’s case it is not immediately relevant.

5. Does she have any signs of bleeding? – Yes – because bleeding leading to hypovolaemia can contribute to low blood pressure. You should check if a patient has a history of gastro intestinal bleeding (or any evidence of blood in stool, urine or vomit). Have you checked full blood count and urea? These are markers of an internal bleed. You should also check if your patient is on warfarin or non steroidal anti-inflammatory drugs, or anti-platelet agents, e.g. aspirin.

6. Does Jean have a fever? – Yes – because the causes of fever might contribute to low blood pressure, such as acute myocardial infarction or pulmonary embolism. Check if the patient has had an ECG or a history of angina. Hypotension results in decreased cerebral perfusion and potentially worse stroke outcome.

7. Does Jean have osteoporosis? – No – this is not relevant to cause of stroke or low BP.

8. Is Jean on any medication? – Yes – check when she last had her medication at home and if she has been given medication since admission.