Refusing the Blood Pressure Check
Ms. Okafor is 68 and alert and oriented. She has high blood pressure and takes medication. Her care plan says to check her blood pressure every morning before breakfast. For three mornings she has refused, saying, "I'm tired of being poked and squeezed. I just want to eat." This morning her face looks flushed and she says she has a headache. She still refuses the cuff. The nurse is in a wound-care treatment and cannot come immediately. Breakfast is being served.
1. What should you do about the refusal, and what makes this refusal different from a routine one?
Read the worked answer
Ms. Okafor is alert and oriented, so she has the right to refuse. I would not force the cuff on her or trick her. But this refusal is different because she now has a headache and a flushed face, which could be signs of high blood pressure or another problem. That makes it important to report promptly rather than simply note the refusal. I would tell her what I notice: "You mentioned a headache and your face looks flushed. That worries me a little. Can I let the nurse know?" I would offer choices, such as checking after breakfast, checking her pulse, or having the nurse come when free. I would report to the nurse now, even though the nurse is busy, because a new symptom with a known blood pressure problem is not routine. I would document the refusal, the symptoms, and the report.
2. How do you balance her right to refuse with the nurse's need for information?
Read the worked answer
The balance is to respect the decision while making sure the nurse has the facts needed to judge risk. I would not withhold information from the nurse because she refused; the nurse needs to know about the headache and flushing. I would also not pressure her by saying the nurse will be angry. I would explain why the reading matters, offer to try again later, and let her decide. If she continues to refuse, the nurse may assess her directly, which is the nurse's role, not mine. I would keep offering care and watch for changes such as worsening headache, vision changes, weakness, or confusion, and report those immediately. Respecting refusal does not mean ignoring symptoms.
3. What would you say and do if she agrees to a check after she eats?
Read the worked answer
I would thank her and confirm the plan: "I'll come back after you finish eating, and we'll check it then." I would make a note so I remember, and I would tell the nurse the plan and the symptoms now. After breakfast I would return as promised, since following through builds trust. I would position her arm at heart level, use the correct cuff size, and let her rest a few minutes first. If the reading is high or she still has a headache, I would report it to the nurse right away per policy. If she changes her mind again, I would accept that and report the ongoing refusal and symptoms.