Nurse Curriculum
Level 2Symptom Triage

High Blood Pressure Calls

Handle high-BP calls safely — distinguish urgency from emergency and avoid over- and under-reacting.

Intermediate~13 min

Learning Objectives

  • 1.Differentiate asymptomatic high BP from a hypertensive emergency.
  • 2.Coach correct home BP technique.
  • 3.Route high-BP calls appropriately.

Purpose

High home readings are common and usually not emergencies — but a high BP WITH symptoms can be. The skill is telling them apart and not overreacting to a single number.

What to ask

  • The actual reading, and how it was taken (rested? correct cuff?).
  • Symptoms NOW: chest pain, shortness of breath, severe headache, vision changes, weakness/slurred speech, confusion?
  • Took their BP meds today? Any recently stopped?
  • What do home readings usually run?

Emergency vs. elevated

  • Hypertensive EMERGENCY: very high BP (often ≥180/120) WITH symptoms of organ damage (chest pain, dyspnea, neuro changes, severe headache) → 911/ED.
  • Asymptomatic high reading: recheck with proper technique after resting; route to provider — not an ED trip by itself.

Escalate

High BP + chest pain, shortness of breath, neuro symptoms, or severe headache → 911/ED now. A high number alone, feeling well, is rechecked and routed.

What to send the provider

  • Reading(s) and technique, symptoms (or none), med adherence, home BP trend, your recheck values, urgency read.

Patient education script

  • "Sit and rest 5 minutes, then recheck with the cuff on a bare arm at heart level."
  • "If you ever have chest pain, trouble breathing, weakness, or a severe headache with high pressure, call 911."

Spanish phrase

Do you have chest pain, trouble breathing, or a severe headache right now?

¿Tiene dolor de pecho, dificultad para respirar, o un dolor de cabeza fuerte ahora?

TYEH-neh doh-LOR deh PEH-cho, dee-fee-kool-TAD PAH-rah res-pee-RAR, oh oon doh-LOR deh kah-BEH-sah FWER-teh ah-OH-rah

Mini case

A patient reports a home BP of 192/110 and a sudden severe headache with blurred vision.

What now?

Show answer

Very high BP WITH neuro symptoms (severe headache, vision changes) = hypertensive emergency. Direct to 911/ED now and notify the provider. This is not a recheck-and-route situation.

Checklist

  • Got the actual reading and technique.
  • Screened for organ-damage symptoms.
  • Distinguished emergency from asymptomatic elevation.
  • Coached recheck technique; routed appropriately.

Knowledge Check Quiz

Disclaimer: This content is for educational purposes only. It is not medical advice, does not replace clinical judgment, and is not a substitute for institutional protocols or certified medical interpreters. No patient health information (PHI) should be entered into this application.