A pediatric patient presented in severe pain from an acute left ear infection and Rebecca noted that the patient had elevated blood pressure on admission and notified the physician. Given the severe pain the child was in and it was likely this could have been due to ear pain, we treated the ear infection with topical analgesic, Hycet, and Augmentin. The patient's pain did indeed improve, but Rebecca being a very conscientious nurse did a repeat blood pressure as part of our discharge planning and again the blood pressure was elevated specifically the diastolic.

We then did 3 extremity blood pressures which were indeed truly high, and her workup proceeded with lab work and giving her a dose of clonidine for their blood pressure. The patient ended up having significant anemia/abnormal renal function and was sent to a pediatric hospital for further management. Rebecca was integral to this patient's diagnosis by doing a complete evaluation including blood pressure management on a child with an earache. Even though initially we had a reasonable explanation for the blood pressure given the level of the patient's pain, Rebecca again did a thorough evaluation before discharge by doing one final blood pressure.

On a busy night in the Peds ED, this patient could have easily been an in and out visit with an obvious ear infection with vital signs that did not include blood pressure. But with a conscientious and caring nurse, a life-threatening diagnosis was made and properly evaluated.