Care Case Study (1)- HTN

question

Pt BP 189/110, LDL 200mg/dl. Pt asks student nurse if he should be concerned about BP. How should student respond?
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Please sit quietly for a few minutes. I need to recheck BP
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Pt-lost weight recently, stress, goes drinking, mother with DM, HTN, smokes and drinks 4-5 cups coffee/day
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Alcohol consumption-strongly associated with HTN
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Student nurse rechecks: 180/106. According to assessment, what rec is most important for nurse to provide
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see HCP w/in next week for BP recheck
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Pt feels great physically and doesn’t see why he needs to see HCP
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question

HCP states stage 2 primary HTN
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BP 184/98
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Why do I have HTN?
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90-95% HTN no identifiable cause, even though there are several known contributing factors
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Pt understand meds
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Take diuril early in day (diuretic) May experience impotence (S/E)
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Health improvement-nothing left to enjoy-hat info is most important?
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Use of tobacco products is linked with increased risk for CV disease
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Pt expresses interest in learning about reducing stress level. Saw tv about biofeedback and guided imagery, but can’t imagine either of those techniques into his lifestyle. How should nurse respond?
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many methods to reduce stress, tell me about your workday
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Nicotine gum to quit. What is most effective intervention to help Mark be successful this time?
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encourage mark to make quit plan
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HTN damage to kidneys, heart, lungs, BV. Mark states his uncle/grandfather both died from aortic aneurysm. High BO cause this problem?
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advise him that his HCP may want to do further testing because of his family Hx
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during initial visit, pt scheduled for ultrasound for aneurysm. nurse notes HCP asks mark to return for follow-up visit in 1month. Considering the overall plan of care, what is the primary reason for the nurse to encourage pt to keep his apt?
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Follow-up measurement of blood pressure (effectiveness of medications)
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Teaching about aneurysm, what info should nurse include?
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maintain normal BP can effectively treat size of aneurysm-<5cm in size, Tx keep it under control and monitor every 6 mos
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98.4 F, P 78, R 20, BP 148/90. What is most concern to nurse?
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Current 148/90-attaining and maintaining normal bp is essential
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Nurse asks Mark if he is limiting salt intake. States wife fixes all the meals.Confirm she understands?
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\”I am preparing a variety of fresh vegetables and avoiding processed foods\”
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Based on data, which nursing diagnosis should be included in plan of care?
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Ineffective health maintenance-reevalutated in order to become normotensive
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HCP adds nefedipine (Procardia) to pt’s other prescriptions. What instruction related to this med is essential for nurse to provide
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avoid grapefruit/grapefruit juice (decreases effectiveness of CCB)
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What statement by Mark indicates to the nurse he understands plan of care?
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If BP is normal on next visit, will stay on meds for at least 1 year longer
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Wife OD’s on diazepam and alcohol. ER Mark is pale and complains onset of severe back pain–> triage nurse. What assessment data obtained during the triage assessment alerts the nurse that Mark needs immediate evaluation
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History of 3cm aortic aneurysm and sudden onset of backpain (could mean the aneurysm ruptured)
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After exam, HCP writes several prescriptions. What prescription should nurse complete first?
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IV of 0.9% NS with large bore angiocath
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When mark returns from radiology where the abdominal CT was performed, diagnosis of dissecting aortic aneurysm. Mark informed needs immediate surgery. Wife intubated and nonresponsive. Place nursing actions in numerical order from the first action through the last action.
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1. Notify Mark’s children and family 2. Call report to the operating room staff 3. Get the surgical consent form signed 4. Consult a social worker
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Which action can be safely delegated to the unlicensed assistive personnel (UAP)?
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Document list of Mark’s personal belongings
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After these tasks are completed, the nurse asks the UAP to obtain a second set of vital signs on Mark. What results indicates that this task was successfully delegated?
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UAP reports the current vital signs to the nurse
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After first unit of packed RBC is available before Mark goes into OR, pt asks f he is going to die. He states he has never been around anyone who was dying and he is scared of what happens after death. What is the best response by the nurse?
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This is a frightening experience. Is there someone with whom you would like to talk about your fears?
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Pt’s kids arrive in ER and spend a few minutes with him before he goes to surgery. After a short period of time, the surgeon reports to the family that the aneurysm repair was unsuccessful and Mark died in surgery. One of pt’s sons returns to the ER and starts yelling at the nurse. What is the nurse’s best initial response?
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Acknowledge son’s anger-understanding his anger is not directed personally at the nurse will help nurse in response in an effective, caring manner.
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In addition to talking with pt’s children and preparing his body for transport to the morgue, what action must the surgical nurse perform?
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Call the organ procurement agency for the region-Federal law nurse to notify the organ procurement agency for their region with all hospital deaths
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Pt’s wife has been taken to ICU. The next day, she becomes alert & responsive. The kids tell ICU nurse that they do not want their mother of her husband’s death. How should nurse respond?
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Talk further with the children and explore options with them-nurse needs to do a further assessment and allow the children to communicate their concerns
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Kids are adamant that the nurse not tell their mother of father’s death. Meanwhile wife continues to ask the nursing staff where her husband is. What resource is most valuable for nurse to use to resolve situation
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Hospital ethics committee- nurse needs to have others involved in this decision. Consulting the ethics committee is the appropriate channel to take to resolve this ethical dilemma

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