Question

CASE SCENARIO I

George is a 75-year-old patient with urosepsis being treated in the Intensive care unit (ICU). The nurse assesses George and finds that he has blood in his urine and stool, and is oozing blood from his central line site and his gums.

Questions:

1. What does the nurse suspect may be occurring with George?
2. What medications should the nurse avoid administering to George?
3. The nurse is monitoring George’s vital signs every 15 minutes. What other monitoring is essential to include along with the vital signs?
4. What medication does the nurse anticipate infusing?

CASE SCENARIO II

Fred, a 43-year-old construction worker, has a history of hypertension. He smokes two packs of cigarettes a day, is nervous about the possibility of being unemployed and has difficulty coping with stress. His current concern is calf pain during minimal exercise, which decreases with rest.

Questions:

5. What does the nurse is the hallmark symptom of peripheral arterial occlusion disease?
6. The patient is having an ankle-brachial index (ABI) determined. The right posterior tibial reading is 75 mm Hg, and the brachial systolic pressure is 150mm Hg. What would the ABI be for this patient?
7. The nurse is educating Fred about managing his condition. What methods can the nurse suggest to increase arterial blood supply?
8. What is the best method for the nurse to assess Fred’s peripheral pulses to obtain consistent results with other health care practitioners?

CASE SCENARIO III

Georgia, a 30-year-old woman, is diagnosed as having secondary hypertension when serial blood pressure recordings 170/100 mm Hg. Her hypertension is the result of renal dysfunction.

Questions:

9. How will Georgia’s kidney help maintain her hypertensive state?
10. The nurse informs Georgia that she should see her ophthalmologist. Why is it important that Georgia adhere to follow up with an ophthalmologist?
11. Georgia is prescribed with Furosemide (Lasix) 20mg once every day. What does the nurse understand the action of Lasix?
12. What health education can the nurse suggest to Georgia to reduce complications and improve disease outcomes?

Answer 1

CASE SCENARIO-I

1The nurse may predict severe septicaemia with internal bleeding due to urosepsis.

2..Aspirin must be avoided since it interfers with blood clotting.

3.Hypotension and shock

4.The nurse may predict antibiotics and clotting factors activators or thrombin medications

CASE SCENARIO- II

1.Hallmark symptom of peripheral artery occlusion is calf pain

2.ABI is calculated based on higher pressure on both the arteries devided by brachial systolic pressure. 75 mm Hg devided by 150 is 0.5.Hence ABI is 0.5

3 Nurse can suggest Fred regarding following to increase peripheral blood supply

a) mild exercise

b) quitting smoking

c) consuming less cholesterol food

4.Auscultation method will be the best way to assess the pulse in Peripheral Occlusion Diseases.

3).CASE SCENARIO-III

1.Kidney retain more sodium and water due to its altered filtered process which in turn maintaining her hypertensive state.

2.The narrowing of the retinal arteries causes less blood supply to retina and may impair vision. Hence, it is important to adhere to the follow up with the Ophthalmologist.

3.lasix blocks the absorption of sodium, chloride, and water from the kidney tubules and increases urination which results in a drop of blood pressure.

4.The health education can be given on the following:-

a) Restriction of sodium diet

b) Restrictions of high cholesterol diet

c) Regular physical activity

d) Stress management

e) Regular follow up and monitoring of blood pressure