Question

scenario 1

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.

1. What does the nurse suspect maybe 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?

scenario 2

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 decrease with rest.

1. What does the nurse is the hallmark symptom of peripheral arterial occlusion disease?

2. The patient is having 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?

3. The nurse is educating Fred about managing his condition. What methids can the nurse suggest

to increase arterial blood supply?

4. What is the best method for the nurse to assess Fred’s peripheral pulses to obtain consistent

results with other health care practitioners?

Scenario 3

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.

1. How will Georgia’s kidney help maintain her hypertensive state?

2. The nurse informs Georgia that she should see her ophthalmologist. Why is it important that

Georgia adhere to follow up with an ophthalmologist?

3. Georgia is prescribed with Furosemide (Lasix) 20mg once every day. What does the nurse

understand about the action of Lasix?

4. What health education can the nurse suggest to Georgia to reduce complications and improve

disease outcomes?

Answer 1

SCENARIO 1

1. What does the nurse suspect maybe occurring with George?

George is developing some internal bleeding due to his sepsis condition. Thats why he is having blood in his stool and urine.  Bleeding from his central line and gum may indicate altered blood coagulation parameters, which may suspect any liver damage. Since the patient already developed uro sepsis, the chance of damamge to liver also very high. Hence, PT, CT, Bleeding time, INR everything may be altered.

2. What medications should the nurse avoid administering to George?

The nurse should avoid the use of drug aspirin which can cause bleeding. If the patient is receiving any anticoagulants like Warfarin, heparin etc, those medications also needed to be stopped immediately with physicians order.

3. The nurse is monitoring George’s vital signs every 15 minutes. What other monitoring is essential to include along with the vital signs?

Assess the oxygen saturation of the patient. Monitor his intake and output. Send the blood for studies like APTT, INR, prothrombin time, bleeding time, clotting time etc. Monitor his blood glucose level and ECG to indentfy any potential damage to the cardio vascular system.

4. What medication does the nurse anticipate infusing?

All medications to be administered only as per ohysicians order.Monitor the Blood pressure, if hypovolemia develop for the client, IV fluid replacement can be intiated. To stop bleeding desmopressin acetate can be infused with physicians order.

SCENARIO 2

1. What does the nurse is the hallmark symptom of peripheral arterial occlusion disease?

Peripheral occulsive disorders are characterized by decresed blood supply to the lower extrimities due to occlusion of most of the blood vessels. The hall mark symptoms includes, absent pedal pulse,atrophy of the skin, the extrimity will be very warm to touch, painful cramps over the lower extrimity after certain activities, leg numbeness, weakness etc.

2. The patient is having 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?

The ABI is calculated with dividing the BP of ankle by dividing the BP of arm. So here, the ABI will be 150/75 = 2

3. The nurse is educating Fred about managing his condition. What methids can the nurse suggest to increase arterial blood supply?

Advise the patient to stop if he have habbit of alcoholism and smoking. Advise th him not to keep his legs crossed for a long period of time. He should not leave his legs hanging for a long period of time and should not sit in a place for a long period of time. Minor range of motion exercise of lower leg can be done to improve the blood circulation to lower extrimities. He need to continue his hypertension medications as per physicians order.

SCENARIO 3

1. How will Georgia’s kidney help maintain her hypertensive state?

The kidneys are the pairs of excretory organs, helps to  remove waste products and excess water from the body. Thus it helps to maintain the normal blood pressure.Kidneys use hormone mechanism also to regulate the blood pressure.With the effective renin-angiotensil- aldosterone mechanism, kidneys helps to maintain the normal blood pressure of an individual.

But in case of renal dysfunction, this may interfere with sodium excretion, leading to water absorption and building up of fluids in the body causing hypertension.

2. The nurse informs Georgia that she should see her ophthalmologist. Why is it important that Georgia adhere to follow up with an ophthalmologist?

Uncontrolled hypertension can cause damage to the minor blood veseels supplying to the eyes, and damage to her eyes. Which can cause permanent vision lost and non functioning of the eyes. It can develop in to hypertensive retinopathy.Hence she need to consult the opthalmologist.

3. Georgia is prescribed with Furosemide (Lasix) 20mg once every day. What does the nurse understand about the action of Lasix?

Lasix is a loop diuretic drug. Diuretics means the drug, which increases the urine output. Here the drug lasix will work op on the loop of henle and helps to excrete the excess water in the form of urine. It is an effective management for Hypertension.

4. What health education can the nurse suggest to Georgia to reduce complications and improve disease outcomes?

Educate her about the importance of DASH diet. Advise her to follow the antihypertensive medications. She need to go for a regular eye examination and full body check up. Since she is very probe to develop stroke, regula BP monitoring at home is necessary. She need to restrict the sodium intake. Closely monitor the intake and output since her renal function is altered. Monitor for symptoms like sudden head ache, nausea, vomiting, paralysis of any extrimities, facial twitching etc, which may indicate stroke,