Question

Applying Your Knowledge: Consider the various scenarios and answer the questions.

• 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?

• 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?

• 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

George -----In urosepsis Or generally sepsis there is a  Coagulation abnormalities these are nearly universal in septic patients and likely play a key role in bleeding from various site and also can cause multiorgan dysfunction( mod)

Medications like anticoagulants are avoided in pts having bleeding tendencies like heparin etc medications like antibiotics are given in sepsis pt

Other signs to b monitored like abdominal girth, weight gain electrolyte monitoring , intake output etc

Life saving medications should b anticipated in case of sepsis leading to septic shock

Freud------ high bp can cause thrombophelibitis. Blood vessels damaged by high blood pressure can narrow, rupture or leak. High blood pressure can also cause blood clots to form in the arteries. Pain in calf can b assessed by means of homan' s test

ABI is calculated by

Artry pressure in leg ÷ arm pressure

75÷150= 0.5

When abi is less than 0.9 it means person is suffering from peripheral artry disease

Methods to increase peripheral artry blood Stop smoking. Smoking contributes to constriction and damage of your arteries and is a significant risk factor for the development and worsening of PAD. ...Exercise. This is a key component. ...Eat a healthy diet. ..avoid cold .

The best site for taking peripheral pulse in legs are poplitral dorsalis pedes. Zero refers to a nonpalpable pulse, 1+ is a barely detectable pulse, 2+ is slightly diminished but greater than 1+, 3+ is a normalpulse and should be easily palpable, and 4+ is “bounding”

Georgia

kidneys play a key role in keepingyour blood pressure in a healthy range. Diseased kidneys are less able to helpregulate blood pressure. As a result, blood pressure increases. If you have CKD, high blood pressure makes it more likely that your kidney diseasewill get worse .

Because the htn of the georgia will affect the microvessels of the eye

The nurse will teach the pt to take the lasix at the morning to avoid sleep disturbance if taken at evening and also don't take asipirin as the asipirin competes with the lasix. Also check daily weight, blood tests etc

The nurse will educate pt to take low sodium diet, and control the bp by taking regular medication