Question

200 case study hypertension

PN 200 Fundamentals of Nursing II Concept Map: Hypovolemia/ Deficient Fluid Volume Charles West, a 70 y/o man was brought to the Emergency Department at 4:30 AM by his wife. She told the emergency room triage nurse that he has a lot of dark red diarrhea for the past 3 days and last night. When he became very dizzy, disoriented and weak this morning, she decided to bring him to the hospital. Mr. West's vital signs were B/P 70/- (diastolic blood pressure inaudible) Pulse 110 weak and easily obliterated and respirations 24. A 16-gauge IV catheter was inserted and Lactated Ringer's infusion at 125 m L per hour was started. Two years ago he experienced a cardiac arrest that was attributed to hypokalemia. He also has a long history of hypertension and arthritis. Fifteen years ago. he was diagnosed with a peptic ulcer. An endoscopy showed a 25mmX15mm duodenal ulcer with adherent clot. The ulcer was cauterized and Mr. West was admitted to the Medical intensive care unit for treatment of his volume deficit. You are the admitting nurse. As you are making him comfortable, Mrs. West gives you a paper bag filled with the bottles of the medications Mr. West has been taking. Vasotec 5mgm po bid Coumadin 5mgm po qd Digoxin 0.125 mg po qd KCL 20 mEq po bid Tolimentin 400mgm po tid (non-steroid NSAID) Doing a quick assessment, you find a pale man who is sleepy but arousable and oriented. He is still dizzy, hypertensive and tachycardia. You hear S3 and S 4 heart sounds. Peripheral pulses are present and trace pedal edema is present. Lung sounds are clear. Bowel sounds are present, gastric tenderness is noted and the liver margin is 4cm below the costal margin. Mr. West receives a total of 4 units of PRBC's, 5 units of FFP (fresh frozen plasma) and many units of crystalloid solution to keep his systolic B/P above 90mmHg. 2.1 As soon as you get a chance, you look at Mr. West's' admission lab results: 6.2 BUN 90mg/dl Creatinine Hgb 8.4 Hct 25% WBC 16,000 PT 23.4 INR 4.2

Answer 1

Nursing diagnosis

Fluid volume deficit/Deficient fluid volume related to increased peristalsis as evidence by diarrhea

Intervention

• Administer intravenous fluid to replace the lost fluids
• Administer anti diarrheal drugs to stop loose stools
• Assess the serum electrolytes levels for imbalance
• Stool sample collection to rule out the cause of bleeding
• Monitor intake and output to prevent complications
• Administer blood products as per order to normalize hemoglobin loss due to diarrhea

Positive outcomes

• The patient will have a normal peristaltic movements

Negative outcomes

• The patient may land up in fluid overload if improperly monitored
• Risk for renal impairment

Evaluation

• The patient will exhibit no loose stools
• Feeling active able to do activities

Nursing diagnosis

• Impaired cardiac output related to decreased blood volume as evidenced by low blood pressure,paleness,

Intervention:

• Monitor vital signs, baseline data to plan for care
• Administer vasoconstrictor as per order to increase blood pressure
• Provide trendlenburg or head low position to improve cardiac function
• Increase the fluid intake ,IVF to improve the blood volume
• Stop antihypertensive drugs
• Decrease the high potassium levels for proper functioning of the

Positive outcomes

• Normal cardiac function
• Normal blood pressure

Negative outcomes

• Risk for arrhythmia,cardiac arrest due to high potassium levels

Evaluation

• The patient exhibit a normal blood pressure reading