Question

pleas help with nanda diagnosis, goal, intervention/rationale, evolution for this patient.

Joan Smith, 55 years of age, is a female patient who presents to the intensive care unit with the diagnosis of intracranial hemorrhage. The patient stopped taking her antihypertensives suddenly because of the cost of the medications and she recently lost her job to outsourcing. The patient is slightly drowsy and complains of a headache and blurred vision. The patient’s blood pressure is 220/130 mm Hg upon presentation.

Answer 1

ANSWER :

* NANDA DIAGNOSIS FOR HYPERTENSION : Decreased cardiac output related to increased peripheral vascular resistance as evidenced by blurred vision, headache, raise in blood pressure.

* GOAL : To maintain normal blood pressure, reduce headache

* INTERVENTIONS :

- Monitor the vital signs of the patient especially blood pressure

- Assess the level of head ache and vision

- Administer Titrate vasodilator medications for blood pressure and assess patients blood pressure every hourly.

- Educate about the importance of taking anti hypertensive medications to avoid further complications

- Educate patient to consult the doctor before stopping of the medication and immediate consultation on having the severe signs and symptoms.

* EVALUATION :

- Patient blood pressure levels are decreased absence of head ache and blurred vision

- Patient is aware of not to stop the medications at any cost, as they will cause serious health problems for her.