Question

Nursing care plan for the following case studies using the rubric

Asswssment and management of patients with hypertention

1. 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.

(Learning Objective 6)

* RUBRIC( please follow the rubric while using the numbers)

Do not write the NCP using a grid format... use an essay format/ bullet point using the numbers of this rubric.

All NCP will be graded according to the following rubric.

1) Definition of the medical diagnosis __________10

etiology/pathophysiology

2) Common signs and symptoms ___________5

3) Potential complications ___________5

4) Head to toe physical assessment you are to write one....use the data in the case if there is none you create it as if this was your patient. ____________10

5) Diagnostic and lab studies ___________5

normal values

expected abnormalities

6) ALL NANADA Nursing diagnoses __________10

7) Develop 3 NANDA priority nursing diagnoses __________10

8) State a patient plan AND goal for each of the __________10

priority nursing diagnosis

9) Write interventions for each of __________10

priority nursing diagnosis

10) Write scientific rationales for you you ___________5

interventions

11) Write evaluation of your interventions __________10

your plan or make changes

12) List of typical medications __________10

category

usual dosage

side effects

patient teaching

Answer 1

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.

1) Intracranial hemorrhage is an abnormal bleeding that occurs inside the skull.

ETIOLOGY: ICH commonly occurs secondary to accidents resulting in head injury, uncontrolled blood pressure causes damage to the blood vessel, Rupturing of the bulged or weakening area of cerebral artery, patient under anticoagulants that increases chances of bleeding, rupture of tumors in the cerebrum.

Pathophysiology: based not the etiology any direct injury results in bleeding within the cranial vault.Intracranial hemorrhage results in pooling of blood secretions, hematoma further increases intracranial pressure and results in complications.

2) Common signs and symptoms:

Loss of consciousness, severe head ache occurs due to elevated ICP, loss of balance, slurred speech, comatose.

3) Potential complications: seizures : abnormal electrical activity of brain, hydrocephalus : elevated cerebrospinal fluid and accumulation of csf in abundant, Difficulty in swallowing, Deep vein thrombosis as a result of moving clot accumulated in the deep vein of lower extremities, reoccurrence of intra cerebral hemorrhage.

4) Diagnostics: Laboratory studies complete blood count, clotting factors, serum blood glucose levels, Computed tomography with out contrast act as a confirmatory test to identify the reason for hemorrhage. Angiography to identify cerebral aneurysm, cerebral AV malformations. Magnetic resonance imaging to identify hemorrhage.

5) NANDA Nursing diagnoses:

- Nurses must prudent in caring client with ICH, periodical monitoring of vital parameters, hemodynamic monitoring, neurological examination , oxygen saturation helps to detect early deviation or detonation of patient status.

i) Ineffective airway clearance related to reduction of cough reflexes.

ii) Ineffective cerebral tissue perfusion related to rupture of cerebral artery secondary to elevated blood pressure.

iii) Deficient fluid volume related to altered level of consciousness as evidenced by low GCS

iv) Imbalanced nutrition less than body requirements related to loss of consciousness

v) Risk of injury related to abnormal firing of electrical impulses as evidenced by altered consciousness.

6) Drug therapy: The first line of treatment in this case is antihypertensives as the route cause for intra cerebral hemorrhage is uncontrolled hypertension. Osmotic diuretics such as mannitol to decrease elevated intracranial pressure. Antipyretics to treat hyperthermia.