Chapter 33 Nursing Management Hypertension

have said with regard to the above questions. You should use all of your knowledge about blood pressure

4. What tips can you give KH’s wife to improve the accuracy of her blood pressure measurement technique? Used the better way to measure the blood and for the cuff to wrap

25) A 62 year-old woman comes to the ER with complaint of breathing difficulty and chest pain. Her blood pressure is 88/58. After the patient is placed on the cardiac monitor, the rhythm is as shown below. What is the best action that the nurse should take for the patient?

When checking for orthostatic changes in vital signs the nurse should measure the serial blood pressure and take the pulse of a patient in the supine, sitting, and standing positions. The nurse should first start by placing the patient in the supine position and allowing the patient to rest for 2 to 3 minutes before taking the blood pressure. Next, the nurse should place the patient in the sitting position with their legs dangling off the side of the bed. Then the nurse should allow the patient to rest for 1 to 2 minutes before measuring the blood pressure once again. Lastly, the nurse should reposition the patient to the standing position and should allow 1 to 2 minutes of rest before proceeding to the last blood pressure measurement. Orthostatic changes in the patients pulse and blood pressure need to be monitored closely because they can indicate signs of dehydration concerning the gastrointestinal system. Usually while the patient is in the standing position the systolic blood pressure will decrease 10 mm Hg, and the diastolic blood pressure will increase a bit. Now, when the systolic blood pressure decreases by 20 mm Hg, the diastolic blood pressure decreases by 10 mm Hg or higher, and there could be no change in heart rate or there could be an increase in the heart rate of 20 beats/minute or higher while reposition from the supine position to the

Seat the patient in a chair and decide from which arm to draw the blood.

The diagnosis of hypertension is not made until the client has an elevated blood pressure on two different occasions.

The importance of manual blood pressure readings are often overlooked, even by experienced healthcare providers. Manual blood pressures closely approximate a person’s direct arterial measurements. However, there have been studies that

An evaluation of Mrs Smith circulation was the next step carried out by the nurse, as in the breathing assessment Mrs Smith pallor was noted as being flushed and the patient appeared confused this could be associated with poor cardiac output. The nurse recorded the patient’s blood pressure using a dinamap it was measured at 88/50, it was then rechecked manually to ensure accuracy. The pulse was checked manually for rate and rhythm it was recorded as 98 beats per minute. Capillary refill was checked, was found to be normal.

Figure 1 shows that the systolic and diastolic pressure while the subject was sitting down, 119/64, is lower than that of the other body positions and exercise. Standing showed the second lowest systolic and diastolic pressure, 121/83. Lying down showed a slightly higher blood pressure of 123/84. The highest blood pressure, 133/94, was measured when the subject had just completed some physical activity. Figure 2 and 3 display, respectively, the difference between heart contractions at rest and after exercise, as illustrated by the greater number of contractions following exercise in the same amount of time compared to resting conditions. In addition to displaying the interval lengths for three sequential beats from Figures 2 and 3, Table 1 also includes the heart rate for before and post exercise, 102 bpm and 132 bpm, respectively. Figure 4 shows similar

In this scenario, the subjected data is chest palpitation, lightheadedness and dizziness, the objective data is elevated heart rate with irregular rhythm, orthostatic blood pressure readings, lying 135/90, sitting 120/80, standing 100/60, and the client becoming dizzy and light-headed as he moves from a sitting to a standing position while taking the blood pressure. The subjective and objective data indicates that the patient has orthostatic hypotension. To determine what is causing the orthostatic hypotension a more in-depth health history, physical assessment, labs and diagnostic testing would need to be done.

I have selected case number 1. An 85 year old man came to the emergency room with palpitations for a few days. He states that he sometimes feels light headed and dizzy. The patient’s heart rate is elevated and irregular. As he goes from a sitting position to a standing position he becomes light headed and dizzy. In taking orthostatic blood pressure you notice that they are positive.

amount of pressure exerted on arterial walls in the patient’s heart. Blood pressure is measured in

BP was performed on the brachial artery, with some patients it may be inappropriate, alternative sites may have to be considered. BP may be measured in the thigh, underneath the cuff with the stethoscope positioned above the posterior popliteal artery for patients prone with middle bladder (Dougherty and Lister 2011).

On the first page of the introduction, line 23, the authors state: Yung et al. (2014) developed a distinctive dose using anterior-to-posterior pressures (AP) of the cervical spine that resulted in a reduction in systolic blood pressure (SBP) and heart rate (HR),

The patient vital signs are normal except for his blood pressure which is 146/89. The medical assistant informs the patient that his blood pressure is high and questions about his day and diet. The patient did have a full day of school before rushing to the office.