Nursing Care Plan for: Hypertension Scenario:

A 65 year old male comes into the ER complaining of blurred vision and a very painful headache. He states his wife took his blood pressure from his home blood pressure machine at home and it read 210/110. He states it scared him so that is why he came to the hospital. The patient has the following history: TIA (2005), Diabetes Type 2, Hyperlipidemia, Hypertension, and 2 Cardiac Stents (2009). The patient takes the following medications: Metformin 150 mg PO Daily, Liptor 20 mg PO at night, Plavix 75 mg PO Daily, Coumadin 2 mg PO once a day, and Clonidine 2 mg PO Daily. Pt admits to not taking Clonidine for the past week because it makes him dizzy and weak feeling. Current VS: HR 85, BP 220/115, O2 Sat 96% on RA, Temp 98.6 F, and RR 16. Pt blood sugar is 150. Nursing Diagnosis:

Decreased cardiac output related to increased peripheral vascular resistance secondary to hypertension as evidence by BP 220/115, patient complaining of blurred vision, and headache. Subjective Data:

A 65 year old male comes into the ER complaining of blurred vision and a very painful headache. He states his wife took his blood pressure from his home blood pressure machine at home and it read 210/110. He states it scared him so that is why he came to the hospital. Pt admits to not taking Clonidine for the past week because it makes him dizzy and weak feeling. Objective Data:

The patient has the following history: TIA (2005), Diabetes Type 2, Hyperlipidemia, Hypertension, and 2 Cardiac Stents (2009). The patient takes the following medications: Metformin 150 mg PO Daily, Liptor 20 mg PO at night, Plavix 75 mg PO Daily, Coumadin 2 mg PO once a day, and Clonidine 2 mg PO Daily. Current VS: HR 85, BP 220/115, O2 Sat 96% on RA, Temp 98.6 F, and RR 16. Pt blood sugar is 150. Nursing Outcomes:

-Pts BP will be SBP 120-130 and DBP 80-95 within 24 hours.-Pt will verbalize an absent in a headache and blurred vision within 12 hours. -Pt will verbalized his understanding of never stopping a medication without the advice of a doctor. Nursing Interventions:

-The nurse will administer and titrate vasodilator medications to meet md parameters for blood pressure.-The nurse will assess the patients blood pressure every hour until meeting md parameters. -The nurse will assess the patients headache pain level and blurred vision every 4 hours until absent. -The nurse will educate the patient on how to consult with his doctor before stopping a medication.

Nursing Care Plan for: Fluid Volume Excess, Fluid Overload, Congestive Heart Failure, Pulmonary Edema, Ascites, Edema, and Fluid and Electrolyte Imbalance. Scenario:

A 74 year old male presents to the ER with complaints of swelling in legs and feet, shortness of breath with any type of activity, non-radiating chest pain, increase cough, and the inability to sleep laying down at night. Pt states he has felt bad since Tuesday and today is Friday. He also states he has gained 7 pounds since he last weight on Tuesday. Pt currently weighs 210 lbs. Pt states he usually weighs around 200-203 lbs. During history collection from pt, pt becomes short of breath and has to stop talking to catch his breath. Pt states that he takes Lasix 60mg PO BID but has not taken any since Monday because he wasnt able to go to the pharmacy due to the snowstorm last week. Pt also takes Lisinopril 2.5 mg PO BID, Coreg 6.25mg PO Daily, Coumadin 5mg PO Daily (has a history of Atrial fibrillation), Potassium PO 20meq BID, and Multivitamin 1 Tab PO Daily. Vital Signs: BP 155/93, HR 95, O2 Sat 90% on 4L nasal cannula, Temp. 98.6. On assessment, 3+ pitting edema noted in lower extremities, bilateral crackles noted through out lung fields, hands and abdomen are swollen, and slight jugular distention noted. Lab and Diagnostic work shows: BNAT 1824, K+5.0, Creatinine 1.8, BUN 21, chest x-ray preliminary results show possible bilateral pleural effusions, and echo-cardiogram results show ejection fraction of 35%.

Nursing Diagnosis:

Fluid volume overload related to decreased cardiac output as evidence by ejection fraction of 35%, edema in lower extremities, jugular distention, bilateral crackles, weight gain, BNAT 1824, and pleural effusions noted in lungs bilaterally.

Subjective Data:

Complaints of shortness of breath on any type of activity, non-radiating chest pain, increase cough, and the inability to sleep laying down at night, gained 7 pounds since last weight on Tuesday, takes Lasix 60mg PO BID but has not taken any since Monday because he wasnt able to go to the pharmacy due to the snowstorm last week.

Objective Data:

Lisinopril 2.5 mg PO BID, Coreg 6.25mg PO Daily, Coumadin 5mg PO Daily (has a history of Atrial fibrillation), Potassium PO 20meq BID, and Multivitamin 1 Tab PO Daily. Vital Signs: BP 155/93, HR 95, O2 Sat 90% on 4L nasal cannula, Temp. 98.6, 3+ pitting edema noted in lower extremites, bilateral crackles noted through out lung fields, hands and abdomen are swollen, and slight jugular distention noted. Lab and Diagnostic work shows: BNAT 1824, K+5.0, Creatinine 1.8, BUN 21, chest x-ray preliminary results show possible bilateral pleural effusions, and echo-cardiogram results show ejection fraction of 35%.

Nursing Outcomes:

-Pts O2 Saturation will be between 90-100% as evidence by nursing documentation during hospitalization.-Pt will weigh 200 lbs by discharge.-Pt will have no evidence of edema in lower extremities within 48 hours of hospitalization.

Nursing Interventions:

-Pt will be titrated on Oxygen via nasal cannula to keep O2 Sat. between 92-100% per MD order. -Pt will be given Lasix 60mg IV BID per MD order and will be weighed daily.- Pt will be placed on a 1500 ml fluid restricted diet per MD order and Intake and Output will be monitor and calculated after each shift.