Management of hypertension
For this Assignment, you will review the interactive media piece/branching exercise provided in the Learning Resources. As you examine the patient case, consider how you might assess and treat patients with the symptoms and conditions presented.
This week we explore the manifestations, implications, and Management of hypertension and shock. One of your required readings is the Clinical Practice Guideline for Hypertension from the American College of Cardiology and American Heart Association—become familiar with this document! You have several videos to support your learning about hypertension and the various mechanisms of shock.
Your assignment this week is another branching exercise, from which you will develop an admission order set for the patient in the branching exercise. This branching exercise provides you with considerable background data on the patient’s history and vital signs. The primary diagnosis of the patient is the one you determine through your choices in the branching exercise and will thus guide your choices of testing and treatments. Remember, this is YOUR patient, at least for the first 24 hours, so be clear about your management plan.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To prepare:
Review the interactive media under Required Media: Branching exercise. This is provided in the Learning Resources.
Review the information provided in the case (patient presentation, vital signs, pmh, home meds, results of labs and diagnostics. With this information, critically think about what is happening with the patient.
Use your critical thinking skills and current guidelines to develop orders. Include additional labs/diagnostics, what needs repeated and followed up on. Medications that need to be ordered or changed.
The Assignment:
Using the required admission orders template found under the Learning Resources: Required Reading.
Develop a set of orders as the admitting provider.
Be sure to address each aspect of the order template
Write the orders as you would in the patient’s chart. Be specific. Do not leave room for the nurse to interpret your orders.
Do not assume anything has already been done/order. Use the information given. Example: If the case does not mention fluids were given, the patient did not receive fluids. You may have to start from scratch as if you are working in the ER. And you must provide orders if the patient needs to be admitted.
Make sure the order is complete and applicable to the patient.
Make sure you provide rationales for your labs and diagnostics and anything else you feel the need to explain. This should be done at the end of the order set – not included with the order.
Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is the appropriate standard of care for this patient.
A minimum of three current (within the last 5 years), evidenced based references are required.
Learning Resources
Required Readings
Fuller, V. J., & McCauley, P. S. (2023). Textbook for the adult-gerontology acute care nurse practitioner: Evidence-based standards of practice. Springer Publishing Company.
Hypertension, pp. 99-101
Shock States, pp. 589-604
Sepsis, pp. 526-529
Intravenous Fluid Management, pp. 586
Types of fluids, p. 587
Harris, C. (2023). Adult-gerontology acute care practice guidelines (2nd ed.). Springer Publishing Company.
Hypertension, pp. 67-70
Hemodynamic Monitoring Devices, pp. 637-641
SIRS/Sepsis, pp. 298-304
VanValkinburgh, D., Kerndt, C. C., & Hashmi, M. F. (2021, August 14). Inotropes and vasopressorsLinks to an external site.. StatPearls [Internet]. Retrieved October 20, 2021. https://www.ncbi.nlm.nih.gov/books/NBK482411/.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., … Levy, M. (2021). Surviving sepsis campaignLinks to an external site.. Critical Care Medicine, Publish Ahead of Print. https://doi.org/10.1097/ccm.0000000000005337
Farkas, J. (2020, February 20). Vasopressors. EMCrit ProjectLinks to an external site.. Retrieved October 20, 2021, from https://emcrit.org/ibcc/pressors/.
Gourd, N. M., & Nikitas, N. (2019). Multiple organ dysfunction syndromeLinks to an external site.. Journal of Intensive Care Medicine, 35(12), 1564-1575. https://doi.org/10.1177/0885066619871452
Document: Admission Orders Template (Word document)
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