Purpose
To work in an interdisciplinary team, use critical thinking, and apply emergency nursing interventions within the scope of practice for the LPN.
Instructions
Read the following scenario and answer the questions. A fingerprint indicates a major clue. Make sure you cite all sources using APA format.
The Story:
You (the LPN) are working in an urgent care center on a team with an RN, Physician, and NP. You receive a client (54 year-old-male) who is complaining of acute lower back pain that began four hours ago. The client has no previous history of back pain and denies any recent injury. The client has a history of hypertension and Marfan Syndrome. You perform data collection, and the client’s vital signs are: 174/90, 112, 24, 98.0 PO. You note that the client’s skin is cool and clammy. The RN performs an assessment and notes a pulsatile mass in the client’s abdomen. His lungs are clear, and his pulse is regular. The physician orders two large bore IV’s to be inserted but no IV fluids and nitroglycerine to lower his blood pressure.
Answer the following questions:
Question # 1: What is the significance of the client’s history of Marfan Syndrome? (5-10 sentences)
Question # 2: What vital sign(s) should the LPN immediately report? Why? (5-10 sentences)
Question # 3: What is the significance of the “pulsatile mass” (5-10 sentences)
Question # 4: Why did the physician order IV’s but no IV fluids? (3 sentences)
Question # 5: Why does the client need to have his blood pressure lowered? (3 sentences)
Format
- Standard American English (correct grammar, punctuation, etc.)
- Logical, original and insightful
- Professional organization, style, and mechanics in APA format
Question #1: What is the significance of the client’s history of Marfan Syndrome?
Marfan Syndrome is a hereditary connective tissue disorder that affects multiple organ systems, including the cardiovascular system. Individuals with Marfan Syndrome are at increased risk of developing aortic aneurysms and dissections due to structural weaknesses in the walls of their blood vessels. The syndrome predisposes the aorta to dilation and can lead to life-threatening complications such as aortic dissection or rupture. Given the client’s presentation of acute lower back pain and hypertension, the history of Marfan Syndrome becomes particularly significant as it raises concern for aortic pathology, necessitating urgent evaluation and intervention to mitigate the risk of catastrophic events such as aortic dissection. This highlights the importance of thorough assessment and consideration of underlying conditions in the management of patients presenting with seemingly unrelated symptoms.
Question #2: What vital sign(s) should the LPN immediately report? Why?
The LPN should immediately report the elevated blood pressure reading of 174/90 mmHg. Hypertension, especially with systolic readings above 160 mmHg, can increase the risk of aortic dissection or rupture in individuals with Marfan Syndrome due to the added stress on weakened arterial walls. Additionally, the LPN should highlight the presence of a pulsatile mass in the abdomen noted by the RN during assessment. A pulsatile mass in the abdomen raises concern for an abdominal aortic aneurysm (AAA), a potentially life-threatening condition that requires prompt evaluation and intervention. Rapid communication of these vital signs is crucial for timely decision-making and initiation of appropriate interventions to prevent further complications.
Question #3: What is the significance of the “pulsatile mass”?
The presence of a pulsatile mass in the abdomen is indicative of an abnormal enlargement of a blood vessel, most commonly the abdominal aorta. In this context, it suggests the possibility of an abdominal aortic aneurysm (AAA). AAAs are particularly concerning due to the risk of rupture, which can lead to severe internal bleeding and shock. The pulsatile nature of the mass indicates that it is likely an arterial structure, further raising suspicion for AAA. Given the client’s history of hypertension and Marfan Syndrome, which predisposes to vascular weaknesses, the discovery of a pulsatile mass necessitates urgent evaluation and intervention to prevent catastrophic outcomes such as rupture and hemorrhage.
Question #4: Why did the physician order IV’s but no IV fluids?
The physician likely ordered IV access without initiating IV fluids initially to maintain access for potential medication administration or emergent interventions. In the case of a suspected AAA, IV access is crucial for the rapid administration of medications such as pain relief or antihypertensive agents. However, withholding IV fluids initially may be a deliberate decision to avoid potentially exacerbating hypertension and increasing the risk of AAA rupture. By maintaining IV access without initiating fluids, the medical team can promptly administer medications if needed while closely monitoring the patient’s hemodynamic status and fluid balance.
Question #5: Why does the client need to have his blood pressure lowered?
Lowering the client’s blood pressure is imperative to reduce the risk of further dilation or rupture of the weakened arterial walls, particularly in the context of Marfan Syndrome and the presence of a pulsatile mass suggestive of an abdominal aortic aneurysm. Hypertension increases the mechanical stress on the arterial wall, exacerbating the risk of aneurysm expansion and potential rupture. Lowering the blood pressure through pharmacological interventions such as nitroglycerine helps alleviate this stress, thereby reducing the risk of catastrophic complications such as aortic dissection or rupture. It is a crucial step in managing the client’s condition and mitigating the risk of adverse outcomes.