1.Ms. C is a 42-year-old black American woman with a 7-year history of hypertension first diagnosed during her last pregnancy. Her family history is positive for hypertension, with her mother dying at 56 years of age from hypertension-related cardiovascular disease (CVD). In addition, both her maternal and paternal grandparents had CVD.
At physician visit one, Ms. C presented with complaints of headache and general weakness. She reported that she has been taking many medications for her hypertension in the past, but stopped taking them because of the side effects. She could not recall the names of the medications. Currently she is taking 100 mg/day atenolol and 12.5 mg/day hydrochlorothiazide (HCTZ), which she admits to taking irregularly because “… they bother me, and I forget to renew my prescription.” Despite this antihypertensive regimen, her blood pressure remains elevated, ranging from 150 to 155/110 to 114 mm Hg. In addition, Ms. C admits that she has found it difficult to exercise, stop smoking, and change her eating habits. Findings from a complete history and physical assessment are unremarkable except for the presence of moderate obesity (5 ft 6 in., 150 lbs), minimal retinopathy, and a 25-year history of smoking approximately one pack of cigarettes per day. Initial laboratory data revealed serum sodium 138 mEq/L (135 to 147 mEq/L); potassium 3.4 mEq/L (3.5 to 5 mEq/L); blood urea nitrogen (BUN) 19 mg/dL (10 to 20 mg/dL); creatinine 0.9 mg/dL (0.35 to 0.93 mg/dL); calcium 9.8 mg/dL (8.8 to 10 mg/dL); total cholesterol 268 mg/dL (< 245 mg/dL); triglycerides 230 mg/dL (< 160 mg/dL); and fasting glucose 105 mg/dL (70 to 110 mg/dL). The patient refused a 24-h urine test.
A- What is the appropriate teaching about life styles modifications to maintain BP under control.
B-Mention at least 2 pharmacological treatment (medications) to treat Hypertension.
1-Ms. Burke is an obese 55-year-old with a history of osteoporosis. Her
healthcare provider (HCP) has recommended that she have a total left hip
replacement. There is no other medical history known.
Ms. Burke is scheduled for preoperative instructions and information in 3
days at the HCP’s office. The LPN/LVN begins the preoperative examination by taking Ms. Burke’s vital signs for the RN. Which vital signs require follow-up by the LPN/LVN?
-BP of 160/88
-Pulse of 68
-Respirations of 14
-Temperature of 97 F
2-Ms. Burke is an obese 55-year-old with a history of osteoporosis. Her
healthcare provider (HCP) has recommended that she have a total left hip replacement. There is no other medical history known. Ms. Burke is scheduled for preoperative instructions and information in 3
days at the HCP’s office. The LPN/LVN reviews Ms. Burke’s preoperative
lab test results, which were obtained earlier in the week.
Which serum lab value require follow-up action by the LPN/LVN
-Sodium 135 mEq/L
-WBC 14000/mm3
-Creatinine 0.8 mg/dl
-Hemoglobin 14 g/dL
3-Ms. Burke is an obese 55-year-old with a history of osteoporosis. Her healthcare provider (HCP) has recommended that she have a total left hip replacement. There is no other medical history known. Ms. Burke is scheduled for preoperative instructions and information in 3 days at the HCP’s office. The LPN/LVN notifies the RN of Ms. Burke’s vital signs and lab values. The RN informs the client and the LPN/LVN that the healthcare provider plans to evaluate Ms. Burke and review the data later in the day. The LPN/LVN reviews with Ms. Burke what to expect the day of surgery and during the immediate postoperative period. The LPN/LVN reinforces instructions regarding deep breathing exercises. Ms. Burke performs a return demonstration by breathing in through her mouth deeply and exhaling through pursed lips forcefully and rapidly. What is the best action for the LPN/LVN to implement first?
-Advise the client to avoid pursing her lips when exhaling
-Remind the client to exhale slowly and steadily
-Demonstrate the deep breathing and coughing technique again
-Document unsuccessful completion of the return demonstration
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