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This report will discuss the Hypotensive and Atrial Fibrillation as two actual problems that Ms Blackmore has experienced. She is admitted to the emergency department with the complaint of increased respiratory rate. She has been discharged from the hospital one week ago post ORIF to hip after a mechanical fall. In this report, the current physical conditions of her will be discussed and the cause of her problems or abnormalities that is pathophysiology for her problems will be found out. She is experiencing increased breathing, high RR, low oxygen saturation. The nursing interventions provided by the nurse to treat the problems and the specific outcomes obtained will also be discussed.
Ms Blackmore has experienced many problems out of those two problems were Hypotensive and Atrial fibrillation. The patient in this case, is admitted to the emergency department with the condition of fast heartbeat and heart rate. She was hypoxic and hypotensive at the time of arrival. She also has the problem of Atrial Fibrillation, dementia, osteoporosis and dyslipidaemia. On the arrival to the hospital, the patient’s blood count is taken which also shows abnormality. Sodium-potassium level is not balanced, platelets are low and decreased hemoglobin is observed. The patient was breathing very fast and had a capillary fill time of 4 seconds which is not normal. The capillary fill should be less than 3 seconds fo a normal peson.
When the arterial blood pressure becomes low abnormally, it is called the state of hypotension. A blood pressure below than 120/80mmHg is considered low. The patient in this case, has blood pressure 82/56 which is very low. Low blood pressure reduces the flow of blood and thus the oxygen supply to the organs of the body becomes low. In the present case, the patient has experienced hip surgery; the loss of blood during the surgery can cause a drop in blood pressure (Magkas, & et al., 2019). The anaesthesia that is given to the patient also contributes in dropping the blood pressure. When the patient’s heartbeat and respiratory rate are very high, there is sudden drop in the blood pressure of the patient. This is because low blood is available to circulate in the body. The heart unable to pump the sufficient amount of blood to the body and thus the blood pressure goes down. The patient is hypotensive due to increase in her heart beat and heart rate (Smischney, & et al., 2020). The saturation level of oxygen is also low in the patient. All these problems may arise due to the large amount of blood loss during the surgery as it is common in the adults to acquire these problems after surgery (Sharma, & et al., 2021). The blood pressure becomes low due to the effect of anaesthesia. Low blood pressure is caused due to the inability of the heart to pump the sufficient amount of blood in the body. The patient’s blood pressure is extremely low in this case and it can be life-threatening to her as such low blood pressure can results in damaging the other parts of the body. All the organs of body need oxygen to perform various functions, when there is not enough oxygen then it leads to damage all the parts of the body. Abnormal heart rate is the main cause of low blood pressure.
Pathophysiology for Hypotension
Nursing intervention for hypotension- The nurse should monitor the vital signs and symptoms of the present condition of the patient. The blood pressure should be check at the regular intervals. The hydration status of body, skin turgor, temperature, heart rate and heartbeat all should be monitored and any abnormalities should be reported immediately (Saab, & et al., 2021). To manage and control the low blood pressure plenty of fluid should be given to the patient to maintain the volume of the blood. After discussing with the multidisciplinary team, first-line drug therapy for controlling blood pressure should be given. It is very important to control the high respiratory rate of the patient. Sufficient amount of oxygen should be provided to the patient so as to maintain the oxygen level in the body. When the proper oxygen will be available in the body, the patient’s heart rate and blood pressure ultimately becomes under control. The patient should be monitored carefully at regular intervals. The hydration status of the body should be maintained. The medication prescribed to the patient should be administered carefully. Education of the patient and her family about the physical conditions should be done. The nurse should communicate effectively with the family of the patient to know more about the medical history of the patient (Wijnberge, & et al., 2019). The blood report of the patient should be observed by the nurse carefully. It should be checked regularly at the fixed intervals that the oxygen level, the blood pressure, the respiratory rate and the heart rate is normal. If there is any abnormal findings are observed then it should be reported immediately.
Specific outcome- Any nursing intervention is given to the patient with a purpose of obtaining the positive outcome on their health. The specific outcomes for the patient in this case should be the blood pressure of 120/80mmHg, she should have the oxygen saturation of 94%. Her respiratory rate should be in between 18 to 21 breaths per minute because currently it 36 breaths per minute. When these conditions are maintained the patient should be in stable condition. The normal respiratory rate can be maintained by giving artificial oxygen supply to the patient through ventilator. The amount of oxygen should not be less in the body. It should be maintained so as to prevent the chances of morbidity. To maintain the heart rate and heart beat by giving enough supply of oxygen to the patient (van Lier, & et al., 2018). When proper oxygen will be there in the body the blood pressure remain normal. The oxygen saturation should be observed regularly to obtain the desired outcomes for the patient. The main goal of the treatment given to the patient is to maintain the oxygen level of the body so that the normal blood pressure can be obtained.
In atrial fibrillation, there is abnormal beating in the upper chamber of the heart. Thus, the flow of blood is not proper from the upper chamber to the lower chamber of the heart. The heart beat becomes rapid and irregular (de Groot, & Allessie, 2019). The cause of having atrial fibrillation is surgical procedures, chronic diseases and pulmonary embolism. Several sociological and postoperative prognostic factors may be linked to the development of AF. It can be caused by a variety of variables, including advanced age, obesity, underlying heart problems, renal impairment, or COPD (Ding, & et al., 2021). Previously existing rheumatic disease and breathing problems, intra-abdominal and large arterial surgeries, and postoperative hypotension are all predictors of AF. Inflammation also is the cause of AF sometimes.
Nursing Intervention for Hypotension
Nursing interventions for Atrial fibrillation- the nurse should discuss with the multidisciplinary team and provide electrocardioversion, or ablation and pace maker to control the rhythm of the patient (Ramirez, & et al., 2019). Artrial fibrillation may result in blood clot so before performing electrocardioversion, the anti-coagulating medicines should be given otherwise the electrocardioversion can result in shifting the blood clot to the brain or other parts of the body (Caceres, & et al., 2020). The rate of heart beat can also be controlled by the beta-blockers. Anticoagulation therapy can also be given to control the heart rhythm (Ferguson, & et al., 2019). A 12 lead ECG should be obtained, all the vital signs should be monitored, any abnormal signs and symptoms should be reported immediately, the patient should be hooked to the cardiac monitor, the prescribed drugs should be administered, the anticoagulants if given should be monitored carefully, any neurological change in the patient should be observed. The nurse should assess the oxygenation.
Specific outcome- After giving the nursing interventions, it is very important to observe the outcomes of the patient. The goal of giving the treatment is fulfilled or not. It is also let the nurse to identify the effect of the nursing considerations on the patient. The outcomes for the patient in this case should be to obtained normal heart rhythm of 100 beats per minute. Normal respiratory rate of 16 to 18 breathes per minute should be obtained (Streur, & et al., 2018). To prevent any blood clots, to reduce the risk of stroke. To observe any change in the neurological system of the patient. The main goal of the nursing intervention given to the patient with arterial fibrillation is to maintain the normal heart rhythm as abnormal rhythm may result in the stroke. Artrial fibrillation may also result in the blood clot so it should also be ensure that no blood clots can occur in the arteries of the heart.
Conclusion
In this report, the patient’s physical conditions and the vital signs and symptoms were discussed. The pathophysiology for hypotension and atrial fibrillation was discussed. This report also explained the given nursing interventions and the rationale for giving these interventions. The goal of the treatment will be obtained or not is also included. The specific patient outcomes observed after the nursing interventions is discussed. The purpose of this report was to understand the assessment and plan of care given to the patient in the present case.
References
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Ding, W. Y., Gupta, D., Wong, C. F., & Lip, G. Y. (2021). Pathophysiology of atrial fibrillation and chronic kidney disease. Cardiovascular Research, 117(4), 1046-1059.
Specific Outcome for Hypotension
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