This is a reflective journal about a patient I cared for in my clinical placement. For ethical reasons, the identity of this 47-year-old Caucasian female will remain undisclosed. The patient was admitted with hypertensive urgency with a blood pressure of 210/110 mmHg. She was having crushing pain in the central chest to start with that later was replaced by burning sensation retrosternally. At the time of presentation, she was not sweating much, but was nauseated despite not vomiting.
The hypertension control was started immediately, and she was admitted to rule out myocardial infarction. When I took over her charge, vital signs were stable, and her heart rate was 82. The continuous blood pressure monitoring demonstrated a record of 150/71, stable and within acceptable range. Her temperature was 36. 6, normal and she was saturating at 94%, a little below the acceptable limit. During my one-day care, I was monitoring her vital signs at frequent intervals, and her prominent complaint was dysphagia.
Since the physician ordered her to remain nil orally, I just gave her some ice chips. However, to maintain her fluid balance and nutritional status, she was placed on total parenteral nutrition at 60 mL/hour. Hypertensive urgency is prone to develop myocardial infraction in a susceptible individual, and the cardiac event may be sudden to appear. The patient was placed in Telemetry, and watching the telemetry became important in this patient, because that would reveal an abnormal cardiac tracing the soonest, and the diagnosis of myocardial infarction may be suggested.
Similar symptoms may appear in dysphagia, and the findings may be confounding. Therefore, the nursing interventions would point ideally to measure the heart rate and blood pressure, since in the event of a myocardial infarction, the heart rate would vary largely from the normal range either on the higher or lower side, and the blood pressure would deteriorate with compromise in the oxygen saturation further.
Hence measurement and monitoring of vital signs and recording them very frequently combined with the Telemetry pattern would suggest an infarction. However, keeping a note of the progression of the dysphagia symptoms would not be unwise since dysphagia would present almost identically, and in that case, the hypertensive urgency of presentation could be considered incidental.
Thus far, the Telemetry is not suggestive of a myocardial infarction, and ice chips could go a long way abating her symptoms. In my consideration, her management had been appropriate, and while reflecting on this, I could apply my academic knowledge in the clinical field and could assert myself in this area of nursing care delivery.
Reference
Twibell, Ryan, & Hermiz, (2005). Faculty Perceptions of Critical Thinking in Student Clinical Experiences. Journal of Nursing Education, 44(2): 71-79.