The nurse is caring for Delina Fuentes, a 44-year-old Hispanic woman who
presents to the emergency department with a severe headache. She tells the
nurse that she does not speak much English, so a translator is brought to her
room. In talking to the patient with the translator, Ms. Fuentes reports that she
has had high blood pressure almost her entire life and is taking medication but
has been unable to afford it lately. She lost her health insurance when she was let
go from her job two months ago and says that all her money goes to providing for
her children. Ms. Fuentes tells the nurse that she often doesnt have enough
money to put food on the table. She reports that her husband died right before
they were to immigrate from Mexico to the United States, so she made the
journey alone with her three young children. She explains that she suffers from
severe anxiety about her ability to provide for her children on her own. She has
been trying to learn English but has been having a difficult time and reports
feeling as if she does not belong in the community. Vital signs: BP 205/107, HR
106, 98% oxygen on room air Orders: The provider has ordered PRN labetalol to
maintain a systolic blood pressure between 120-150. UNFOLDING CLINICAL
SCENARIO INFORMATION Three days later, Ms. Fuentes is being discharged from
the hospital. Her blood pressure has been well controlled for over 24 hours and
she has new, more affordable blood pressure medication prescriptions. She
reports being thankful for the staff that cared for her, and she is motivated to
keep her blood pressure controlled and find a good job to care for her family.
Discussion Questions
- What additional factors should the nurse include in the plan of care for this
client? e.g., age, religion, nursing knowledge, literacy, or
cultural preferences
- Identify potential client problems.
- What findings require immediate follow-up?
- Identify the clients primary problem. Provide rationale for your decision.
- What safety considerations should be included when planning care for this
client? ( a. Fall risk (e.g., medication, age, mobility).
- What education should the nurse provide for this client? a. Self-
care, health promotion, disease management (e.g., medication, diet, activity,
ADLs).
- How will you determine if expected client outcomes are achieved?
- Discuss ways to modify or revise the plan of care when client outcomes are not
met.
Full Answer Section
- Psychosocial Factors: Her anxiety and stress can exacerbate her hypertension and other health problems.
2. Potential Client Problems
- Uncontrolled Hypertension: This is the primary concern, as uncontrolled hypertension can lead to severe health complications.
- Anxiety and Stress: Her emotional distress can contribute to hypertension and other health problems.
- Non-Adherence to Medication: Financial constraints may limit her ability to afford medications.
- Limited Health Literacy: Language barriers and low health literacy can hinder her understanding of health information and self-care.
3. Findings Requiring Immediate Follow-up
- Persistent Hypertension: Despite medication, her blood pressure remains elevated.
- Socioeconomic Factors: Her financial situation and lack of health insurance could impact her ability to access care and adhere to treatment plans.
- Psychosocial Distress: Her anxiety and stress may require additional support and interventions.
4. Primary Problem
The primary problem is uncontrolled hypertension. This condition can lead to serious complications, such as stroke, heart attack, and kidney failure. Addressing this problem is crucial to improve Ms. Fuentes' overall health and well-being.
5. Safety Considerations
- Fall Risk: Due to potential side effects of medications and potential dizziness, fall risk assessments should be conducted.
- Medication Safety: Ensure that Ms. Fuentes understands her medication regimen and potential side effects.
- Home Safety: Assess her home environment for potential hazards, especially if she lives alone.
6. Client Education
- Medication Adherence: Educate her about the importance of taking medication as prescribed, even if she feels better.
- Blood Pressure Monitoring: Teach her how to monitor her blood pressure at home and report any significant changes.
- Healthy Lifestyle: Provide guidance on healthy eating, regular physical activity, and stress management techniques.
- Resource Utilization: Refer her to community resources, such as food banks, social services, and language classes.
- Cultural Considerations: Tailor educational materials and communication strategies to her cultural background and language preferences.
7. Evaluating Client Outcomes
To determine if expected outcomes are achieved, the nurse can:
- Monitor Blood Pressure: Regularly assess blood pressure to ensure it is within target range.
- Evaluate Medication Adherence: Ask Ms. Fuentes about her medication adherence and any side effects.
- Assess Understanding of Health Information: Use teach-back methods to ensure understanding.
- Monitor for Signs of Stress and Anxiety: Be attentive to any changes in her mood or behavior.
8. Modifying the Plan of Care
If outcomes are not met, the nurse may need to:
- Adjust Medication: Consider adjusting the dosage or type of medication.
- Refer to a Specialist: Consult with a cardiologist or nephrologist for further evaluation and management.
- Provide Additional Support: Offer additional support services, such as home health care or social work assistance.
- Re-evaluate the Plan of Care: Regularly assess the plan of care and make necessary adjustments.
By addressing Ms. Fuentes' physical and psychosocial needs, the nurse can help her manage her hypertension, improve her quality of life, and reduce the risk of future complications.