2d • General discussion
QOD Answer/Response 8/26
Question: BP during well check is 166/101. What is your next step?
I ask a lot of questions when you post an answer. These are to push you out of your comfort zone and move your thought process from RN to NP.
A few thinks about this one. I make these vague on purpose. Your interview and assessment are the most important parts of a patient interaction. You need to learn how to ask the right questions.
A few things important about this patient are:
History Information
Age/Sex/History/Family History- it's important to assess all of these things before anything else
Medications/drug use/caffeine or energy drink use (don't ask how much caffeine I drink a day!)
Activity/Movement/exercise tolerance
Assessment
Recheck BP on both arms
What other findings are important (nosebleeds, headaches, chest pain, shortness of breath)
Physical exam findings (edema, murmur, neuro deficits, eye exam (cotton wool spots)
Work Up
Blood pressure logs
Risk factor scores
Labs (thyroid, lipids, CMP)
If murmur or signs of heart failure echo?
Stress test for anginal symptoms
Intervention
Lifestyle changes
Per AHA guidelines this patient needs 2 medications from 2 different classes
Guidelines are just that, but if you deviate from guidelines, you MUST document why
(Example Documentation: patient takes no medications and no BP logs available. Will start on lisinopril today but will follow up in 4 weeks. Patient will keep daily BP logs and if BP is sustained over 150/90 for more than 2 readings will follow up sooner. If this patient has a stroke and guidelines were not followed AND there isn't any rationale that will be a mess!)
Anything else you would add? Please share it in the comments!
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QOD Answer/Response 8/26
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