You (the LPN) are working in an urgent care center on a team with an RN, Physician, and NP.

You (the LPN) are working in an urgent care center on a team with an RN, Physician, and NP.

Purpose

To work in an interdisciplinary team, use critical thinking, and apply emergency nursing interventions within the scope of practice for the LPN.

Instructions

Read the following scenario and answer the questions. A fingerprint indicates a major clue. Make sure you cite all sources using APA format.

The Story:

You (the LPN) are working in an urgent care center on a team with an RN, Physician, and NP. You receive a client (54 year-old-male) who is complaining of acute lower back pain that began four hours ago. The client has no previous history of back pain and denies any recent injury. The client has a history of hypertension and Marfan Syndrome. You perform data collection, and the client’s vital signs are: 174/90, 112, 24, 98.0 PO. You note that the client’s skin is cool and clammy. The RN performs an assessment and notes a pulsatile mass in the client’s abdomen. His lungs are clear, and his pulse is regular. The physician orders two large bore IV’s to be inserted but no IV fluids and nitroglycerine to lower his blood pressure.

Answer the following questions:

Question # 1: What is the significance of the client’s history of Marfan Syndrome? (5-10 sentences)

Question # 2: What vital sign(s) should the LPN immediately report? Why? (5-10 sentences)

Question # 3: What is the significance of the “pulsatile mass” (5-10 sentences)

Question # 4: Why did the physician order IV’s but no IV fluids? (3 sentences)

Question # 5: Why does the client need to have his blood pressure lowered? (3 sentences)

Format

public health
nursing practice

· Standard American English (correct grammar, punctuation, etc.)

· Logical, original and insightful

· Professional organization, style, and mechanics in APA format

· Submit document through Grammarly to correct errors before submission.

Resources

APA Online Guide

· https://guides.rasmussen.edu/apa

· https://guides.rasmussen.edu/nursing/prn1409

You (the LPN) are working in an urgent care center on a team with an RN, Physician, and NP.

**Question #1:**

The significance of the client’s history of Marfan Syndrome lies in the potential implications for his current presentation of acute lower back pain and elevated blood pressure. Marfan Syndrome is a genetic connective tissue disorder that can affect various systems in the body, including the cardiovascular system. Individuals with Marfan Syndrome are at increased risk of developing aortic aneurysms and dissections due to structural abnormalities in the aorta, such as weakness of the vessel wall. Therefore, the presence of Marfan Syndrome raises concerns about the possibility of an aortic dissection as a cause of the client’s back pain and elevated blood pressure. Aortic dissection is a life-threatening emergency that requires prompt recognition and intervention to prevent catastrophic complications such as rupture and hemorrhage. Additionally, individuals with Marfan Syndrome may also have other musculoskeletal manifestations, such as scoliosis or joint laxity, which could contribute to back pain. Therefore, the history of Marfan Syndrome is a crucial piece of information that guides further assessment and management of the client’s condition.

 

**Question #2:**

The LPN should immediately report the client’s elevated blood pressure (174/90 mmHg) and tachycardia (heart rate of 112 bpm). These vital sign abnormalities indicate hypertension and increased cardiac workload, which may be suggestive of an underlying cardiovascular emergency such as an aortic dissection. Hypertension is a significant risk factor for aortic dissection and requires immediate attention to prevent further complications. Additionally, the cool and clammy skin observed by the LPN may indicate poor tissue perfusion, further highlighting the urgency of the situation. Prompt reporting of these vital signs allows the interdisciplinary team to initiate appropriate interventions and escalate the client’s care as needed.

 

**Question #3:**

The presence of a pulsatile mass in the client’s abdomen is concerning for an abdominal aortic aneurysm (AAA). An AAA is a localized dilation of the abdominal aorta, which can lead to the formation of a pulsatile mass upon palpation. In the context of the client’s symptoms of acute lower back pain and elevated blood pressure, the pulsatile mass raises suspicion for aortic pathology, such as an aneurysm or dissection. AAA rupture is a life-threatening emergency associated with high mortality rates, emphasizing the importance of prompt recognition and intervention. Therefore, the presence of a pulsatile mass warrants immediate further evaluation and consideration of emergent imaging studies, such as a computed tomography angiography (CTA) scan, to assess the integrity of the aorta and determine the appropriate course of action.

 

**Question #4:**

The physician ordered IV access but no IV fluids to facilitate rapid administration of medications, such as nitroglycerin, to lower the client’s blood pressure. IV access allows for immediate medication administration and ensures that medications can be titrated quickly to achieve the desired effect. In this case, the physician likely opted not to administer IV fluids initially to avoid exacerbating the client’s hypertension and potentially worsening the cardiovascular emergency. Instead, the focus is on administering vasodilator medications such as nitroglycerin to lower blood pressure and reduce the risk of further complications such as aortic dissection or rupture.

 

**Question #5:**

The client needs to have his blood pressure lowered urgently to reduce the risk of complications associated with hypertension, particularly in the context of suspected aortic pathology. Hypertension increases cardiac workload and arterial wall stress, potentially exacerbating the risk of aortic dissection or rupture in individuals with pre-existing vascular abnormalities such as Marfan Syndrome. Lowering the blood pressure helps to decrease the shear forces acting on the vessel wall and may mitigate the risk of further cardiovascular events. Therefore, prompt intervention to lower the client’s blood pressure is essential to optimize hemodynamic stability and minimize the risk of adverse outcomes.

https://www.health.state.mn.us/communities/practice/research/phncouncil/docs/PHInterventions.pdf