Question

Which client should the nurse assess first? a client being treated for right side heart failure who has 1+ pitting edema to lower extremities bilaterally and reports a 2 lb (.9 kg) weight gain in the last week. a client with type 2 diabetes requesting medication refills whose a1c level is 5 mg/dl. a client being treated for chronic stable angina who reports a recent increase in chest pain frequency. a client with chronic hypertension whose blood pressure today is 182/98 mm hg?

Answer 1

The client with chronic hypertension with a current blood pressure reading of 182/98 mmHg should be managed first. According to the AHA guidelines for hypertension, this is considered as a hypertensive urgency and should be managed first by having the patient lie down comfortably and reassessing the blood pressure again. If there is no improvement, the patient should be referred to a physician and a rapid blood pressure lowering drug should be given (i.e. Clonidine 75 mcg tablet sublingually up to 3 doses every 15 minutes). The patient with right-sided heart failure with edema can be treated non-urgently or as out-patient with diuretics. The patient asking for a refill can be entertained last.