CNA344: Clinical Encounter Analysis for Hypotension and Tachycardia

CNA344: Becoming a RN: Practice consolidation
Practice Portfolio of Evidence PART B:Clinical Encounter Analysis
Consider the
patient
situation/context
Provide an overview
of the encounter.
What happened,
how it occurred, etc
what was it that
alerted you to that
fact that you needed
to take action in the
encounter.
(150 words)
I had the opportunity to be involved in the care program of a patient named Mrs. Jane Smith, a 73 year old woman who had been
suffering from headache, dizziness, lightheadedness, and weakness and faintness. She lives alone in her own house and she had
recently lost her husband 8 months ago.
The first care activity that I had been assigned had been checking the vital signs of the patient which was represented a few notable
anomalies. First and foremost, the patient had an alarmingly low blood pressure at 95/70 mmHg. Similarly his heart rate was
accelerated at 120 beats per minute with low oxygen saturation at 93%.
On the observation being complete, it was discovered that she had persistent hypotension and due to the lack of any medical action,
the patient the patient had also developed tachycardia. Both of her conditions required immediate actions being taken to restore
homeostasis in his body and retain normal functionality. Hence, the patient Mrs Smith will require monitoring, surveillance and
treatment to address the pressing care needs and restore optimal health and wellbeing for her.
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Review:what key
information was
already available to
you and how did this
influence your
thinking? (eg:
handover, history,
charts, result of test,
assessments,
medical orders
etc.).
(150 words)
Gather:
What was the new
information you
Review:
Vital signs Observations
Temperature 36.9°C
Heart rate (HR) 120 bpm
Respiratory rate 21bpm
Blood pressure (BP) 95/65 mmHg
Oxygen saturation 93% on room air
Blood Glucose Level (BGL) 4.2 mmol
As per the clinical reasoning cycle, the first and foremost activity for the nurse to proceed for care planning after initial patient
situation consideration, is the recording, reviewing, interpreting and analysing the vital sign data and recognise the care priorities
(Dalton, Gee and Levett-Jones 2015). Critically evaluating the symptoms that Mrs smith had been exhibiting, it was discovered that
her eating and drinking patterns could be affected due to the bereavement she had been suffering after losing her husband and living
alone without any assistance. Self-imposed malnutrition and dehydration is a very common aspect observed in elderly patients,
especially for the elderly patients that are suffering from loss or bereavement. In this case, lack of appetite in the grieving elderly
individuals is associated with early signs of depression, social isolation, lack of social interaction, and most important the lack of will
to live after losing a close relative or family member (Low and Tomalia 2015). As per the vital signs that the patient is exhibiting, she
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gathered from
additional
assessment?
(150 words)
Dot points are fine
for this section
Recall:
Recall and apply
your existing
knowledge to the
above situation to
ensure you have a
broad understanding
of what is/may be
occurring before
proceeding with the
is exhibiting hypotension, dehydration and tachycardia for which she would require specialized or patient centred care.
Relevant medications (where relevant):(not included in word count)
IV paracetamol for headache
Gather:
A very important step in the care planning is thorough assessment based on the vital sign evaluation, the issues observed in the patient
include as follows-
 Condition of oral mucosa – dry mouth and furrowed tongue
 Oral intake – sips only
 Cognitive state – anxious and restless,
 Skin turgor – poor and delayed
 Level of thirst –high feeling of thirst
 Appearance- pale, cracked lips
 Urine – dark, cloudy, smelly
 Last bowel motion- 2 days ago, small amount
Recall:
This is the step where the nurses are required to recall, assess and evaluate the exact conditions that the patient have been suffering
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rest of the cycle.
What was telling
you that the
encounter was
presenting you with
a problem that
required resolution?
(200 words)
Use scholarly,
evidence-based
literature/clinical
guidelines and/or
policy/NSQHS
materials to
substantiate your
from. The three major issues that the patient in this case is suffering from includes hypotension, dehydration and slight tachycardia.
Hypotension can be defined as the clinical state where the patients are suffering from a condition where the systolic blood pressure is
less than 90 mmHg and diastolic blood pressure is less than 60 mmHg for a persistent period. Hypotension is a very common
condition for elderly population and for older adults that are suffering from bereavement or loss are often prone to neglecting self-care
needs and ignoring normal eating habits (Hooper et al. 2015). In this case as well, Jane had been suffering from depression and
overwhelming grief which led her to abandon her normal eating habits which in turn led to dehydration and BGL level drop resulting
in the hypotension in the patient. In this case, if her hypotension persists there is a considerable chance of the patient going into
hypovolemic shock, which if not addressed on an urgent basis can even cause death of the patient. Hence, in this case, it will be the
foremost priority of the patient receiving care would be to raise her blood pressure to 120/80 mmHg within the next 24 hours.
The next most important health issue or challenge for Jane is the tachycardia. It has to be mentioned that she suffered a significant
drop in the blood pressure which indicates at the chance of blood volume reduction through the dehydration and reduction in the
blood flow. This is also known as reflex tachycardia which is caused by the shift in blood volume due to dehydration and unexpected
change in the blood flow. The oxygen deficiency in the body due to hypotension also leads to risk of tissue necrosis which in turn
causes high cardiac output to compensate for the reduced oxygen supply to the tissues. Hence, the next most important care priority
for Jane would be reducing her heart rate to normal level (Kataria and Jacobson 2018).
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