The Professional Practice

Professional Practice 1
Professional Practice
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Professional Practice 2
CNA253 AT2 Scenario: Mrs Gwen Boren
Interpret:
Normal (Subjective & Objective) Abnormal (Subjective & Objective)
RR 21
SpO 99%₂
BP 170/95mmHg (Reference range 90/60mmHg-
120/80mmHg)
Pulse 108bpm (Reference range 60-80bpm)
CRT 5seconds (Reference range ≤ 2seconds)
Relate & Infer:
The patient had a fracture on the left lateral malleolus due to the underlying conditions which
she was having, which include; hypertension and cerebrovascular accident. The patient is said
to have hypertension because of the elevated blood pressure blood which was measured and
found to be 170/95mmHg (Mozaffarian et al, 2016, pp. 38-45). Since the patient had been
diagnosed of cerebrovascular accident before, this must have contributed to the fracture and
explains why the patient fell. Patients with stroke are more susceptible to bone fractures this is
because they have fragile bones and low bone mineral density. The patient has been using a
walking frame to get around, it was easy for her to lose balance and this indicates that the
patient is also physically unstable hence prone to fall. Due to the fracture the patient could
move her leg actively but with pain. The patient has elevated blood pressure that is
170/95mmHg which is above the expected reference range of 120/80mmHg (Zhao et al, 2016
pp.270-280). The hypertension must be due to the mid left-brain injury. The injury might have
caused blood vessel damage hence the increased blood pressure. The patient right have
develop a weakness on the right side of the body due to injury to the left side of the brain and
this may explain the unwitnessed fall. The patient confusion and amnesia were also brought

Professional Practice 3
upon by the injury of the brain. The patient capillary refill time was 5 seconds, this was
prolonged compared to the normal capillary refill time which is less or equal to 2 seconds. The
reason for prolonged capillary refill time may suggest that the patient is having a peripheral
artery disease. CRT is the visual inspection of the returning of blood to distal capillaries after
blanching. The upper limit of CRT measurement has been defined as 2 seconds. In the
presence of severe shock and other neurological conditions capillary refill time may be
prolonged (Shinozaki et al,2019, pp.259-267). Pulse rate of the patient was also high, 108bpm,
this was as a result of stress. The patient was reluctant, confused and also in pain. This
situation imparted stress on the patient therefore resulting to increase pulse rate. Normally,
heart rate is expected to increase during exercise or physiological response to trauma, illness or
stress (Hayase, 2020, pp.1-14). But in this case the patient heart beat remained quicker even
when the patient was at rest. This could be due to hypertension, brain injury or inflammation
in her lower limb. The reference range of heart beat is usually 60 to 100 beats per minute
(Wallis, Healy and Maconochie, 2005, pp.1117-1121). Increased heart beat can be due to
tachycardia. This is where normal electrical impulses that control the action of heart to pump
blood is disrupted by condition such as high blood pressure, psychological stress and damage
of heart tissue among others. Due to mild left-brain injury, the patient right lower limb was
affected. This explains why the patient fell. The left brain controls the right side of the body
hence mild injury to the left-brain leads to mild right sided weakness.
Predict:

Professional Practice 4
When hypertension goes untreated it may lead to many adverse effects which include:
damage/narrowing of the blood arteries, blood clots formation in the arteries of the brain
which in turn leads to stroke and permanent brain damage hence paralysis of the entire body
can occur. Damage of the arteries which supply the brain with blood brain can lead to
dementia and memory loss. Heart attack and heart failure can also occur due to damage to the
arteries, pulmonary oedema due to backflow of fluid to the lungs as a result of impaired
pumping of blood by the heart can also occur when hypertension goes untreated (Doiron,
Langlois, Dupré and Simard, 2017, pp. 94-100). when the arteries are damaged and there is
inadequate supply of blood to the brain due to loss of elasticity of the blood vessel, it can result
to hypoxia. If the patient fracture goes untreated, she might develop various complication such
as permanent nerve damage, bone deformity may even develop ataxia on the place where the
fracture had occurred (Rahmawati and Bajorek,2018, pp.228-240).
Develop, Articulate and Prioritise Nursing Diagnoses
Diagnosis 1: Hypertension
Diagnosis 2: mid left sided brain injury
Diagnosis 3: Tachycardia
Goals, Actions and Evaluation
Diagnosis 1 Goal/Desired
outcome/s
Related actions Rationale Evaluate
outcomes
Lower blood
pressure to
the reference
Administering
therapy and
administering
Combination of
therapy and
administration of
In order to
evaluate the
benefit of my