The nurse on the intermediate care unit received a change-of-shift report on four patients with hypertension. Which patient should the nurse assess first?
A.
52-yr-old with a blood pressure of 198/90 mm Hg who has intermittent claudication.
B.
48-yr-old with a blood pressure of 160/92 mm Hg who reports chest pain.
C.
43-yr-old with a blood pressure of 172/98 mm Hg whose urine shows microalbuminuria.
D.
50-yr-old with a blood pressure of 190/104 mm Hg who has a creatinine of 1.7 mg/dL.
The correct answer and Explanation is :
The nurse should assess B: the 48-year-old with a blood pressure of 160/92 mm Hg who reports chest pain first.
Here’s why:
Chest pain in a patient with hypertension can be a sign of an acute coronary syndrome (ACS), which includes conditions like myocardial infarction (heart attack) or unstable angina. These conditions are medical emergencies and require immediate evaluation and intervention. A patient with chest pain, even if the blood pressure is not extremely high, may be experiencing reduced blood flow to the heart muscle, which can result in significant damage if not promptly treated. In this case, timely assessment is crucial to rule out life-threatening complications like a heart attack.
Let’s break down the other options:
- A: 52-year-old with a BP of 198/90 mm Hg and intermittent claudication: This patient has severe hypertension and intermittent claudication, which suggests peripheral arterial disease (PAD). While this condition requires prompt management, it does not pose an immediate life-threatening risk like chest pain associated with ACS.
- C: 43-year-old with a BP of 172/98 mm Hg and microalbuminuria: This patient shows signs of early kidney damage (microalbuminuria) due to hypertension, but the condition is chronic rather than acutely life-threatening. Proper treatment is needed, but the patient is stable for now.
- D: 50-year-old with a BP of 190/104 mm Hg and creatinine of 1.7 mg/dL: Elevated creatinine indicates possible renal impairment due to hypertension. This is serious and needs attention but is still a chronic condition that is not immediately life-threatening like chest pain.
In summary, the 48-year-old patient with chest pain (Option B) has the most urgent need for assessment because chest pain can indicate a potentially fatal cardiac event that requires immediate medical intervention.