What Should the Nurse Do?

Charlie is a nurse in the emergency department (ED), and his admission just arrived. Jacob has housing insecurity and is well-known to the ED and was brought in by the police for altered mental status. Nursing staff were able to get vital signs monitoring equipment on Jacob, but now he is more agitated and will not let anyone near him. From a distance, Charlie can see that Jacob’s face is flushed, and he appears sweaty and anxious. His vital signs are as follows: BP 160/85 mm Hg, temperature 102.3°F (39.1°C), heart rate 110, respirations 25, and oxygen saturation 96 percent on room air. Which of these vital signs should be most concerning to Charlie? What can he do to obtain additional information?

Laurel is obtaining vital signs on a 75-year-old patient during a wellness visit at the doctor’s office. She notices that the oxygen saturation probe is reading the patient’s SpO₂ level as 87 percent. Assessing the patient, Laurel notes her patient appears comfortable and in no distress; the patient had just been telling Laurel about her granddaughter. What possible reasons can there be for this SpO₂ reading? What should Laurel do?

Markus enters the room to take his patient’s vital signs and notices that the patient’s family is visiting and that they have brought him his favorite chicken noodle soup from home. The patient is laughing and talking with his family. What should Markus consider when taking his patient’s vital signs?

Ahmad has orders to take a series of blood pressures on his patient while lying in bed, sitting at the side of the bed, and standing next to the bed. The doctors are checking to see if the patient’s blood pressure drops as they go from a lying, sitting, to standing position, called orthostatic pressures. When giving directions to his patient, what should Ahmad be mindful of in order to get the best possible readings? What safety considerations should Ahmad keep in mind when performing this assessment?

Aly is checking her patient’s dorsalis pedis pulse and cannot find it either by palpation or with a Doppler. What should she do?

Manuela’s patient is being sent home with a heart monitor and new medication to address a new diagnosis of hypertension and tachycardia. The patient is being directed to record their blood pressure and heart rate once a day. What are some of the important teaching points that Manuela should include in her discharge teaching for this patient?

Lucy’s patient has been educated about the importance of taking their blood pressure medication. At their follow-up appointment, however, the patient states that they have not been taking their blood pressure medication because they “took it for a week” and when they checked their pressure, “it was fine.” What are some questions that Lucy can ask her patient? What can she do to educate them further about their hypertension and blood pressure medication?