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Module 2: Health Promotion and Disease Prevention.

Terms in this set (118)

Assess for focal neurological deficits

Assess for a history of light-headedness, dizziness, and syncope

Discuss with the primary health care provider performing serial troponin levels

Initiate a referral for the diabetes nurse educator and outpatient
endocrinology follow-up

Collaborate with the primary health care provider on prescribing a bilateral carotid ultrasound

RATIONALE:
The carotid arteries are located in the groove between the trachea and sternocleidomastoid muscle, medial to and alongside the muscle. On auscultation, the nurse listens for the presence of a bruit (a blowing, swishing sound), which indicates blood flow turbulence. Normally a bruit is not present, so this finding, whooshing noted over the right carotid artery, necessitates the need for follow-up. Assessing for focal neurological deficits and a history of light-headedness, dizziness, and syncope are important to determine if blood flow to the brain has been compromised as a result of carotid stenosis. A carotid ultrasound should be done due to the detection of a bruit on physical assessment, as well as the risk factors of hypertension, type 2 diabetes mellitus, coronary artery disease, and smoking. Serial troponin levels should be prescribed because of the elevation noted with the first level, as well as consultation with cardiology for further testing to determine if the client experienced a myocardial infarction. The client's serum glucose level and HbA1C indicate poor diabetes control; therefore, the nurse should initiate a referral to the diabetes nurse educator and outpatient endocrinology follow-up. An as needed antihypertensive should not be administered at this time because the blood pressure, although elevated beyond normal levels, is not elevated to the point of requiring additional blood pressure management.
TEST-TAKING STRATEGY:
Focus on the data in the question and determine if an abnormality exists. Use of clinical judgment is necessary in making the decision regarding blood pressure management. Given the context of other clinical findings, as well as the current blood pressure reading, the safest option would be to hold off on administering as needed blood pressure medication.