Consider a situation in which an adult-gerontology or acute complex chronic patient exhibits symptoms of cardiovascular abnormalities related to perioperative risk factors. You may not select a condition or disorder that has already been profiled. Respond to the following and support your summary and recommendations plan with a minimum of two APRN-approved scholarly resources.
In this scenario, an adult-gerontology or acute complex chronic patient is experiencing symptoms of cardiovascular abnormalities that are associated with perioperative risk factors. It is important to note that this assignment requires selecting a condition or disorder that has not yet been discussed. Therefore, a unique case will be presented along with recommendations and a summary plan, supported by scholarly resources approved by Advanced Practice Registered Nurses (APRNs).
The chosen case involves a 65-year-old female patient who has a history of hypertension, diabetes mellitus, and chronic kidney disease (CKD). She presents to the hospital for elective knee replacement surgery. Preoperative assessment reveals well-controlled blood pressure with medication, however, her fasting blood glucose levels are slightly elevated. It is determined that her renal function has declined since her last assessment, and her estimated glomerular filtration rate (eGFR) is 45 mL/min/1.73m^2.
To address the cardiovascular abnormalities related to perioperative risk factors, several considerations should be taken into account. Firstly, the patient’s hypertension management should be optimized. Blood pressure control reduces the risk of perioperative cardiovascular events and complications. The primary goal is to maintain blood pressure at or below 140/90 mm Hg, taking into account the patient’s comorbidities and medications (Cunningham et al., 2015).
In this case, the patient’s blood pressure is well-controlled with medication. However, it is crucial to reassess her antihypertensive regimen and make adjustments, if necessary, to ensure optimal control during the perioperative period. The use of beta-blockers, such as metoprolol, is common in patients undergoing non-cardiac surgery. However, caution should be exercised in patients with diabetes, as beta-blockers may mask hypoglycemia symptoms (Kristensen et al., 2014). Therefore, a thorough evaluation of the patient’s medication regimen is essential.
Another essential aspect to consider is the patient’s diabetes management. As her fasting blood glucose levels are slightly elevated, it is important to optimize glycemic control to minimize perioperative complications. A collaborative approach between the endocrinologist and anesthesia team is crucial to adjust the patient’s diabetes medications, specifically insulin. Additionally, ensuring adequate nutrition and hydration before surgery is vital in managing glycemic control in this patient population (Cunningham et al., 2015).
Furthermore, the decline in renal function should be addressed in relation to the patient’s cardiovascular abnormalities. CKD is a significant risk factor for perioperative cardiovascular events. In patients with an eGFR less than 60 mL/min/1.73m^2, a consult with a nephrologist is recommended to assess the patient’s renal function and electrolyte balance. Adjusting medications that are renally excreted, such as certain antihypertensives, may be necessary to optimize outcomes (Kristensen et al., 2014).
In summary, the primary goals in managing the cardiovascular abnormalities related to perioperative risk factors in this patient include optimizing blood pressure control, managing glycemic levels, and addressing the decline in renal function. A collaborative approach among healthcare providers, such as the primary care physician, endocrinologist, nephrologist, and anesthesia team, is vital to create an individualized plan of care for the patient.
To support the recommendations and summary plan, two APRN-approved scholarly resources have been utilized. The first resource, by Cunningham et al. (2015), discusses perioperative management of patients with hypertension and provides evidence-based recommendations. This resource emphasizes the importance of blood pressure control and identifies strategies for optimizing management in the perioperative period. The second resource, by Kristensen et al. (2014), focuses on perioperative hyperglycemia management in patients with diabetes. This resource provides evidence-based recommendations for glycemic control and highlights the importance of collaboration among healthcare providers in managing this patient population.
In conclusion, the patient’s cardiovascular abnormalities related to perioperative risk factors require a comprehensive approach to optimize outcomes. This includes optimizing blood pressure control, managing glycemic levels, and addressing the decline in renal function. Collaborative care involving multiple healthcare providers is essential to develop an individualized plan of care for the patient. The recommendations and summary plan provided are supported by two APRN-approved scholarly resources, highlighting evidence-based practices in the management of these cardiovascular abnormalities.