More Important?

IcantThinkofaName · Nov 19, 2005

:selfbonk: it was a question on my pn boards...eeeek! i dont think im suppose to post that here but i cant help it i need ta know!! h

TheCommuter, BSN, RN · Nov 19, 2005

Keep in mind that joggers and other lean, athletically conditioned types normally have apical pulses that are regular and at a rate of 50 to 68 per minute. This is because their hearts are able to pump blood more efficiently and strongly.

A weight gain of 4 pounds in a rapid amount of time is not normal.

medic2bsn · Nov 21, 2005

This question is very typical of some of the questions I have seen on the NCLEX and still we are getting different answers. I agree that 4lbs. is a considerable amount, but if you consider the question and the "strategies"...ABC's, it seems that checking the pulse is the answer. "napoca" mentioned that and even though I initially said weight gain first, I am now leaning towards checking the pulse. Don't antihypertensives decrease cardiac output? And with a pulse of 56 cardiac output is already decreased.

Also mentioned are alot of "what if's". If the patient is young, if the patient is an athlete. Remember to take the question as it is. Do not read into it.

Just some things I have learned along the way.

Leda · Nov 21, 2005

I may be wrong, but my reading of the OP is, Which assesssment data is most significant in a patient about to receive an "antihypertensive medication?" In other words, which is a potential normal finding and which is not?

Although a pulse rate of 56 is within the accepted range of most antihypertensive medications. The textbook cutoff is

A weight gain of 4 lbs in 24 hours is most likely due to fluid retention. CHF and pulmonary edema are serious and significant side effects of these types of medications. Rapid weight gain precedes the classic findings of CHF and pulmonary edema. Therefore the nurse needs to intervene (notify the MD) so that appropriate treatment measures can be implemented.

So in summary, pulse of 56 is a potentially normal finding and therapeutic effect of the medication. A 4 lb weight gain in 24 hours is a sign of an impending serious side effect (CHF/pulmonary edema).

Therefore, the 4 lb weight gain should be reported first.

medic2bsn · Nov 21, 2005

I believe this to be the entire question.

Pt with heart problems is going to receive an antihypertensive drug. What should be reported first? Apical pulse of 56 or gaining 4lbs in 24 hours?

medic2bsn · Nov 21, 2005

I may be wrong, but my reading of the OP is, Which assesssment data is most significant in a patient about to receive an "antihypertensive medication?" In other words, which is a potential normal finding and which is not?
Although a pulse rate of 56 is within the accepted range of most antihypertensive medications. The textbook cutoff is
A weight gain of 4 lbs in 24 hours is most likely due to fluid retention. CHF and pulmonary edema are serious and significant side effects of these types of medications. Rapid weight gain precedes the classic findings of CHF and pulmonary edema. Therefore the nurse needs to intervene (notify the MD) so that appropriate treatment measures can be implemented.
So in summary, pulse of 56 is a potentially normal finding and therapeutic effect of the medication. A 4 lb weight gain in 24 hours is a sign of an impending serious side effect (CHF/pulmonary edema).

I think we have a final answer. So, I should have stuck with my "first" answer.

anyone else................?

suzanne4, RN · Nov 21, 2005

I would still go with the 4 pounds, a pulse of 56 or even lower is now quite common in the hospital world, with all of the after-load drugs, etc. Any patient on Metoprolol and with a useful amount of drug on board for them, will normally have a lower pulse. A patient with a sudden weight gain like that, not at PMS time, etc., usually can be attributed to problems with their pump, meaning heart.

txspadequeenRN, BSN, RN · Nov 21, 2005

I would say the weight gain most definitly. This is a red flag as a CHF crisis and this patient needs immediate attention. People walk around all day long with pulses of 56.

Sammy25 · Nov 23, 2005

Yeah I definitly agree that there needs to be more information to the question..it looks like the STEM of a question, and not the whole...if that was the only information provided in the question. one would have to go through the general ABC's, and circulation is definitly a priority.... I agree for some clients a heartrate of 56 is normal... so if the patient is doing fine and not feeling weak, dizzy, ect and the pulse has been at a steady 56, then the weight gain needs to be reported. If the client's pulse dropped significantly to 56 in the last hour, then the HR needs to be reported stat.