Health problems associated with untreated hypertension include heart attack and stroke that results from hardening and thickening of blood vessels due to high blood pressure. It also cause blood vessels to be weak and bulge causing what is called aneurysm which it rupture can cause instant death. Pumping blood against the high pressure causes the heart to overwork causing left ventricular hypertrophy eventually leading to heart failure. It also leads to kidney failure due to weakened and narrowed blood vessels in the kidneys preventing the kidneys from functioning normally. A person may also develops metabolic syndrome to include low high density lipoprotein and high insulin levels leading to diabetes. Memory loss or difficulty in understanding due to narrowed or blocked arteries that limits blood flow to the brain.

African Americans adults are at higher risk of getting high blood pressure and they often develop it due to genetics meaning it runs in the family, obesity, poor diet, physical inactivity, alcohol abuse and cigarette smoking.

Albuterol and corticosteroids were administered because the child presented with frequent flare ups and had asthmatic attack. Albuterol is used to prevent bronchospasms in asthmatic patient. Its adrenergic bronchodilators that is inhaled via the mouth to open up bronchial tubes in the lungs relieving cough, wheezing and dyspnea by increasing the flow of air through the bronchial tubes. Corticosteroids are mainly used to reduce inflammation.

Common side effect that a patient taking albuterol should know includes fast irregular pounding heartbeat or pulse, shaking of legs, arms, hands or feet and trembling.

The negligence actions of the hospital staff includes not assessing the patient for more than an hour on arrival in the pediatric intensive care unit and also delayed to start albuterol breathing treatment for an an hour and intravenous medication for two and a half hours as prescribed by attending physician. The hospital staff also discontinued the oxygen and albuterol for almost an hour while transferring the patient from pediatric intensive care to adult respiratory floor and the transfer was also done without consulting with the attending physician or obtaining orders and did not comply with hospital policies in that before transporting the patient the hospital staff was required to ascertain that the room was ready and equipped to dispense the oxygen and albuterol.

The nurse would have assessed the patient on arrival, administer albuterol breathing treatment and intravenous medication immediately and continued with administration of oxygen and albuterol without stopping. The nurse would have also ascertain that the adult intensive care room was ready and equipped to dispense oxygen before transferring the patient there and consult the physicianfirst before the transfer.

NPSG.03.05.01 is a nursing care center national patient safety goal number three that deals with reducing the likelihood of harm to patients and residents associated with the use of anticoagulant therapy. The rationale for NPSG.03.05.01 is that anticoagulation therapy can be used as therapeutic treatment for number of conditions most common which are atrial fibrillation, deep venous thrombosis, pulmonary embolism, and mechanical heart valve implant. However anticoagulant medications are more likely to cause harm due to complex dosing, insufficient monitoring and inconsistent patient or resident compliance. This national patient safety goal has great potential to positively impact the safety of patients and residents on this class of medications and result in better outcomes.

Patient/resident/family education should include importance of follow up monitoring, drug compliance, drug-food interactions and the potential for adverse drug reactions and interactions.

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