a. Outline the pertinent information within this case study:

In this case study, a 58-year-old ironworker has been admitted to the unit with acute hypertension. He initially became symptomatic at work and was brought to the emergency department (ED) via ambulance. Upon arrival to the unit, he is asymptomatic except for a blood pressure reading of 178/106. Four hours later, the patient reports a headache (rated 6 on a scale of 0 to 10) and dizziness.

b. How often would you expect to measure the patient’s vital signs based on his history?

Based on the patient’s history of acute hypertension and the development of symptoms, it is important to monitor his vital signs frequently. In this case, I would expect to measure the patient’s vital signs at least every 4 hours or more frequently depending on the severity of his symptoms and the response to interventions. This regular monitoring is necessary to identify any changes in blood pressure, heart rate, respiratory rate, and temperature that may indicate a worsening of his condition.

c. What would be your first intervention upon his reporting increased symptoms? Include rationale.

Upon the patient’s reporting of increased symptoms such as headache and dizziness, the first intervention would be to reassess his vital signs and document them. This is important to determine if there have been any significant changes in his blood pressure or other vital signs. The rationale for this intervention is to identify any worsening of his condition and provide timely and appropriate interventions.

d. What is the patient’s pulse pressure?

Pulse pressure can be calculated by subtracting the diastolic blood pressure from the systolic blood pressure. In this case, the patient’s systolic blood pressure is 178 mmHg, and the diastolic blood pressure is 106 mmHg. Therefore, the patient’s pulse pressure is 72 mmHg (178 – 106 = 72).

e. Describe risk factors that could be contributing to your patient’s hypertension.

There are several risk factors that could be contributing to the patient’s hypertension. These risk factors include:

1. Age: As the patient is 58 years old, advancing age is a risk factor for hypertension.
2. Occupation: Working as an ironworker can involve physical exertion and exposure to various pollutants, which may increase the risk of hypertension.
3. Family history: If the patient has a family history of hypertension, he may be genetically predisposed to high blood pressure.
4. Lifestyle factors: Poor diet, lack of physical activity, excessive alcohol consumption, and smoking can all contribute to the development of hypertension.
5. Stress: Chronic stress can lead to elevated blood pressure levels.
6. Medical conditions: Other medical conditions such as obesity, diabetes, and kidney disease can increase the risk of hypertension.

2. As a nurse in a critical care unit, your newest admission is a 24-year-old victim of a motor vehicle accident (MVA). Report from the OR nurse indicates that the patient has several surgically repaired fractures, a closed head injury, and elevated temperature. Additionally, he has IV fluid running postoperatively and dressing changes scheduled every shift. The patient is intermittently alert and disoriented, with his pain adequately controlled by IV analgesics.

a. Outline the pertinent information within this case study.

In this case study, the patient is a 24-year-old victim of a motor vehicle accident (MVA) with several surgically repaired fractures, a closed head injury, and an elevated temperature. He has IV fluid running postoperatively and dressing changes scheduled every shift. The patient is intermittently alert and disoriented, but his pain is adequately controlled by IV analgesics.

b. What factors could be causing the patient’s elevated body temperature?

There are several factors that could be causing the patient’s elevated body temperature:

1. Inflammatory response: The surgical repair of fractures and the trauma from the motor vehicle accident can trigger an inflammatory response, which can lead to an elevated body temperature.
2. Infection: The patient’s elevated temperature could be indicative of an underlying infection, which is common in traumatic injuries.
3. Medications: Some medications, such as certain antibiotics or pain medications, can cause an elevated body temperature as a side effect.
4. Tissue injury: The tissue injury from the fractures and the head injury can lead to an elevated body temperature as part of the body’s healing process.

c. Why is determining the fever’s cause important?

Determining the cause of the patient’s fever is important as it can help guide appropriate interventions. If the fever is due to an infection, timely administration of antibiotics may be necessary. If the fever is due to tissue injury or inflammation, interventions such as pain management and wound care may be indicated. Additionally, identifying the cause of the fever can help monitor for complications or changes in the patient’s condition.

d. Indicate areas that are important to monitor in a patient with elevated body temperature.

In a patient with an elevated body temperature, it is important to monitor the following areas:

1. Vital signs: Frequent monitoring of the patient’s temperature, heart rate, respiratory rate, and blood pressure is necessary to assess for any changes or worsening of the condition.
2. Fluid balance: Monitoring the patient’s fluid intake, output, and electrolyte levels is crucial to ensure proper hydration and to identify any imbalances or dehydration.
3. Infection signs: Assessing for signs of infection such as redness, swelling, warmth, or drainage at surgical sites, wounds, or any invasive lines is important to detect any potential sources of infection.
4. Neurological status: Monitoring the patient’s level of consciousness, orientation, and neurological function is important to assess for any changes or deterioration.
5. Pain: Assessing the patient’s pain level and response to pain management interventions is vital, as pain can contribute to an elevated body temperature.

e. Describe cause-specific interventions useful in treating the patient’s elevated body temperature.

The interventions for treating the patient’s elevated body temperature will depend on the underlying cause. If the fever is due to an infection, interventions may include administering antibiotics, culturing any suspected sources of infection, and implementing infection control measures. If the fever is due to tissue injury or inflammation, interventions may include pain management, wound care, and monitoring for signs of complications such as abscess formation. Additionally, interventions to promote comfort and manage the patient’s anxiety may be beneficial.