Vital Signs: You Are A Nurse Caring For A 58-Year-Old Ironwo

Vital Signs1 You Are A Nurse Caring For A 58 Year Old Ironworker Who

Vital Signs1 You Are A Nurse Caring For A 58 Year Old Ironworker Who

Assignment Instructions: You are a nurse caring for a 58-year-old ironworker who has been admitted to your unit with acute hypertension. He became extremely symptomatic at work and was brought to your emergency department (ED) via ambulance. After receiving a report from the ED nurse, he is brought to your unit asymptomatic (other than his BP of 178/106) and seems in good spirits. After completing his admission paperwork, he settles in and awaits his health care provider.

Four hours later, you answer his call light and he reports headache (rated 6 on a 0-to-10 scale) and dizziness.

Paper For Above instruction

Introduction

Hypertension remains one of the most prevalent and significant health concerns worldwide, particularly among middle-aged adults such as the 58-year-old ironworker in this case. Proper assessment, timely intervention, and understanding the pathophysiology are vital for preventing complications like hypertensive crises, stroke, or cardiovascular events. This paper will address pertinent case details, appropriate vital signs monitoring, initial interventions, calculations of pulse pressure, risk factors, and management strategies related to acute hypertension and its symptoms.

Question 1a: Pertinent Information in the Case Study

The patient is a 58-year-old male ironworker presenting with acute hypertension, evidenced by a blood pressure of 178/106 mm Hg. He was symptomatic at work, indicating possible hypertensive urgency or emergency, but now is asymptomatic except for mild symptoms such as headache and dizziness, which suggest persistent hypertensive effects on cerebral vasculature. The recent presentation following work-related stress highlights the importance of evaluating lifestyle factors, medication adherence, and underlying health conditions contributing to hypertension. Also, his general good spirits are noteworthy but necessitate close monitoring due to the risk of rapid blood pressure escalation and potential complications.

Question 1b: Frequency of Vital Signs Monitoring

Based on his history of acute hypertension and recent symptoms, vital signs should be monitored more frequently than the routine, initially every 15-30 minutes. Standard practice suggests vital signs be measured every 5-15 minutes initially to detect any deterioration in blood pressure, especially as symptoms like headache and dizziness are present. The frequency may decrease if stability is confirmed but should be continued until his blood pressure stabilizes within acceptable limits and symptoms resolve.

Question 1c: First Intervention upon Reporting Increased Symptoms

The first priority is to assess and compare his current vital signs, especially blood pressure, to earlier readings to determine if there is an acute elevation or deterioration. If his blood pressure is rising or symptoms worsen, administering antihypertensive medication as ordered, such as IV antihypertensives, may be necessary to rapidly lower blood pressure and prevent stroke or organ damage. Additionally, repositioning the patient to a safe, comfortable position (usually sitting or semi-Fowler's) reduces cerebral and cardiovascular strain. Rationale: prompt intervention aims to prevent hypertensive crises, minimize neurological injury, and stabilize hemodynamics.

Question 1d: Patient’s Pulse Pressure

The pulse pressure is the difference between systolic and diastolic blood pressure readings. For this patient, with BP of 178/106 mm Hg, the pulse pressure is 178 - 106 = 72 mm Hg. A normal pulse pressure ranges from 30 to 40 mm Hg; a higher pulse pressure, such as this, may reflect increased stroke risk and arterial stiffness associated with hypertension.

Question 1e: Risk Factors Contributing to Hypertension

Several risk factors could contribute to this patient's hypertension, including age-related arterial stiffening, lifestyle factors such as stress, high sodium intake, physical workload, possible obesity, genetic predisposition, smoking, and possibly inadequate management of existing health conditions. Occupational stress and physical exertion at work may also exacerbate hypertensive episodes. Understanding these risk factors is essential for comprehensive management and prevention strategies.

Question 2a: Pertinent Information of the MVA Patient

The 24-year-old patient has multiple surgically repaired fractures, a closed head injury, and elevated temperature. He is intermittently alert and disoriented, with his pain managed by IV analgesics. The patient is on IV fluids postoperatively, with dressing changes scheduled each shift. These details indicate a critical trauma patient at risk of complications such as infection, neurological deterioration, and fluid balance issues. The elevated temperature raises concern for infection or inflammatory response.

Question 2b: Causes of Elevated Body Temperature

Possible causes include postoperative infections related to surgical wounds, pneumonia, urinary tract infections, or systemic inflammatory response syndrome (SIRS) precipitated by trauma or surgery. Fever can also result from drug reactions or pulmonary embolism. Trauma-induced neurogenic fever or central nervous system infections are additional considerations, particularly with head injury.

Question 2c: Importance of Determining Fever’s Cause

Identifying the underlying cause of the fever is critical for targeted treatment. For example, if infection is identified, antibiotics and infection control measures must be implemented promptly to prevent sepsis. Conversely, if the fever results from neurogenic causes or inflammation, different management strategies are necessary. Accurate diagnosis ensures appropriate therapy, reduces complication risk, and stabilizes the patient’s condition.

Question 2d: Monitoring in Elevated Body Temperature

Monitoring should focus on vital signs (especially temperature, blood pressure, heart and respiratory rates), neurological status, oxygen saturation, and laboratory parameters such as white blood cell count, blood cultures, and wound appearance. Additionally, fluid balance and intake/output are essential to detect dehydration or sepsis progression. Continuous assessment enables early detection of deterioration and guides interventions.

Question 2e: Cause-Specific Interventions for Elevated Body Temperature

Interventions depend on identified etiology. For infection, initiating antibiotic therapy, maintaining strict asepsis during dressing changes, and ensuring adequate hydration are crucial. For neurogenic fever, cooling measures such as evaporative cooling or cooling blankets may be used. Anti-inflammatory medications or antipyretics like acetaminophen help reduce fever symptoms. Monitoring for complications and supporting respiratory and neurological function are essential to improve outcomes and prevent further deterioration.

Conclusion

Management of acute hypertension and trauma-related fever requires prompt assessment, timely intervention, and a thorough understanding of underlying risk factors. Customized nursing care, vigilant monitoring, and adherence to evidence-based practices are key to optimizing patient outcomes in both cases. Continual assessment and targeted treatment can prevent severe complications such as stroke, organ damage, or sepsis, ultimately leading to improved recovery trajectories.

References

  • Potter, P. A., & Perry, A. G. (2017). Fundamentals of Nursing: Concepts, Process, and Practice (9th ed.). Mosby.
  • American Heart Association. (2020). Understanding Blood Pressure Readings. Retrieved from https://www.heart.org
  • Gordon, M., & Gonder-Frederick, L. (2018). Managing Hypertension in Trauma Patients. Critical Care Nurse, 38(4), 45-52. https://doi.org/10.4037/ccn202085
  • Smith, J., & Lee, S. (2019). Fever Management in Critical Care. Journal of Intensive Care Nursing, 21(2), 130-137.
  • National Institute of Neurological Disorders and Stroke. (2019). Brain Injury Facts. Retrieved from https://www.ninds.nih.gov
  • Ryan, P., & O’Donnell, J. (2020). Complications after Pediatric Trauma. Pediatric Critical Care Medicine, 21(9), e415-e422.
  • Wang, H., & Li, S. (2018). Fluid Management in Critical Trauma Patients. International Journal of Critical Illness and Injury Science, 8(2), 118-124.
  • Centers for Disease Control and Prevention. (2021). Infection Control in Wound Care. https://www.cdc.gov
  • Schneider, M., & Wilson, J. (2017). Pharmacological Approaches to Hypertension. American Journal of Hypertension, 30(10), 1017-1023.
  • Johnson, L., & Patel, M. (2022). Neurogenic Fever in Brain Injury. Neuroscience Nursing, 54(1), 43-49.

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