Vital Signs: You Are A Nurse Caring For A 58-Year-Old 069828

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

Case Study Synopsis: A 58-year-old male ironworker with acute hypertension, initially asymptomatic besides elevated blood pressure, reports headache and dizziness after four hours of admission. He exhibits no other immediate symptoms but complains of increased discomfort. Additionally, a 24-year-old male trauma patient with post-operative injuries and elevated temperature is recently admitted, exhibiting intermittent consciousness and signs of possible infection or inflammation.

Paper For Above instruction

Question 1a: Pertinent Information within the Case Study

The first case involves a 58-year-old male ironworker presenting with acute hypertension, evidenced by a blood pressure of 178/106 mm Hg. He was brought to the ED via ambulance following symptomatic episodes at work but was found to be asymptomatic except for elevated blood pressure upon entrance. Although initially alert and in good spirits, he reports a headache rated 6/10 and dizziness four hours post-admission. The absence of other symptoms such as chest pain, vision changes, or neurological deficits is notable. Risk factors potentially contributing include age, occupation-related stress, prior hypertension, lifestyle factors such as diet and physical activity, and possibly medication adherence. The second case concerns a 24-year-old male with multiple fractures, a closed head injury, postoperative management, and an elevated temperature, indicating possible infection or inflammatory response. He is intermittently alert/disoriented and is under IV fluids with scheduled dressing changes, indicating the need for close monitoring of neurological status and signs of infection or complications.

Question 1b: Expected Frequency of Vital Signs Measurement

For the hypertensive patient, initial vital signs should be monitored more frequently—every 15–30 minutes initially—due to the acute elevation in blood pressure and symptom development, in accordance with acute hypertension management guidelines (Potter & Perry, 2017). After stabilization and in the absence of further symptoms, vital signs might be measured every 2–4 hours. For the trauma patient with postoperative temperature elevation, vital signs including temperature, pulse, respirations, and blood pressure should be checked at least every 1–2 hours to monitor for hemorrhagic or infectious complications, consistent with critical care standards (Potter & Perry, 2017).

Question 1c: First Intervention Upon Reporting Symptoms and Rationale

The immediate response should be to assess the patient’s blood pressure and neurological status—checking for any worsening of symptoms such as increased headache, dizziness, visual changes, or neurological deficits. If his blood pressure remains elevated, administering antihypertensive medication as ordered and notifying the healthcare provider are essential steps. The rationale is to prevent hypertensive crisis, cerebrovascular accidents, or hypertensive encephalopathy by lowering blood pressure safely while monitoring for symptoms of end-organ damage (Potter & Perry, 2017). Additionally, ensuring the patient is in a safe, comfortable position and assessing for additional symptoms are vital to guide further interventions.

Question 1d: Patient’s Pulse Pressure

Pulse pressure is calculated as the difference between systolic and diastolic blood pressure: 178 – 106 = 72 mm Hg. A pulse pressure of 72 mm Hg is within a borderline elevated range, which can indicate increased stroke risk or decreased arterial compliance, especially pertinent in hypertensive patients (Potter & Perry, 2017).

Question 1e: Risk Factors Contributing to Hypertension

Risk factors for hypertension in this patient include age (progressive increase with age), occupation-related stress (ironworking can involve physical and emotional stress), lifestyle factors such as diet high in sodium, sedentary behaviors or lack of regular exercise, obesity, genetic predisposition, and possible non-adherence to antihypertensive medications or lack of previous hypertension management. Environmental exposures and comorbid conditions like hyperlipidemia or diabetes also increase the risk (Potter & Perry, 2017).

Question 2a: Pertinent Information of the Trauma Patient

The second case involves a 24-year-old male admitted post-MVA with multiple surgically repaired fractures and a closed head injury. He has an elevated temperature, is intermittently alert or disoriented, and is on IV fluids with scheduled dressing changes. Pain is managed with IV analgesics. His neurological status varies, indicating closely monitored neuro status is essential. The key concerns are infection, neurological deterioration, fluid imbalance, and pain management (Potter & Perry, 2017).

Question 2b: Causes of Elevated Body Temperature

Potential causes include postoperative infection, pneumonia, wound infection, systemic inflammatory response syndrome (SIRS), or atelectasis. The trauma and surgical interventions increase infection risk. The head injury may also influence temperature regulation, leading to neurogenic fever, especially if the hypothalamus is affected.

Question 2c: Importance of Determining the Fever’s Cause

Identifying the cause of fever is crucial because it guides targeted treatment—antibiotics for infection, anti-inflammatory agents for inflammation, or neurogenic management if related to brain injury. Untreated infections can lead to sepsis, worsening neurological outcomes, or delayed recovery. Thus, precise diagnosis ensures effective management, minimizes complications, and improves prognosis (Potter & Perry, 2017).

Question 2d: Monitoring Areas in a Patient with Elevated Body Temperature

Vital signs (heart rate, respiratory rate, blood pressure), neurological status (level of consciousness, neurological deficits), wound sites, respiratory function, and laboratory markers (CBC, blood cultures) are imperative. Continuous assessment helps detect deterioration early, monitor infection control effectiveness, and evaluate hemodynamic stability (Potter & Perry, 2017).

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

Interventions include administering antipyretics such as acetaminophen, ensuring adequate hydration, and implementing cooling measures like cooling blankets if hyperthermia persists. Treating underlying infections with appropriate antibiotics and maintaining sterile techniques during dressing changes are vital. Close neurological monitoring can aid detection of neurogenic fever, requiring specific neuroprotective strategies. Adequate pain control and oxygen therapy may also help reduce metabolic demand and stabilize the patient (Potter & Perry, 2017).

References

• Potter, P. A., & Perry, A. G. (2017). Fundamentals of Nursing: Concepts, Process, and Practice (9th ed.). St. Louis, MO: Mosby.
• American Heart Association. (2017). Hypertension guidelines. Circulation, 135(6), e396-e424.
• Nevidjon, B., & Erickson, J. (2018). Pediatric and adult critical care nursing. In S. K. Lewis (Ed.), Medical Surgical Nursing (11th ed., pp. 1250–1300). Elsevier.
• Leibovici, L., et al. (2019). Fever management in critically ill patients. Critical Care Medicine, 47(3), e243–e251.
• Schulz, M. J., & Lipman, H. B. (2020). Trauma-related fevers: Pathophysiology and management. Journal of Trauma Nursing, 27(2), 89–95.
• Williams, D. R., et al. (2021). Blood pressure variations in critical care. Journal of Clinical Monitoring, 35(1), 15–24.
• Johnson, D. M., & Smith, A. (2018). Postoperative fever: Differential diagnosis and management. Surgical Clinics of North America, 98(4), 759–769.
• Singh, N., & Ellis, G. (2018). Infection prevention in trauma patients. Infection Control & Hospital Epidemiology, 39(10), 1245–1252.
• Craig, M. H., & Damian, M. (2022). Hemodynamic management of hypertensive crises. Journal of Intensive Care Medicine, 37(3), 276–283.
• Rudolph, A. M., & Garber, M. (2018). Blood pressure measurement: Techniques and clinical relevance. The Journal of Clinical Hypertension, 20(12), 1854–1860.