Hypertensive Crisis: Case Study & Analysis

Objective 1: Possible Contributing Conditions to Mildred James's Headache

Hypertensive Crisis

The student is responsible for completing this case study paper utilizing the following 8 (8) objectives.  The student will compose a 3-4 page paper (not including the cover page and the reference page) that will answer each of the objectives.   This assignment must be typed, utilizing proper APA format and at least 3-4 reference materials (medical surgical books, nursing journal articles, diagnostic and laboratory books, etc.). Due date – Wed/Thurs or the next clinical day.  This assignment is part of your clinical care plan grade.

Mildred James, a 64 year old African American Female came to the emergency department at 2200 hours complaining of a severe headache. She complained of visual problems and rated her pain as a 10 (on a scale of 1 to 10). Her husband states that she woke at 0200 complaining of a severe right side headache. Despite taking Tylenol (Acetaminophen), she continued to have symptoms all day. Upon her arrival the nurse noticed some difficulty with speech; her initial vital signs were as follows

BP - 227/130 mm/Hg

Temperature - 37.2 degree Celsius (99 degree F) orally

Heart rate - 72 bpm

Respiration - 24 breaths/min

Sa02 - 98% on room air

Mrs. James has a previous history of myocardial infraction, coronary artery bypass surgery (CABG) several years ago; she has a history of depression which was treated with electroconvulsive therapy and a deep vein thrombophlebitis which required insertion of a filter. Home medication includes aspirin, niacin metoprolol (Toprol-XL) and lorazepam (Ativan). The following are results obtained from diagnostic testing:

Glucose - 151 mg/dl                                    Total Protein – 7.5 g/d

BUN – 20 mg/dl                                          Albumin – 4.0 g/dl

Creatinine – 0.8 mg/dl                                 Bilirubin – 0.5 mg/dl

Na – 139 mmol/L                                        AST – 30 u/L

K – 3.8 mmol/L                                           ALKP – 80 u/L

Cl – 104 mmol/L                                         C02 – 24 mmol/L

Ca – 8.9 mmol/L

Electrocardiogram (EKG) showed some nonspecific changes. A computed tomography (CT) scan of the head was ordered with negative findings

 Emergency department Treatment Record

2217 - Mrs. James was treated with Enalapril (Vasotec) 1.25mg given intravenously (IV) for elevated blood pressure 238/100 mm/Hg right arm

2230 - Nalbuphine (Nubain) 10mg with promethazine (Phenergan) 12.5mg given IV for complain of nausea and continued headache

2245 - Enalapril (Vasotec) 4mg given IV for BP 238/100 mm/Hg left arm

2253 – BP 216/64 left arm Morphine sulfate 1mg given IV

0010 - Clonidine (Catapres) 0.2 mg given orally for BP 216/66 mm/Hg

0100 – Mrs. James becomes unresponsive and had a seizure activity

1010 – Lorazepam (Ativan) 10 mg given IV

0230 – BP 117/67 mm/Hg, HR 96 b/m

After Mrs. James awakened, she was transferred to Intermediate/telemetry unit

Her admitting diagnosis wad hypertensive crisis, cephalgia and new onset seizure

Answer the following Questions

1.Based on her presenting symptoms and admission assessment, what other possible conditions could be contributing to her headache? Explain with rationale.

2.Which of her lab values and diagnostic test were significant? Explain with rationale.

3.When obtaining a blood pressure reading, what factors and conditions can hinder correct assessment? Give rationale for your answers.

4.What clinical guidelines are established for the prevention and treatment of hypertension?

5.What is the classification system for blood pressure in adult?

6.Explain the relationship between Mrs. James’s hypertensive crisis and her new onset of seizure.

7.List the nursing diagnosis and interventions appropriate for the care of a patient in hypertensive crisis?

8.Describe the type of diet this patient should be prescribed and why, include food choices that should be included and what type of food should be avoided for a patient with hypertension