VNSG 1261 CASE STUDY
WEEK 1: Hypertensive Crisis
Scenario
Mrs. Phillips, a 43-year old African American female, presents to the Emergency
Department (ED) complaining of the worst headache of her life. She says it started
about 3 hours ago. She reports taking 1,000 mg of Acetaminophen with no relief.
Upon further questioning, Mrs. Phillips also reports blurry vision. She denies any past
medical history.
1. What initial nursing assessments need to be performed for Mrs. Phillips?
The initial nursing assessment is taking the patients vital signs more importantly her blood
pressure.
Upon further assessment, Mrs. Phillips’ lungs are clear, pulses are 2+ bilaterally in
radial and pedal pulses, S1/S2 are present with no extra sounds. Her vital signs were
as follows:
BP 216/108 mmHg
Ht 162 cm
HR 92 bpm and regular
Wt 107 kg
RR 20 bpm
SpO2 96% on Room Air
Temp 36.9°C
2. What are your top concerns for Mrs. Phillips at this time? Why?
My top concern for Mrs. Phillips is her high Blood pressure, it can lead to a stroke.
3. What medications do you anticipate the provider ordering for Mrs. Phillips?
This study source was downloaded by 100000864555261 from CourseHero.com on 03-27-2023 01:07:17 GMT -05:00
https://www.coursehero.com/file/59637065/WEEK-1-HTN-Crisis-Q-docx/
VNSG 1261 CASE STUDY
I will anticipate that the doctor will have her on Lisinopril to help keep it under control.
The ED provider orders the following:
Blood – CBC, BMP, BNP.
Diagnostics – CT head, CXR.
Interventions – Insert 2 large bore IV’s.
Nasal Cannula to keep SpO2> 92%.
Meds –
o Metoprolol 5mg IV push x 1 dose now.
o Hydralazine 10mg IV push, PRN q1h for SBP >200.
o Morphine 2 mg PRN q4h for pain.
4. Which order would you implement first and why?
I would first implement would be to insert the IV lines, so that I am able to administers the medications
that were ordered.
You initiate two large bore IV’s for Mrs. Phillips and send off blood work. You
administer 5 mg Metoprolol over slow IV push and attach Mrs. Philips to a bedside
cardiac monitor. She is still complaining of 7/10 pain in her head, so you also
administer 2 mg Morphine IV push. You return 30 minutes later to take another set of
vital signs and find the following:
BP 204/102 mmHgPain 7/10 HR 86 bpmSpO2 94% on Room AirRR 14 bpm
Mrs. Phillips’s lab results have also resulted, the following abnormal values were
reported:Glucose 193 mg/dLHgb A1c 9.2%BNP 160 pg/mL
This study source was downloaded by 100000864555261 from CourseHero.com on 03-27-2023 01:07:17 GMT -05:00
https://www.coursehero.com/file/59637065/WEEK-1-HTN-Crisis-Q-docx/
VNSG 1261 CASE STUDY
5. Based on previous orders you have received, what action(s) should you take at this
time? Why?
I would administer the hydralazine and check her blood pressure every half hour or hour.
6. What risk factors have you identified that put Mrs. Phillips at risk for hypertensive crisis?
Mrs. Phillips’ blood pressure after the Hydralazine 10mg IV push went up to 218/110 and her
heart rate went up to 104 bpm. She is transferred to the ICU to be started on a Nicardipine
infusion, which is initiated at 2.5 mg/hr to keep her SBP between 180-200 mmHg.
Her A1c is high, she might be diabetic. Based on her weight it tells us she is over weight and that she is
an African American which puts her at more risk.
Shortly after arriving in the ICU, Mrs. Phillips is no longer able to speak, the right side of her
face is drooping, and she cannot lift her right arm. You check another set of vital signs to find
her BP is 208/112 mmHg, HR 110, SpO2 92%.
7. Why don’t the providers want her SBP going below 180 mmHg at this time?
They do not want her blood pressure to go low at a quick pace. They need to go down gradually.
8. What, physiologically, is going on with Mrs. Phillips at this time?
It looks to be that Mrs. phillps is having a stroke which is paralizing onside of her body.
This study source was downloaded by 100000864555261 from CourseHero.com on 03-27-2023 01:07:17 GMT -05:00
https://www.coursehero.com/file/59637065/WEEK-1-HTN-Crisis-Q-docx/
VNSG 1261 CASE STUDY
This study source was downloaded by 100000864555261 from CourseHero.com on 03-27-2023 01:07:17 GMT -05:00
https://www.coursehero.com/file/59637065/WEEK-1-HTN-Crisis-Q-docx/
VNSG 1261 CASE STUDY
Mrs. Phillips is taken to the OR to evacuate a large subarachnoid hematoma from
around her brain. You inform her family that she has had a hemorrhagic stroke
because of her high blood pressure. After 2 days in the ICU, she has recovered all
movement in her arms, her speech and facial symmetry are normal, and she has
been transitioned from IV nicardipine to PO metoprolol, amlodipine, and
hydrochlorothiazide. She is tolerating these medications well and has been
ambulating to the bathroom easily needed. Her blood pressure is now averaging 140-
150 systolic. She tells you she had no idea that she had high blood pressure, she’s
never been sick or even felt bad until she got the headache. She reports not getting
yearly check-ups because she “felt fine”. She will be discharged on the same
medications tomorrow.
9. What education topics would you want to provide to the patient before discharge?
Mrs. Phillips need to make lifestyle changes in her diet to help her lose weight. She will probably need to
follow a low sodium diet, exercise and be stress-free. She also needs to keep up with taking her
medications every day to help her not get to the state she was in as well.
This study source was downloaded by 100000864555261 from CourseHero.com on 03-27-2023 01:07:17 GMT -05:00
https://www.coursehero.com/file/59637065/WEEK-1-HTN-Crisis-Q-docx/
Powered by TCPDF (www.tcpdf.org)
