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20 Nov

RNSG1341-Medical-Surgical Nursing I Theory


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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

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