S: PaFent is a 91 y/o female who has been diagnosed
with a hypertensive emergency with blood pressure
of 250/115. PaFent reports no current chest pain or
pressure. PaFent is a DNR/DNI.
B: PaFent was brought into the ED on 11/12 aWer she
had complaints of difficulty walking for two days that
was worsening. Pt. was ambulaFng in the hallway of
her home and became light headed with mild chest
pain. PaFent called 911 for help and EMS recorded
her blood pressure to be 230/114. PaFent was given
Labetalol 10 mg IV, 325 mg po aspirin and Nitropaste
1 in applied to the chest. TEE showed slight
depressions of the ST segment depressions resolved
with Labetalol. PaFent is not currently on Labetalol.
A: PaFent has HR of 69, BP 126/55, SpO2 97%, temp
36.7 C, pain 0. PaFent is on room air, lungs
diminished in lower lobes. Upper lobes are clear and
equal bilaterally. Heart rate and rhythm is normal. +1
edema in lower extremiFes. PaFent is a stand by
assist with walker with no problems using the
restroom. Last bowel movement was 11/13. Bowel
sounds normal in all 4 quadrants.
R: Pt’s blood pressure must be maintained at pt’s
baseline. Pt. must be educated about lifestyle factors
and exercise to decrease the chance of further
atherosclerosis. Pt. must be educated when to
contact emergency services if feeling light headed or
prolonged chest pain.
Medica5ons
Aspirin—> NSAID for analgesia, anF-platelet,
anFpyreFc properFes. 81 mg, oral, once daily
Rocephin—> cephalosporin anFbioFc. 2g in
water for injecFon IV q24h
Enoxaparin (Lovenox)—> low molecular weight
heparin. 40 mg, IV, daily
Lasix (furosemide)—> loop diureFc. 20 mg IV
daily
Conceptual Care Map Lab Values/Diagnos5c Tests
Sodium 142 Potassium 4.1 Chloride 107 Total CO2 26
Student Name Courtney Crawford Anion gap 9 Glucose 117 Calcium 8.5 BUN 14 CreaFnine
0.67 GFR 82 Troponin .07. WBC 12,000. Urine Culture:
Age 91 Gender Female Admission Date 11/12/2023 posiFve
CODE Status DNR/DNI Allergies NKA Braden Score 21 Treatment/Procedures
Transthoracic Echocardiogram. Results: EjecFon
Diet Cardiac Diet AcFvity Stand by assist with walker
FracFon of 55-60%
Weight 88.9 kg Height 5’6 Religion ChrisFan CT scan of the head without contrast. Results: no
acute intracranial abnormaliFes
IV Therapy: LeW peripheral IV
X ray showing mild edema
Admi8ng Diagnosis/Chief Complaint
Risk Factors
Hypertensive Emergency with BP 250/115 Risk of in-compliance to treatment plan due to hx of
untreated medical list
Path Flow Flow
Patho Diagram
Diagram Risk for falls (no walker at home)
Lives with 2 sons in Valor, ID (rural)
Unhealthy lifestyle factors such as poor diet high in sodium,
cholesterol and fat can increase the blood flow through your arteries, Interdisciplinary Collabora5on
resulFng in high blood pressure (NIH, 2022). Atherosclerosis OccupaFonal Therapy (in need of at home walker)
(hardening of the walls of the artery) is common with advanced age.
Hospital Chaplain
When arteries become narrow and grow sFff, the force in which
TTE technician
blood moves through the arteries increases, resulFng in hypertension
Radiology (CT scan & X-ray)
(Alexander, 1995). Untreated, chronic hypertension puts increased
stress workload on the heart which can make the heart muscle less Psych./Soc./Economic Data
effecFve in perfusing all areas of the body. Non-compliance and an Lives in rural Valor ID, does not seek medical
increased heart rate (such as ambulaFng) adds addiFonal stress on tx regularly. No hx of psychosocial or
the heart’s ability to funcFon. Over Fme, the heart cannot maintain psychological problems. No apparent
this increased stress, leading to a lowered ejecFon fracFon and problems with economics. 2 sons are pt.’s
potenFal heart failure (Alley & Schnick, 2023). A low ejecFon fracFon caregivers who are farmers. Sons report
being their mothers primary caregivers has
puts the body at risk for organ failure due to decreased perfusion to
“been a joy”. PaFent is widowed with no
all organs and systems.
addiFonal family in Valor.
Discharge Teaching Needs
Past Medical/Surgical History Importance of follow up appointments &
seeking healthcare when necessary
Hx of untreated HTN, concern for HF and acute cysFFs. No previous surgeries.