Question 1 10 pts Scenario George Long is a 41-year-old male who was brought the

Question

Question 1 10 pts Scenario George Long is a 41-year-old male who was brought the emergency department by his wife. The patient’s wife states the patient has been throwing up off and on for the last week and she is concerned because he seems very tired. The patient has a primary doctor but has not been to see his doctor in over a year. Medical records show a longstanding history of hypertension and diabetes. The patient states he feels itchy and tired, but attributes it to his recent nausea and vomiting, stating “It must have been something I ate.” On physical exam, the patient is a well-developed, well-nourished male in moderate distress. Blood pressure 180/110, pulse 80, respirations 24 and he is afebrile. Body weight 76.5 kg. Fundoscopic findings show changes consistent with hypertensive injury. Cardiac exam reveals S1, S2 and S4. The patient has 2+ lower extremity edema and superficial excoriations of his skin from scratching. The remainder of the exam is unremarkable. In review of the objective and subjective assessment data, what is significant? Why is it significant?

Explanation / Answer

Blood pressure of 180/110mm of Hg is an indication of malignant hypertension or hypertensive emergency. This may be associated with acute impairment of more than one organ systems such as the central nervous system, cardiovascular system or the kidneys. The persistent high blood pressure can cause irreversible organ damage.

Papilledema is usually identified during a Fundoscopic examination in malignant hypertension. In the patient, the fundoscopic findings show changes consistent with a hypertensive injury.

The central nervous system shows manifestations of increased ICP manifested as a headache, nausea, vomiting, and/or subarachnoid or cerebral hemorrhage.

Effect of malignant hypertension in kidneys may cause renal failure and present as pathological edema of the lower extremity.

  S4 heart sound often indicates a diastolic heart failure occurs in association with hypertensive emergency.

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