The nurse assists with care of a confused patient who presents to the emergency department with stroke symptoms. Vital signs are blood pressure 174/100 mm Hg. pulse 64 beats per minute, and SpO2 88% on room air. Which nursing intervention is priority?

Has the patient been taking his medications as prescribed? This is the most important information to collect. Understanding the patient's medication adherence is crucial because if the patient is not taking his medications as prescribed, it could explain why his blood pressure is elevated. Noncompliance with medication regimens is a common cause of hypertensive urgency and can lead to severe complications. Therefore, knowing whether he has been taking his medications regularly and correctly would directly influence the management plan and help identify the cause of the current crisis.

Does the patient hurt anywhere else? While it’s important to assess for pain and discomfort to address immediate symptoms, this information does not directly address the potential cause of the elevated blood pressure. The patient already reported pain in the head, chest, and left leg, so the primary concern is managing his hypertensive urgency and understanding its underlying causes rather than identifying additional pain locations at this moment.

When does the patient take his furosemide? Knowing the timing of furosemide intake could provide insights into his diuretic therapy management and its potential impact on his blood pressure. However, it is less immediately relevant than understanding whether he has been taking all his medications as prescribed. This question might be more pertinent once medication adherence is confirmed to understand diuretic effects throughout the day.

Has the patient fallen before? This is relevant for assessing the risk of recurrent falls and potential underlying issues such as orthostatic hypotension or balance problems, which are crucial for long-term management and safety. However, it is not as immediately critical in the context of the current hypertensive urgency and the elevated blood pressure despite medication.

A. Use a picture board.: A picture board can help patients with expressive aphasia communicate their needs and thoughts visually, bypassing their difficulty with verbal expression.
B. Provide pencil and paper.: Providing pencil and paper allows the patient to write down words or draw pictures, which can facilitate communication.
C. Obtain an interpreter.: An interpreter is not necessary unless the patient has a language barrier in addition to aphasia. Aphasia is a language disorder resulting from brain damage, not a problem with understanding different languages.
D. Speak slowly and clearly.: Speaking slowly and clearly can help the patient understand what is being said, which is important as they may have difficulty processing spoken language.
E. Speak loudly.: Speaking loudly is unnecessary and can be counterproductive. The issue with expressive aphasia is not related to hearing but to the ability to express thoughts through speech.