The nurse is preparing for a home visit to a patient with an external fixation device of the lower extremity. What priority care is anticipated?

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.

Condition the Patient is Most Likely Experiencing:

Intracerebral Haemorrhage (ICH) : The patient presents with a severe headache, lethargy, decreased level of consciousness, and slurred, incomprehensible speech, which are common signs of a stroke or intracerebral haemorrhage. A history of hypertension and atrial fibrillation increases the risk for both ischemic and hemorrhagic strokes. The use of apixaban, an anticoagulant, suggests the patient is at risk for bleeding complications, including intracerebral haemorrhage.

Interventions to Perform/Anticipate:

1. Perform a CT Scan of the Head:
   • Rationale: A CT scan will help determine if there is bleeding or an ischemic event in the brain. It is crucial for differentiating between ischemic and hemorrhagic stroke, guiding subsequent treatment.
2. Administer Intravenous Antihypertensives:
   • Rationale: Controlling blood pressure is critical to reduce the risk of further bleeding in the brain. Immediate BP management is essential in the acute setting of suspected stroke.

Parameters to Monitor:

1. Neurological Status:
   • Rationale: Monitoring changes in the patient’s level of consciousness, pupil reactions, and motor response will help assess the progression of the neurological deficit and effectiveness of interventions.
2. Blood Pressure:
   • Rationale: Maintaining blood pressure within a safe range is essential to prevent exacerbation of the hemorrhage. Hypertension management is key to avoid further complications.