Final answer:
- Emergency orders: Administer IV hydration, monitor vital signs, and start antihypertensive medication (labetalol)
- Physical exam: Check for signs of end-organ damage (e.g., funduscopic examination for papilledema)
- Diagnostic tests: Repeat blood pressure measurements, electrocardiogram (ECG), and head CT scan
- Therapy: Encourage medication compliance and smoking cessation counseling
- Location: Admit to the intensive care unit (ICU) for close monitoring
- Final order: Consult with a neurologist and internist for further management
- Dx: Hypertensive emergency with possible target organ damage
Explanation:
The patient presents with symptoms of hypertensive emergency, including severe hypertension (BP 230/140), nausea, vomiting, blurred vision, and headache. The absence of chest pain and focal neurologic deficits suggests that the patient is not experiencing an acute stroke or myocardial infarction. However, the high blood pressure may still cause end-organ damage, such as retinal hemorrhages or papilledema. Therefore, it is essential to repeat blood pressure measurements to confirm the diagnosis of hypertensive emergency and monitor for any changes. An ECG should also be performed to assess for cardiac involvement, such as left ventricular hypertrophy or ischemia. A head CT scan may reveal intracranial bleeding or edema.
The patient's history of noncompliance with medications and heavy smoking further increases the risk of complications. Therefore, it is crucial to encourage medication adherence and smoking cessation counseling to prevent future hypertensive emergencies. Antihypertensive medication, such as labetalol, should be initiated to lower blood pressure rapidly and prevent further end-organ damage.
Close monitoring in the ICU is necessary due to the high risk of complications associated with hypertensive emergency, such as acute renal failure, congestive heart failure, and stroke. Consultation with a neurologist and internist may be necessary to manage any underlying medical conditions that contribute to the patient's hypertension and noncompliance with medications.