You are called at 2AM by the nurse taking care of Mrs. O’Brien, a 72 y/o female, who is now POD #2 from an ORIF of her left hip. The nurse reports that Mrs. O’Brien’s BP is 185/100, and she wants to know what you want to do about the elevated BP reading. You look at your sign-out (cross-cover) sheet: Mrs. O 72y/o fem POD2 s/p ORIF soft diet RA NTD (nothing to do)
See question #1.
The nurse reports a HR of 90, T 98.8F, and RR 22. Prior to seeing the patient, you take a brief inventory of the patient’s chart.
See question #2.
The patient had been on a Clonidine patch and a sleeping pill prior to hospitalization, but she is not on any antihypertensives currently. She was transitioned from a Morphine PCA this AM to scheduled analgesia. The nursing notes reveal no requests for additional pain medicine and no acute events during the day and early evening, Further history in the Admit note shows that Mrs. O suffers from dementia and moderate hearing loss. After reading through the chart, you begin to evaluate her. She denies any pain, but she does note some difficulty sleeping. Her BP is elevated, but her other vital signs are normal. Her neurological, cardiovascular, and pulmonary exams are normal, too.
See questions #3-4.