87 Case Study 1: Adult Client (continued)

1. Which findings are considered abnormal for this adult client? What medical terminology is used to define/label these findings?

  • The temperature is higher than expected: hyperthermia/febrile (> 37.3°C)
  • The pulse in lying position is within normal limits, but in the sitting and standing position, the pulse is elevated and is identified as tachycardia (> than 100 bpm)
  • The pulse increased more than 20 bpm and the systolic BP decreased more than 20 mm Hg when the client moved from lying to standing, indicating orthostatic hypotension
  • The pulse is weak and thready at 1+ force, which is abnormal
  • The respiration rate is high: tachypnea (> 20 bpm)
  • The oxygen saturations are slightly low (< 97%)

2. What further assessment should the healthcare provider do based on this adult client’s findings?

Continue to assess for signs of dehydration:

  • Dry mucous membranes
  • Poor skin turgor
  • Decreased and concentrated urine output

3. What actions should the healthcare provider take based on this adult client’s findings?

  • Notify the most responsible provider such as the physician or nurse practitioner.
  • If you are the most responsible provider, discuss and initiate treatments such as fluid rehydration.
Go to the next page to start Case Study 2.


Icon for the Creative Commons Attribution 4.0 International License

Vital Sign Measurement Across the Lifespan - 1st Canadian edition Copyright © 2018 by Ryerson University is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

Share This Book