Question: Situation: 18 Year Old Male, Brought In By Ambulance Following An Alleged Altercation Where Patient Struck Head On Road Curb At 2300 Hrs. Patient Is Denies Loss Of Consciousness But Unable To Recall All Events. Patient Appears Alert But Teary And Takes A Couple Of Moments To Answer Questions. On Examination, 4cm Laceration Noted With Slow Ooze From …

Situation:

• 18 year old male, brought in by ambulance following an allegedaltercation where patient struck head on road curb at 2300hrs.
• Patient is denies loss of consciousness but unable to recallall events. Patient appears alert but teary and takes a couple ofmoments to answer questions.
• On examination, 4cm laceration noted with slow ooze from wound.Dressing insitu. Vital signs and GCS recorded at 2325 hrs as perchart. No other obvious injuries.
• Patient denies drug use, states has had approximately ‘fivebeers since 7pm’. Breath alcohol taken at 2330 hours 0.06%.
• Patient reports pain to be 5/10 at occipital region, noanalgesia taken prior to presentation.
• Patient states is usually fit and well.

Past medical history

Childhood asthma, up-to-date with immunisations (last tetanus 12months ago).
Not on any medications and no known allergies.

Intervention:

• The decision is made to keep Zac in hospital overnight, forobservation.
• Paracetamol is charted for pain. No other medications arecharted.
• Vital signs and neurological observations to be undertakenhourly.

You are the nurse who is allocated to care for Zac. Youreview all Zac’s documentation and go to attend his observations at0700. You gather the following data:

Vital signs:

• BP: 146/98 mmHg
• Pulse: 106 bpm
• RR: 18
• Sp02: 98%
• Temp: 37.3C
• Pain: he mumbles that his “head is hurting”, but cannot ratethe pain; he is holding his head with his hands

Neurological Assessment:

• Best Eye Response: Eye opening to verbal stimuli
• Best Verbal Response: Confused
• Best Motor Response: Obeys commands – slow to respond
• Pupils: Right – size 3 mm, sluggish reaction; Left – size 3 mm,sluggish reaction
• Limb Movements: Left arm only – normal power; Bilateral legs -normal power

Question: At 0700, Zac is presenting with elevated bloodpressure.

Explain the most likely pathophysiological mechanismsfor the presentation of elevated blood pressure atthis time relate to Intracranial pressure. Include consideration ofall other related cues/data.