A nurse is caring for a 20-year-old client who has a fever a…
A nurse is caring for a 20-year-old client who has a fever and reports severe headache. Vital Signs at 0800 Temperature 38.9° C (102° F); Tympanic Apical pulse 118/min; strong and regular Respirations 20/min; even and unlabored Blood pressure 114/78 mm Hg Oxygen saturation 97% on room air Nurses Notes 0800: Client reports missing classes at a local community college the last two days due to fever and headache. Rates pain with headache as a 9 on a scale of 0 to 10. Verbalizes that headache was not relieved by acetaminophen or ibuprofen taken at home. Client awake, alert, and oriented to person, place, and time. Pupils equal, round, and reactive to light. Temperature elevated. Skin warm and dry, face flushed. Petechiae noted on trunk. Reports nausea and vomiting frequent for the last 24 hr. Bowel sounds positive x 4 quadrants. Abdomen soft and nontender to light palpation. Photophobia present. Nuchal rigidity noted. Brudzinski’s sign positive. Respirations easy and unlabored. Lungs clear to auscultation. Which of the following issues is the client at risk of developing?