NUR 102 Hypertension Case Study- McKenzie Goodman

NUR 102 Hypertension Case Study- McKenzie Goodman Hypertension Assessment: George’s blood pressure is 189/110. His LDL Cholesterol is 200 mg/dL. He asks the student nurse if his blood pressure is something he should be concerned about 1. How should the student respond? A. Your blood pressure is very high. You need to see your healthcare provider today. B. You have hypertension. You need to start making some lifestyle changes. C. Please sit quietly for a few minutes. I need to recheck your blood pressure. D. I need you to remain seated. I am going to call for the emergency squad. *I chose C because you always want to recheck the BP if it’s running high, and it could’ve also been elevated to George being stressed or some recent physical activity. The student nurse asks George about his health history. George is 6 feet tall (182.88cm) and his weight is 190 pounds (86.18 kgs). George states that he has lost a lot of weight recently. He also reports feeling a lot of stress at work and that he often goes out with the crew after work to have several beers. He reports that his mother who had Diabetes Mellitus passed away recently which has also contributed to his emotional health. He believes his mom also had hypertension. George smokes a pack of cigarettes a day and drinks 4 to 5 cups of coffee a day too. 2. What significant risk factors for hypertension does the nursing student identify for George according to his reported health history? SELECT ALL THAT APPLY A. Family history of Diabetes B. Alcohol Consumption C. Smoking D. Stress E. Caffeine consumption *I chose alcohol consumption, smoking, and stress because these are all risk factors for hypertension. A family history of diabetes isn’t important in this scenario, and caffeine is not a risk factor for hypertension. The student retakes George’s blood pressure now that George has been sitting quietly for a few minutes. His blood pressure is 180/106 mmHg. 3. According to the assessment of this client, which recommendation is most important for the student nurse to provide George? A. See your Healthcare Provider as soon as possible within the next week for a blood pressure check. B. Limit his salt intake and start a weight loss program. C. Attend a stress reduction seminar offered in his community. D. Learn about high fiber foods and add more fiber to his diet. *I chose to have his BP rechecked because the previous two were taken in the same day, and taking another BP in a few days would be a better and accurate indicator of George having hypertension. The student nurse continues to talk to George about his blood pressure results. He states that he feels great physically and does not see why he needs to see his Doctor. 4. Which is the best response the student nurse can give to George about the urgent need to see a Healthcare Provider (HCP)? A. Your blood pressure is dangerously elevated. You could have a heart attack or stroke at any time. B. While often there are no symptoms, high blood pressure can damage many organs. C. Hypertension is called the silent killer. I am sure you do not want to die at your young age. D. It is always better to treat high blood pressure before you start having symptoms. *Hypertension could cause major organ damage to an individual, before they start to experience symptoms, so it is important for us to diagnose asap. A week later, George has an appointment with his HCP. After the exam the HCP explains to George that he has stage 2, primary, (essential) hypertension. 5. Which information obtained during the assessment supports this diagnosis? A. Blood Pressure of 184/98 mmHg B. Family history of Hypertension C. Irregular pulse rate of 110 beats/min. D. A auscultated heart murmur *Stage 2 hypertension is classified as a systolic reading of 140 or higher, and a diastolic reading of 90 or higher, so Georges reading helps us further understand that he has stage 2 hypertension. The HCP informs George that he needs to be on a low salt diet, stop smoking, limit his alcohol intake, decrease his stress level, and start taking Chlorothiazide (Diuril) and Atenolol (Tenormin). The nurse enters the room to give George his prescriptions and spends some time teaching him about his care and medications. When speaking with the nurse, George expresses some concern that the HCP did not prescribe any additional tests. He asks, “Shouldn’t the HCP find out why I have hypertension? History Note the following points when interviewing the hypertensive client: • Family history of hypertension, diabetes mellitus, cardiovascular disease, hyperlipidemia, or renal disease; smoking; stress; obesity; or sedentary lifestyle • Previous documentation of high blood pressure, including age at onset, level of elevation, and currently prescribed medical regimen • History of all prescribed and over-the-counter medications and the client's exact compliance with taking the medications. NOTE: Medications that may either raise blood pressure or interfere with the effectiveness of antihypertensive medications include oral contraceptives, steroids, nonsteroidal anti-inflammatory drugs, nasal decongestants, appetite suppressants, cyclosporine, tricyclic antidepressants, monoamine oxidase inhibitors, and erythropoietin • History of any disease or trauma to target organs • Results and side effects of previous antihypertensive therapy • Clinical manifestations of cardiovascular disorders, such as angina, dyspnea, or claudication • History of or recent weight gain, exercise activities, sodium intake, fat intake, alcohol use, and smoking • Psychosocial and environmental factors (e.g., emotional stress, cultural food practices, economic status) that may influence blood pressure control Physical Examination Physical assessment should include an accurate determination of blood pressure as well as an evaluation of target organs: • Vital signs and weight • Blood pressure—because blood pressure is variable and can be affected by multiple factors, it should be measured so that readings are representative of the client's usual level; the following techniques are strongly recommended: The client should be seated with the arm bared, supported, and positioned at heart level. The client should not have smoked tobacco or ingested caffeine within the previous 30 minutes. Measurement should begin after at least 5 minutes of quiet rest. The client's back should be supported, and both feet should be flat on the floor with the legs uncrossed. The client should not speak while the blood pressure is being monitored. Use of the appropriate cuff size will ensure an accurate measurement. The rubber bladder should encircle at least 80% of the limb being measured. The bladder's width should be one- third to one-half the circumference of the limb. Several sizes of cuffs (e.g., child, adult, large adult) should be available. • Measurements should be taken with a mercury sphygmomanometer, a recently calibrated aneroid manometer, or a validated electronic device. • Postural blood pressures should be measured and recorded according to position and arm used, including lying, sitting, and standing measurements from both arms. • Both systolic and diastolic blood pressures should be recorded. The disappearance of sound (phase V) should be used for the diastolic reading. Two or more readings should be averaged. If the first two readings differ by more than 5 mm Hg, additional readings should be obtained. • Funduscopic examination for retinal arteriolar narrowing, hemorrhages, exudates, and papilledema • Examination of the neck for distended veins, carotid bruits, and enlarged thyroid • Auscultation of the heart for increased heart rate, dysrhythmias, enlargement, precordial impulses, murmurs, and S3 and S4 heart sounds • Examination of the abdomen for bruits, aortic dilation, and enlarged kidneys • Examination of extremities for diminished or absent peripheral pulses, edema, and bilateral inequality of pulses • Neurologic evaluation for signs of cerebral thrombosis or hemorrhage Laboratory Studies Studies used in the routine evaluation of hypertension include a complete blood count, urinalysis, determinations of serum potassium and sodium levels, fasting blood glucose level, serum cholesterol level, blood urea nitrogen and serum creatinine levels, electrocardiogram, and chest radiography. These rests provide useful information in determining the severity of vascular disease, the extent of target organ damage, and the possible causes of hypertension. Clients with the potential for secondary hypertension may need more extensive studies. Algorithm for Treatment of Hypertension 6. How should the nurse respond to George’s question? A. “The HCP does not think we need to determine the cause now. Further tests may be done once your blood pressure is in the normal range.” B. “95% to 90% of all cases of hypertension are without an identified cause, so unless there is some indicator in your health history the HCP does not look for one.” C. “If there is a cause for your hypertension, it will become evident very soon. You will see your HCP frequently until the cause is determined” D. “Don’t worry! Stress causes your blood pressure to go up even more. The HCP knows what tests to order and when they should be done.” *Primary (essential) hypertension has no identifiable causes, but there are contributing risk factors. George also asks the nurse about his medications, Chlorothiazide (Diuril) and Atenolol Tenormin). The nurse review the medication, side effects, and the importance of taking medications on a daily basis. 7. While evaluating George’s understanding, which statements indicate that George understands the nurse’s instructions about his medications? SELECT ALL THAT APPLY A. “I will take Diuril early in the day” B. “I will be taking these medications for the rest of my life” C. “I can expect my heart rate to increase as my blood pressure goes down” D. “I may experience impotence with this drug regimen” E. “An irritating cough often develops but will subside in a few days” F. “I should avoid drinking alcohol” *Diuril is a diuretic, so taking at night may disrupt Georges sleeping pattern. Due to the side effects it is common for people to not want to take their medications. Side effects include dizziness, so avoiding alcohol will help decrease his chances of more dizziness. Evaluation The nurse shares with George that there are several things he can do besides taking the medication to improve his health. George says, “I know, the doctor told me to quit smoking, change my eating habits, decrease the stress in my life, and stop drinking so much alcohol. There is no way I can make all these changes. There would be nothing left to enjoy in life!” 8. When discussing these lifestyle changes with George, what is the most important information for the nurse to share? A. Use of tobacco products is linked with increased risk for cardiovascular disease. B. Drinking 24 ounces of beer a day or less is acceptable for clients with hypertension. C. Clients with hypertension respond differently to sodium restricted diets. D. There is evidence that stress only elevates blood pressure for a short time. *Smoking is known to have an effect on the cardiovascular system, so quitting smoking will decrease his BP.