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The Client with Hypertension Client Case Study Catanzaro 2011

Meet Mrs. M… • 68 year old female arrives at the office of her nurse practitioner (FNP) • Complaining of headaches, irritability, anger, shortness of breath and fatigue. • Seen one month ago for fatigue and blood pressure was 160/72. • Husband passed away two weeks ago. Daughter lives near by. • Has begun to smoke since husband’s death.

Socrative Interactive Question Short Answer Identify four risk factors not related to lifestyle?

Correct Answer: Age: Progresses with increasing age. Gender: More prevalent in men up to age 45 and women above the age of 64. Ethnicity/Race: Affects more African Americans Family History/Genetics: Children/siblings should be screened and taught healthy lifestyles.

History • Advised at last visit, to reduce intake of cholesterol-rich foods, reduce salt intake and not add salt on preparation of food. • Indicates she does little exercise or activity since husband died. • Indicates she does not take OTC meds or anything alternative. States she is “allergic to everything”. • No family history of hypertension.

Physical Examination • • Very irritable, loud and speaking fast. Angry and reporting she has a bad headache. “If you let me rest a minute, it will come down. ” Weight 150 lb; Height 5 ft. 2 in. BP 190/92, P 120, R 22, T 98. 0 F, SAO 2 90% BP lying 200/100; sitting 190/95, standing 184/90 Admitted to rule out Stage 2 Hypertension

Lab Data Test Week 1 Week 2 Week 3 Total Cholesterol 300 mg/d. L 310 mg/d. L 295 mg/d. L HDL 50 mg/d. L 45 mg/d. L 49 mg/d. L LDL 250 mg/d. L 275 mg/d. L 265 mg/d. L Glucose (fasting) 175 mg/d. L 182 mg/d. L 170 mg/d. L BUN 25 mg/d. L 23 mg/d. L Creatinine 2. 0 mg/d. L 1. 9 mg/d. L Urinalysis Protein 2+ Glucose 2+ Na 152 150 158 K 4. 0 4. 2 4. 5 Cl 105 100

Medications • Atenolol (Tenormin) 50 mg once daily • Quinapril (Accupril) 40 mg once daily • Tylenol 500 mg prn for headache

Critical Thinking Question 1 • Mrs. M. is admitted to your medical division. • Discuss your initial assessment both subjective and objective data as well as her current psychological and social condition.

Critical Thinking Question 2 • Discuss Mrs. M’s risk factors. • Which are modifiable and non-modifiable? • As Mrs. M’s nurse, what do you feel is most important to help her with?

Critical Thinking Question 3 • Discuss the dietary care and nutrition for Mrs. M? • What are your priorities?

Critical Thinking Question 4 • Discuss Beta-adrenergic blockers. • What is the action, indication for and nursing responsibility for this classification of drugs?

Critical Thinking Question 5 • Discuss Mrs. M’s lab results. • What are your concerns? • Are there any interventions you would add to your care plan based on these results?

Critical Thinking Question 6 • Day 2 of Mrs. M’s admission. • You have gotten report from the night nurse and Mrs. M’s blood pressure remains 150/88 at rest. • She continues to complain of a headache and states the “Tylenol is just not doing anything. ” • Discuss your management of this current situation?

Critical Thinking Question 7 • Day 2 blood work indicates a blood glucose of 150. • Considering Mrs. M’s admitting lab work, what concerns as her nurse do you have? • What is your next intervention?

Critical Thinking Question 8 • Discuss Target Organ Damage. • What does this mean? • What is the correlation to Mrs. M?

Socrative Interactive Question Most organ damage that occurs from hypertension is related to: A. B. C. D. Increased fluid pressure exerted against organ tissue. Atherosclerotic changes in vessels that supply the organs. Erosion and thinning of blood vessels from constant pressure. Increased hydrostatic pressure causing leakage of plasma into organ interstitial spaces.

Correct Answer: B. Atherosclerotic changes in the vessels that supply the organs. Rationale: Elevated BP causes the entire inner lining of arterioles to become thickened from hyperplasia of connective tissue in the intima and affects coronary, cerebral, peripheral, renal and retinal blood flow. Narrowed vessels lead to ischemia and organ damage.

Critical Thinking Question 9 • Discuss ACE inhibitors. • What is the action, the indication and the nursing responsibilities of this classification of drugs?

Critical Thinking Question 10 • Discuss calcium channel blockers. • What is the action, indication for and nursing responsibilities for this classification of drugs?

Critical Thinking Question 11 • Discuss the issue of noncompliance with the hypertensive client. • What can the nurse do to assist with client compliance?

Critical Thinking Question 12 • Mrs. M is preparing for discharge. • Discuss health promotion and discharge priorities. • Discuss your plan to include Mrs. M’s daughter.

Socrative Interactive Quiz • YOU MAKE THE CALL… • Please complete the 5 question quiz on Hypertension during the last 10 minutes of class. • Total of 5 points.