What is the most appropriate initial action for the nurse to take when evaluating a patient with a history of mild hypertension during a routine follow-up visit?

B) Measure the patient's blood pressure

A) Assess for signs of end-organ damage

B) Measure the patient's blood pressure

C) Inquire about the patient's dietary habits

D) Evaluate the patient's exercise routine

During the assessment of a patient with hypertension, the nurse notes a blood pressure reading of 130/85 mmHg. What is the most appropriate interpretation of this finding?

D) This blood pressure reading indicates well-controlled hypertension.

A) This blood pressure reading indicates a hypertensive crisis.

B) This blood pressure reading is within the normal range for adults.

C) This blood pressure reading suggests stage 1 hypertension.

D) This blood pressure reading indicates well-controlled hypertension.

When monitoring a patient with controlled hypertension and early-stage renal involvement, which lifestyle modification is most important to emphasize to prevent further complications?

B) Reduce dietary sodium intake

A) Increase fluid intake to stay hydrated

B) Reduce dietary sodium intake

C) Increase protein consumption

D) Limit physical activity to prevent fatigue

A patient with controlled hypertension presents with a slight increase in blood pressure, mild fatigue, and a slight increase in serum creatinine levels. What is the most appropriate nursing action to address these findings?

B) Reinforce the importance of adhering to a low-sodium diet and regular exercise.

A) Advise the patient to increase fluid intake to improve kidney function.

B) Reinforce the importance of adhering to a low-sodium diet and regular exercise.

C) Suggest the patient stop taking antihypertensive medication until symptoms improve.

D) Recommend the patient increase dietary protein to support renal function.

What is a key nursing intervention to reinforce during the follow-up appointment for a patient who is managing hypertension with lifestyle modifications and medication?

A) Emphasize the importance of regular exercise

B) Recommend increasing sodium intake

C) Advise reducing fluid intake to prevent edema

D) Suggest stopping medication if blood pressure improves

Which of the following actions should the nurse take to address the patient's report of mild dizziness when standing up quickly?

B) Advise the patient to rise slowly from sitting or lying positions

A) Instruct the patient to increase fluid intake

B) Advise the patient to rise slowly from sitting or lying positions

C) Recommend the patient avoid all physical activities

D) Suggest the patient discontinue her antihypertensive medication

Which of the following nursing interventions is appropriate for managing the patient's reported symptom of dizziness upon standing?

B) Advise the patient to rise slowly from sitting or lying positions

A) Encourage the patient to increase fluid intake

B) Advise the patient to rise slowly from sitting or lying positions

C) Suggest the patient reduce cardiovascular exercises

D) Recommend the patient skip doses of antihypertensive medication

What is the most appropriate initial nursing intervention for a patient experiencing dizziness when standing up after prolonged sitting?

B) Advise the patient to rise slowly from a sitting position.

A) Encourage the patient to drink more water.

B) Advise the patient to rise slowly from a sitting position.

C) Suggest the patient avoid all physical activity until the dizziness resolves.

D) Recommend the patient increase their salt intake significantly.

A patient reports experiencing mild dizziness when standing up after prolonged sitting. Which nursing intervention is most appropriate to address this symptom?

B) Suggest the patient rise slowly from sitting to standing positions

A) Advise the patient to increase caffeine intake to improve alertness

B) Suggest the patient rise slowly from sitting to standing positions

C) Encourage the patient to engage in high-intensity exercise to improve circulation

D) Recommend the patient to avoid standing up to prevent dizziness

Hypertension - Nursing Case Study

Pathophysiology

• Primary mechanism: Increased peripheral resistance - Blood vessels become narrower due to factors like plaque buildup or constriction, making it harder for blood to flow and raising blood pressure.

• Secondary mechanism: Increased blood volume - Excess sodium and water retention by the kidneys can expand blood volume, adding pressure on vessel walls and elevating blood pressure.

• Key complication: Organ damage - Persistent high blood pressure can damage organs, particularly the heart, kidneys, and brain, leading to conditions like heart failure, kidney disease, or stroke.

Patient Profile

Demographics:

45-year-old female, accountant

History:

• Key past medical history: Mild hypertension diagnosed 6 months ago

• Current medications: Lisinopril 10 mg once daily

• Allergies: None

Current Presentation:

• Chief complaint: Routine follow-up for hypertension management

• Key symptoms: Occasional mild headaches, no other symptoms

• Vital signs: Blood pressure 130/85 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F, BMI 24.5

Section 1

Initial Assessment Findings:

During the routine follow-up visit, the nurse conducts a thorough assessment of the patient to evaluate the current status of her hypertension and any related complications. The patient, a 45-year-old accountant, appears well-nourished and is in no acute distress. Her blood pressure reading is 130/85 mmHg, which, while slightly elevated, indicates relatively stable control of her previously diagnosed mild hypertension. The nurse notes that the patient reports occasional mild headaches, but denies any visual disturbances, dizziness, or shortness of breath. Her heart rate is steady at 72 bpm, respiratory rate is normal at 16 breaths per minute, and her temperature is within the normal range at 98.6°F.

The nurse performs a focused cardiovascular and renal assessment, paying close attention to any signs of target organ damage. The cardiac examination reveals a regular heart rhythm with no murmurs, and peripheral pulses are palpable and equal bilaterally. There are no signs of edema in the extremities, which suggests that fluid retention is not currently an issue. Additionally, the nurse checks for signs of end-organ damage by reviewing recent lab results, which show normal renal function tests and electrolytes, indicating that the kidneys are functioning well and there is no significant sodium or water retention. The nurse records the patient’s BMI as 24.5, placing her in the normal weight range, which is a positive factor in managing her blood pressure.

Overall, the initial assessment suggests that the patient's hypertension is under control with the current medication regimen, and there are no immediate signs of complications or organ damage. The nurse plans to reinforce the importance of medication adherence, lifestyle modifications such as a low-sodium diet and regular exercise, and scheduling regular follow-up appointments to continue monitoring her blood pressure and prevent potential complications. This approach aims to maintain the patient's health and prevent progression to more severe hypertension stages.

Section 2

Two months following the initial assessment, the patient returns for a scheduled follow-up visit. During this appointment, the nurse observes a slight increase in the patient's blood pressure, recorded at 135/88 mmHg. Although still within the range of controlled hypertension, this change prompts further investigation. The patient mentions experiencing mild fatigue more frequently, but continues to deny any significant symptoms such as chest pain, vision changes, or shortness of breath. Her heart rate remains stable at 74 bpm, and her respiratory rate is normal at 16 breaths per minute. Temperature is also unchanged at 98.6°F.

To further evaluate the patient's condition, the nurse reviews recent lab work and diagnostic tests. The results show a slight increase in serum creatinine levels, now at 1.2 mg/dL, which, while within the normal range for an adult female, suggests a need for closer monitoring of renal function. Electrolyte levels remain stable, and no significant changes are noted in her lipid profile. Given the patient's report of fatigue and the gradual rise in blood pressure, the nurse considers the possibility of early-stage renal involvement and the need for potential adjustments in her management plan.

The nurse discusses these findings with the patient, emphasizing the importance of continuing her current medication regimen and adhering to lifestyle modifications, particularly focusing on reducing dietary sodium intake and maintaining regular physical activity. The nurse also schedules a more frequent monitoring plan, with follow-up visits every four weeks, to closely track her blood pressure and renal function. This proactive approach aims to address the subtle changes observed in her condition, prevent further complications, and ensure optimal management of her hypertension.

Section 3

Four weeks later, the patient returns for her follow-up appointment. During this visit, the nurse conducts a thorough assessment and notes that the patient's blood pressure has decreased slightly to 130/85 mmHg. This improvement suggests a positive response to the ongoing lifestyle modifications and medication adherence. The patient reports feeling less fatigued, attributing this change to her commitment to a regular exercise routine and healthier dietary choices, including reduced sodium intake. Her heart rate remains stable at 72 bpm, and her respiratory rate is consistent at 16 breaths per minute. Her temperature is steady at 98.6°F.

The nurse reviews the latest laboratory results, which show that the patient's serum creatinine level has returned to 1.0 mg/dL, indicating an initial stabilization of her renal function. Electrolyte levels continue to be within normal ranges, and her lipid profile shows slight improvements, particularly with a reduction in LDL cholesterol. These positive trends are encouraging, yet the nurse remains vigilant, emphasizing the importance of continued adherence to the management plan to prevent any potential complications.

The nurse and patient discuss the next steps, agreeing to maintain the current treatment regimen and lifestyle modifications. The nurse reiterates the importance of regular monitoring and schedules the next follow-up visit in four weeks. This proactive approach ensures that any changes in the patient's condition are detected early, allowing for timely interventions. The patient leaves the appointment feeling motivated and reassured, committed to her health and well-being.

Section 4

Four weeks later, the patient arrives for her scheduled follow-up appointment. The nurse begins with an initial assessment and notes that the patient's blood pressure has improved further to 125/82 mmHg, reflecting continued success with her management plan. The patient enthusiastically shares that she has incorporated more cardiovascular exercises into her routine and is actively participating in a local walking group, which has helped her maintain her motivation for staying active. Her heart rate remains stable at 70 bpm, and her respiratory rate is slightly improved at 15 breaths per minute. Her temperature is consistent at 98.6°F, indicating no signs of infection or fever.

During the review of the latest diagnostic results, the nurse observes continued positive trends. The patient's serum creatinine level is stable at 1.0 mg/dL, and her electrolyte levels remain within normal ranges, further confirming the stabilization of her renal function. Her lipid profile shows additional improvement, with her LDL cholesterol decreasing to 110 mg/dL, moving closer to her target range. The nurse commends the patient on her progress and reinforces the importance of maintaining her dietary modifications, particularly the reduction in saturated fats and cholesterol.

Despite these encouraging findings, the nurse remains attentive to potential new complications. The patient mentions experiencing occasional mild dizziness when standing up quickly, a possible side effect of her antihypertensive medication. The nurse educates the patient on how to manage this by rising slowly and suggests discussing medication adjustments with her healthcare provider if the symptom persists. The patient is reassured and leaves the appointment feeling empowered to continue her health journey, with the next follow-up visit planned in another four weeks. This careful monitoring approach ensures that any subtle changes in her condition are addressed promptly, keeping her on track for further improvement.

Section 5

Four weeks later, the patient returns for her next scheduled follow-up appointment. During the initial assessment, the nurse notes that the patient's blood pressure remains well-controlled at 123/80 mmHg. Her heart rate is steady at 68 bpm, and her respiratory rate is now consistently at 14 breaths per minute, indicating a slight improvement in her overall respiratory efficiency. Her temperature remains stable at 98.6°F. The patient continues to engage actively with her walking group, which she credits with maintaining her cardiovascular health and overall well-being.

The nurse reviews new diagnostic results with the patient. The patient's serum creatinine remains stable at 1.0 mg/dL, reassuring the healthcare team of her renal health. Additionally, her lipid profile shows further progress; her LDL cholesterol has decreased to 105 mg/dL, edging even closer to the target range. Her HDL cholesterol has increased to 55 mg/dL, reflecting the positive impact of her exercise regimen and dietary changes. The nurse praises the patient for her continued commitment to lifestyle modifications, emphasizing the importance of these changes in managing hypertension and reducing cardiovascular risk.

However, the patient reports experiencing slightly more frequent episodes of mild dizziness, particularly when standing up after prolonged sitting. The nurse recognizes this as a common side effect of antihypertensive therapy and provides the patient with strategies to manage these episodes, such as ensuring adequate hydration and rising gradually. The nurse suggests that the patient discuss these symptoms with her healthcare provider to consider potential medication adjustments. The patient is encouraged to continue her efforts and is reassured that her proactive approach to managing her health is leading to significant improvements. The next follow-up is scheduled in four weeks, with a focus on closely monitoring her response to any potential medication changes and further evaluating her symptoms.