A nurse is reviewing the case of Mr. Thompson, who is experiencing persistent hypertension with signs of renal impairment and left ventricular hypertrophy. Which intervention should the nurse prioritize to address Mr. Thompson's current condition?

B) Suggest a referral to a nephrologist for further evaluation.

A) Increase the dosage of his current antihypertensive medication.

B) Suggest a referral to a nephrologist for further evaluation.

C) Implement immediate dietary changes to reduce sodium intake.

D) Initiate continuous cardiac monitoring to assess for arrhythmias.

Mr. Thompson, a patient with persistent hypertension and signs of renal impairment, presents with a blood pressure of 165/105 mmHg and reports headaches and dizziness. Given these findings and his recent laboratory results showing an elevated serum creatinine level, which nursing intervention is most appropriate at this time?

D) Initiate a referral for renal ultrasound to assess the extent of renal impairment.

A) Administer a loop diuretic to reduce fluid volume and lower blood pressure.

B) Educate the patient on the importance of adhering to a low-sodium diet to help control blood pressure.

C) Recommend increasing the dosage of his current antihypertensive medication without further testing.

D) Initiate a referral for renal ultrasound to assess the extent of renal impairment.

Given Mr. Thompson's presentation with hypertension, left ventricular hypertrophy, mild hydronephrosis, and reduced ejection fraction, which intervention should be prioritized to address both his cardiac and renal concerns?

B) Starting an ACE inhibitor to reduce blood pressure and protect renal function.

A) Initiating a high-protein diet to support renal function.

B) Starting an ACE inhibitor to reduce blood pressure and protect renal function.

C) Increasing fluid intake to prevent dehydration and promote kidney perfusion.

D) Encouraging vigorous exercise to enhance cardiac output and lower blood pressure.

Mr. Thompson has been experiencing increased fatigue and mild swelling in his lower extremities, and his recent echocardiogram indicates left ventricular hypertrophy with a decreased ejection fraction. Considering his current symptoms and findings, which nursing intervention is most appropriate to prioritize in his care plan?

B) Administer prescribed diuretics to manage fluid retention.

A) Encourage a high-protein diet to improve energy levels.

B) Administer prescribed diuretics to manage fluid retention.

C) Advise increased physical activity to reduce fatigue.

D) Monitor daily weight and intake/output to assess fluid status.

Mr. Thompson, who is experiencing worsening heart failure, has been prescribed an ACE inhibitor. Which nursing action is most important to perform after the initiation of this medication to prevent complications?

B) Assess for signs of hyperkalemia

A) Monitor blood pressure closely for hypotension

B) Assess for signs of hyperkalemia

C) Educate Mr. Thompson on a low-fat diet

D) Measure daily weight to monitor fluid status

A nurse is assessing Mr. Thompson, who has recently started on an ACE inhibitor for heart failure management. He reports increased fatigue and lightheadedness upon standing, and his blood pressure readings show significant variability, with occasional drops to 95/60 mmHg. His serum potassium level is 5.5 mmol/L. What is the most appropriate nursing intervention to address these findings?

B) Educate Mr. Thompson on the importance of rising slowly from a seated or lying position.

A) Increase Mr. Thompson's fluid intake to help stabilize his blood pressure.

B) Educate Mr. Thompson on the importance of rising slowly from a seated or lying position.

C) Instruct Mr. Thompson to stop taking the ACE inhibitor until his next follow-up appointment.

D) Encourage Mr. Thompson to consume potassium-rich foods to counteract his fatigue.

A nurse is caring for Mr. Thompson, who is experiencing increased fatigue and lightheadedness after starting an ACE inhibitor for heart failure management. His blood pressure drops to 95/60 mmHg upon standing, and his serum potassium level is 5.5 mmol/L. What is the most appropriate nursing action to address Mr. Thompson's current condition?

B) Instruct Mr. Thompson to rise slowly from sitting to standing positions.

A) Educate Mr. Thompson about increasing fluid intake to manage hypotension.

B) Instruct Mr. Thompson to rise slowly from sitting to standing positions.

C) Recommend Mr. Thompson increase dietary potassium intake to prevent deficiencies.

D) Suggest Mr. Thompson discontinue the ACE inhibitor until symptoms resolve.

Mr. Thompson, who has heart failure and chronic kidney disease, is being treated with a low-dose diuretic and a potassium-binding resin. During a follow-up visit, he reports new onset muscle weakness. Which of the following actions should the nurse prioritize?

C) Review Mr. Thompson's recent laboratory results for electrolyte imbalances

A) Advise Mr. Thompson to increase his salt intake to address electrolyte imbalance

B) Assess Mr. Thompson's blood pressure and heart rate before notifying the healthcare provider

C) Review Mr. Thompson's recent laboratory results for electrolyte imbalances

D) Educate Mr. Thompson on the importance of maintaining fluid restriction

Mr. Thompson is experiencing a decrease in ejection fraction and a decline in eGFR. Considering his current management plan, which nursing intervention should be prioritized to address his risk of fluid overload while minimizing further renal impairment?

D) Schedule frequent laboratory tests to monitor electrolyte levels and renal function

A) Increase the dose of the diuretic to manage fluid retention more aggressively

B) Monitor blood pressure closely to adjust antihypertensive medications as needed

C) Educate Mr. Thompson on a low-potassium diet to prevent hyperkalemia

D) Schedule frequent laboratory tests to monitor electrolyte levels and renal function

Htn - Nursing Case Study

Pathophysiology

• Primary mechanism: Increased systemic vascular resistance due to narrowing of small arteries and arterioles. This narrowing is often caused by endothelial dysfunction, which can result from factors like high salt intake, stress, and genetic predisposition, leading to sustained elevated blood pressure.

• Secondary mechanism: Overactivation of the renin-angiotensin-aldosterone system (RAAS). This hormonal system regulates blood pressure and fluid balance, but when overactive, it causes vasoconstriction and sodium retention, further increasing blood pressure.

• Key complication: Persistent hypertension can lead to target organ damage, including hypertrophy of the heart (left ventricular hypertrophy), which increases the risk of heart failure, stroke, and kidney damage due to the increased workload on these organs.

Patient Profile

Demographics:

55-year-old male, construction worker

History:

• Key past medical history: Hypertension diagnosed 5 years ago, borderline hyperlipidemia

• Current medications: Lisinopril 10 mg daily, Hydrochlorothiazide 25 mg daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent headache and dizziness

• Key symptoms: Blurred vision, chest discomfort on exertion, occasional shortness of breath

• Vital signs: Blood pressure 160/100 mmHg, heart rate 98 bpm, respiratory rate 20 breaths/min, temperature 98.6°F

Section 1

The patient, Mr. Thompson, has been experiencing persistent hypertension despite adherence to his medication regimen, suggesting the development of potential complications due to poorly controlled blood pressure. Upon further assessment, the healthcare team notes that Mr. Thompson's blood pressure remains elevated at 165/105 mmHg, and he continues to report symptoms of headache and dizziness. Additionally, his laboratory results reveal a serum creatinine level of 1.6 mg/dL (elevated from his baseline of 1.2 mg/dL), indicating possible renal impairment. An ECG shows signs of left ventricular hypertrophy, which are consistent with longstanding hypertension and suggestive of increased cardiac workload.

These findings prompt the healthcare team to consider the possibility of hypertensive crisis or impending target organ damage, necessitating a reassessment of his current treatment plan. Given that Mr. Thompson's renal function appears compromised, the team discusses the potential need for adjusting his antihypertensive therapy, including the consideration of adding a calcium channel blocker or increasing the dose of his current medications under close monitoring. Furthermore, lifestyle modifications such as dietary changes, including reduced sodium intake, and stress management are reinforced as critical components of his management plan.

The new complications underscore the importance of timely intervention to prevent further deterioration. The healthcare team deliberates on the necessity of further diagnostic testing, such as renal ultrasound or echocardiography, to evaluate the extent of organ damage. This situation highlights the need for careful clinical reasoning to balance aggressive blood pressure control while minimizing adverse effects, particularly on renal function. The team plans to closely monitor Mr. Thompson's response to any changes in treatment and to educate him on recognizing signs of worsening condition, which could lead naturally to the next steps in his care journey.

Section 2

As the healthcare team continues to monitor Mr. Thompson, it becomes evident that his condition is evolving. Despite the adjustment in his antihypertensive regimen with the addition of a calcium channel blocker, Mr. Thompson's blood pressure remains difficult to control, with readings fluctuating between 160/100 mmHg and 170/110 mmHg. Over the subsequent days, he begins to experience increased fatigue and mild swelling in his lower extremities. These new symptoms prompt the team to conduct a more thorough cardiovascular and renal assessment to identify any further complications.

A renal ultrasound is performed, revealing mild hydronephrosis, which raises concerns about possible structural abnormalities or obstructions contributing to his renal impairment. Additionally, an echocardiogram confirms the presence of left ventricular hypertrophy and shows a decrease in ejection fraction to 45%, indicating systolic dysfunction and suggesting that his heart is struggling to effectively pump blood. These findings suggest that Mr. Thompson is developing heart failure secondary to chronic hypertension, necessitating a reevaluation of his treatment strategy to better address both his cardiac and renal health.

Recognizing the complexity of Mr. Thompson's case, the healthcare team decides to integrate a multi-disciplinary approach, consulting with a nephrologist and a cardiologist to optimize his management. The focus shifts towards achieving tighter blood pressure control while simultaneously protecting renal function and managing emerging heart failure symptoms. Dietary modifications are emphasized, particularly the importance of a low-sodium diet, and diuretics may be considered to address fluid retention. Continuous education about lifestyle changes and medication adherence is reinforced to empower Mr. Thompson in managing his condition, while the team remains vigilant for any signs of further deterioration that may require immediate intervention.

Section 3

Following the initial assessment and the integration of the multi-disciplinary team, Mr. Thompson's condition continues to be closely monitored. Despite the implementation of a low-sodium diet and the introduction of a loop diuretic to manage his fluid retention, Mr. Thompson begins to exhibit new symptoms over the next few days. He reports experiencing increased shortness of breath, particularly during exertion, and a persistent dry cough. Additionally, his weight has increased by two kilograms in one week, suggesting further fluid accumulation. His vital signs show a blood pressure of 165/105 mmHg, a heart rate of 98 beats per minute, and oxygen saturation at 93% on room air.

In response to these developments, further diagnostic testing is conducted to assess the extent of his heart failure. A repeat echocardiogram reveals a further reduction in ejection fraction to 40%, reinforcing the concern of worsening systolic dysfunction. Laboratory tests show elevated B-type natriuretic peptide (BNP) levels, indicating increased cardiac strain. Renal function tests reveal a slight increase in serum creatinine, now at 1.8 mg/dL, highlighting the delicate balance needed in managing his renal and cardiac conditions. These findings suggest that Mr. Thompson's heart failure is progressing, necessitating a reassessment of his medication regimen to include an ACE inhibitor to reduce cardiac workload and potentially improve renal perfusion.

The healthcare team gathers to discuss the implications of these findings and the need to intensify Mr. Thompson's treatment strategy. Emphasis is placed on the importance of strict fluid management and monitoring of electrolyte levels to prevent further complications. Mr. Thompson is also educated on recognizing signs of heart failure exacerbation, such as increased dyspnea or edema, to ensure timely intervention. The team remains focused on achieving better control of his blood pressure and heart failure symptoms while being cautious of his renal function, setting the stage for ongoing adjustments in his care plan and further consultations with his specialists.

Section 4

As Mr. Thompson's treatment progresses, the healthcare team closely monitors his response to the adjusted medication regimen. The addition of the ACE inhibitor brings about some expected changes, but new complications arise. Within a few days, Mr. Thompson reports a noticeable increase in fatigue and lightheadedness upon standing, raising concerns about possible orthostatic hypotension, a known side effect of ACE inhibitors. His blood pressure readings now vary more widely, with occasional drops to 95/60 mmHg when he's in an upright position. Despite these fluctuations, his resting blood pressure remains elevated at around 150/95 mmHg, indicating persistent hypertension. These observations necessitate a careful balance between managing his heart failure symptoms and avoiding hypotensive episodes.

Further laboratory tests reveal that his serum potassium levels have risen to 5.5 mmol/L, approaching the upper limit of normal, which is a common concern with ACE inhibitor therapy, especially in the context of reduced renal function. This hyperkalemia poses a risk for cardiac arrhythmias, adding another layer of complexity to his treatment plan. The multidisciplinary team deliberates the need for dietary modifications to limit potassium intake and considers adding a potassium-binding resin to his regimen to prevent further increases. They also discuss the potential need for adjusting or temporarily holding the ACE inhibitor should his potassium levels continue to rise.

Mr. Thompson's case underscores the intricate interplay between heart failure management, renal function, and electrolyte balance. The team remains vigilant in monitoring his clinical status and laboratory parameters, recognizing that any adjustment in his treatment plan could have cascading effects. They emphasize patient education on the importance of adhering to dietary restrictions and understanding the signs of electrolyte imbalance. As Mr. Thompson continues his treatment journey, the team prepares for further adjustments to optimize his clinical outcomes, ensuring both his cardiac and renal concerns are addressed in tandem.

Section 5

As Mr. Thompson's treatment continues, the healthcare team conducts a new series of diagnostic evaluations to further assess his cardiac and renal function. A repeat echocardiogram reveals a slight decrease in his ejection fraction, now at 35%, suggesting a marginal decline in cardiac output despite ongoing management efforts. Concurrently, a renal ultrasound shows no significant structural abnormalities, but his estimated glomerular filtration rate (eGFR) has declined to 45 mL/min/1.73m², indicating a progression in chronic kidney disease. These findings prompt the team to reassess the current medication regimen, considering the potential impact on both cardiac and renal health.

In light of the persistent hypertension and increasing signs of renal impairment, the team decides to initiate a low-dose diuretic with the aim of alleviating fluid overload and improving symptomatic relief without exacerbating Mr. Thompson's hypotensive episodes. Laboratory results are closely monitored, revealing a slight improvement in potassium levels, now at 5.2 mmol/L, yet still requiring vigilance. To address the ongoing risk of hyperkalemia, the team initiates a potassium-binding resin, carefully balancing the need for effective heart failure management with the risk of electrolyte imbalance.

These developments underscore the need for ongoing adjustment and close monitoring of Mr. Thompson's treatment plan. The healthcare team emphasizes the importance of frequent follow-up visits and continuous patient education. Mr. Thompson is advised on recognizing early signs of fluid retention and electrolyte disturbances, such as swelling, muscle weakness, or palpitations. The collaborative effort remains focused on achieving a stable hemodynamic state while mitigating the risk of further renal deterioration and ensuring quality of life improvements. As the team plans the next steps, they remain prepared to adjust the therapeutic approach based on Mr. Thompson's evolving clinical picture.