Hypertension - Nursing Case Study

Pathophysiology

• Primary mechanism: High Blood Pressure - Hypertension occurs when the force of blood against the artery walls is too high, often due to the blood vessels becoming narrower. This can be caused by factors such as high salt intake, obesity, and genetic predisposition.

• Secondary mechanism: Overactive Renin-Angiotensin System - The kidney releases a hormone called renin when blood flow is low. Renin triggers a chain of reactions that produce angiotensin II, a hormone that constricts blood vessels and increases blood pressure. In hypertension, this system can become overactive, leading to chronically high blood pressure.

• Key complication: Heart Damage - Chronic hypertension can lead to heart damage as the heart has to work harder to pump blood. Over time, this can lead to heart failure, heart attack, or stroke.

Patient Profile

Demographics:

56, Male, Office Worker

History:

• Key past medical history: Non-smoker, no history of cardiovascular disease, diabetes, or kidney disease

• Current medications: Over-the-counter multi-vitamin

• Allergies: None

Current Presentation:

• Chief complaint: Slightly elevated blood pressure during routine checkup

• Key symptoms: Occasional mild headaches, no other symptoms

• Vital signs: Blood pressure 140/90, heart rate 70 bpm, respiratory rate 16 breaths per minute, body temperature 98.6 °F, oxygen saturation 98%

Section 1

Initial Assessment Findings:

During the patient's physical examination, the nurse notes that the patient's weight is 220 pounds and height is 5'8", indicating a Body Mass Index (BMI) of 33.5, which falls into the obese category. This could be a contributing factor to his hypertension. The nurse also asks the patient about his dietary habits and discovers that he consumes foods high in sodium, such as fast food and processed snacks, several times a week.

On auscultation, the nurse could hear a regular heart rhythm, lung sounds are clear bilaterally, and the abdomen is soft and non-distended. The nurse also performs an ophthalmic examination and finds no retinal vascular changes or bleeding, which suggests that the patient's hypertension is still in an early stage. However, the patient's blood pressure remains elevated at 140/90 mmHg over several readings, confirming the diagnosis of hypertension.

The nurse decides to educate the patient on lifestyle modifications, including a low sodium diet, regular exercise, and maintaining a healthy weight to manage his hypertension. The patient is also scheduled for a follow-up appointment in a month to monitor his blood pressure and assess his response to lifestyle modifications. The nurse emphasizes the importance of adherence to these changes to prevent complications such as heart disease and stroke.

Section 2

One month later, the patient returns for his follow-up appointment. The nurse conducts an initial assessment and finds that the patient's weight has reduced to 210 pounds. This decrease in weight has resulted in a slight reduction in the patient's BMI to 31.9, which is still within the obese category but shows progress towards a healthier weight. The patient's blood pressure has also decreased slightly to 135/85 mmHg, indicating that the lifestyle modifications are having a positive effect.

The patient reports that he has been attempting to follow a low-sodium diet and has been exercising regularly. The nurse praises the patient's efforts to make healthier choices and encourages him to continue with these changes. The nurse also reiterates the importance of maintaining these lifestyle modifications to prevent complications associated with hypertension. She provides the patient with additional resources related to diet and exercise and schedules another follow-up appointment in three months. The nurse reminds the patient to monitor his blood pressure at home and to report any significant changes.

Section 3

Three months later, at the follow-up appointment, the nurse notes that the patient's weight has continued to decrease and is now at 200 pounds. His BMI is 30.1, just on the cusp of the obese category. His blood pressure readings have also improved to 125/80 mmHg, which is within the prehypertensive range. The patient states he has maintained his low-sodium diet and exercise routine, and he has also started incorporating stress-management techniques into his daily routine.

The nurse commends the patient for his commitment to his health and his consistent efforts to manage his hypertension. She encourages him to continue with the lifestyle changes, emphasizing the importance of regular exercise, healthy diet, and stress management in maintaining a healthy blood pressure. The nurse also suggests the patient to get a lipid profile done to assess his cholesterol levels, as hypertension can often be associated with high cholesterol. She schedules another follow-up appointment in three months and reminds him to keep monitoring his blood pressure at home.

Section 4

At the next appointment, the patient shares with the nurse that he has been experiencing intermittent palpitations and occasional bouts of dizziness over the last few weeks. He notes that these episodes tend to occur after periods of intense exercise or during particularly stressful moments at work. His most recent blood pressure reading at home was 138/88 mmHg, slightly higher than the previous readings. His pulse rate is 92 beats per minute, respiratory rate is 16 breaths per minute, and oxygen saturation is 98%.

The nurse, considering these new symptoms, decides to conduct a more in-depth cardiovascular assessment. The physical examination reveals no noticeable abnormalities: heart sounds are regular without murmurs, jugular veins are not distended, and peripheral pulses are palpable and symmetrical. However, given the patient's history of hypertension and his recent symptoms, the nurse decides to refer him for an EKG and a Holter monitor to evaluate his heart rhythm over a 24-hour period. The nurse reassures the patient that these tests will provide valuable information for managing his hypertension and related symptoms more effectively. She also encourages him to continue his current lifestyle changes but to avoid overexertion during his exercise routine. The patient is instructed to report any worsening symptoms immediately.

Section 5

The results of the EKG come back normal, showing regular sinus rhythm. However, the Holter monitor reveals occasional premature ventricular contractions (PVCs) - a type of heart rhythm disturbance that can cause palpitations and dizziness, particularly in patients with hypertension. The PVCs seem to correlate with the times the patient reported feeling symptoms, further confirming the diagnosis.

In light of these findings, the nurse discusses the results with the patient. She explains that PVCs are not uncommon, particularly in individuals with high blood pressure, and that they are often harmless. However, she also stresses the importance of managing his hypertension to prevent any potential complications from these extra heartbeats. The nurse suggests adjusting his antihypertensive medication regimen, with the approval of his primary care physician, and re-emphasizes the importance of regular exercise, proper diet, and stress management. The patient's blood pressure will be closely monitored over the next few weeks to assess the effectiveness of the adjusted treatment plan and to ensure his hypertension is being adequately controlled.