Which dietary modification should the nurse emphasize to the patient with early-stage hypertension to help manage her condition?

A) Increase intake of processed foods

C) Increase consumption of caffeinated beverages

A nurse is educating a patient with early-stage hypertension on dietary modifications. Which of the following dietary changes should the nurse emphasize to help manage the patient's condition?

A) Increase intake of processed foods

C) Limit consumption of fruits and vegetables

What is the primary reason for considering the addition of a diuretic to the patient's medication regimen?

A) To improve the patient's overall energy levels

C) To enhance the effectiveness of dietary modifications

D) To increase the patient's heart rate

What is the most appropriate next step for the nurse to suggest to the patient in order to manage her persistent lower extremity edema?

B) Schedule an appointment with the primary care provider to discuss medication adjustments.

A) Increase fluid intake to promote diuresis.

B) Schedule an appointment with the primary care provider to discuss medication adjustments.

C) Discontinue the current exercise routine to prevent further edema.

D) Increase dietary sodium to help balance electrolytes.

Which of the following dietary recommendations should the nurse make to help the patient manage her mild hypokalemia?

A) Increase intake of bananas and spinach

B) Limit intake of high-sodium foods

C) Increase intake of calcium-rich foods

D) Limit fluid intake to prevent edema

Which dietary recommendation should the nurse provide to a patient with mild hypokalemia due to diuretic therapy?

B) Include more potassium-rich foods like bananas and spinach

A) Increase intake of high-sodium foods

B) Include more potassium-rich foods like bananas and spinach

C) Limit fluid intake to avoid further potassium loss

D) Increase protein intake to support muscle function

Which dietary change should the nurse recommend to a patient experiencing mild edema and muscle cramps due to diuretic therapy?

A) Increase intake of potassium-rich foods

B) Reduce fluid intake significantly

A patient on diuretic therapy presents with persistent mild edema and occasional muscle cramps. Which dietary recommendation should the nurse prioritize to address the patient's symptoms?

A) Increase intake of potassium-rich foods

B) Increase intake of sodium-rich foods

C) Increase intake of calcium-rich foods

D) Increase intake of magnesium-rich foods

Which dietary change did the patient implement to help manage her hypertension?

B) Consuming more potassium-rich foods

heypertantuin - Nursing Case Study

Pathophysiology

• Primary mechanism: Increased blood volume - Excessive salt intake or kidney disorders can cause the body to retain more water, leading to increased blood volume. This puts extra pressure on blood vessel walls, raising blood pressure.

• Secondary mechanism: Narrowing of blood vessels - Hormones like angiotensin can cause blood vessels to constrict. Narrower vessels mean the heart must pump harder to push blood through, elevating blood pressure.

• Key complication: Organ damage - Persistent hypertension can damage vital organs such as the heart, kidneys, and eyes due to the constant high pressure, potentially leading to heart attacks, kidney failure, or vision problems.

Patient Profile

Demographics:

45-year-old female, office administrator

History:

• Key past medical history: Diagnosed with hypertension 1 year ago

• Current medications: Lisinopril 10 mg once daily

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Routine follow-up for hypertension

• Key symptoms: Occasional mild headaches, otherwise asymptomatic

• Vital signs: Blood pressure 132/84 mmHg, heart rate 78 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F, BMI 26.

Section 1

Initial Assessment Findings:

During the routine follow-up visit, the nursing assessment revealed that the patient's blood pressure was moderately controlled at 132/84 mmHg. Her heart rate was steady at 78 bpm, and her respiratory rate was normal at 16 breaths per minute. The patient's temperature remained stable at 98.6°F. Her BMI of 26 indicated she was slightly overweight, which could contribute to her hypertension. She reported occasional mild headaches but was otherwise asymptomatic, which is consistent with her diagnosis of early-stage hypertension. Upon further questioning, the patient admitted to a diet high in processed foods and salty snacks, suggesting dietary habits may be contributing to her condition.

The physical examination showed no signs of end-organ damage, such as heart murmurs or abnormal retinal findings. However, the nurse noted mild edema in the lower extremities, which could indicate fluid retention. This finding is consistent with the primary mechanism of increased blood volume due to excessive salt intake. The nurse educated the patient about the importance of dietary modifications, emphasizing the need to reduce salt intake and incorporate more fruits and vegetables into her diet. Additionally, the patient was encouraged to engage in regular physical activity to help manage her blood pressure and maintain a healthy weight.

The nurse also reviewed the patient's current medication regimen, confirming adherence to Lisinopril 10 mg daily. Given the slightly elevated blood pressure reading and the presence of lower extremity edema, the nurse suggested a follow-up appointment with the primary care provider to evaluate the effectiveness of the current treatment plan and consider potential adjustments. This continued patient education and follow-up care aim to prevent progression of the disease and mitigate the risk of future complications, ensuring a proactive approach in managing her hypertension.

Section 2

Two weeks after the initial assessment, the patient returned for a follow-up appointment. During this visit, the nurse noted a slight improvement in the patient's blood pressure, now reading at 128/82 mmHg. The patient's heart rate remained stable at 76 bpm, and her respiratory rate and temperature were unchanged. She reported adhering to the dietary recommendations, having significantly reduced her intake of processed foods and salty snacks. The patient also mentioned starting a light exercise routine, including walking for 30 minutes each day.

However, during the physical examination, the nurse observed that the mild edema in the patient's lower extremities persisted, though it had not worsened. Despite these lifestyle changes and adherence to her medication regimen, the edema suggested that additional intervention might be necessary. To gain further insight into the patient's condition, the nurse arranged for a basic metabolic panel, which revealed a normal serum sodium level but a slightly elevated creatinine of 1.3 mg/dL, indicating some renal involvement.

Based on these findings, the nurse discussed the results with the patient and emphasized the importance of maintaining the current lifestyle changes while considering additional interventions. The nurse recommended that the patient schedule an appointment with her primary care provider to discuss the possibility of adjusting her medication regimen. This next step could potentially include adding a diuretic to help manage fluid retention and protect renal function. The patient's ongoing commitment to lifestyle modifications, combined with any necessary medication adjustments, would aim to stabilize her condition further and prevent any progression of hypertension-related complications.

Section 3

Two weeks after her follow-up visit, the patient returned for another appointment. During this visit, the nurse observed that the patient’s blood pressure had improved further, now reading at 124/80 mmHg. Her heart rate was steady at 74 bpm, and her respiratory rate and temperature remained within normal limits. The patient reported feeling more energetic and continued to adhere to her dietary and exercise regimen, which now included 45 minutes of walking five times a week.

Despite these positive changes, the nurse noted that the mild edema in the patient's lower extremities persisted, prompting further evaluation. The nurse ordered an additional basic metabolic panel. The results showed that the patient's creatinine level had returned to normal at 1.1 mg/dL, suggesting that the renal function was stabilizing, possibly due to the improved blood pressure and lifestyle modifications. However, the patient's serum potassium level was slightly lower at 3.4 mEq/L, likely a side effect of the diuretic therapy initiated during her last visit.

The nurse reviewed these findings with the patient, emphasizing the importance of maintaining hydration and incorporating potassium-rich foods into her diet, such as bananas, oranges, and spinach, to address the mild hypokalemia. The nurse also reinforced the need for regular monitoring of her blood pressure and kidney function. Encouraged by the improvements and the patient’s proactive approach, the nurse scheduled another follow-up appointment in one month to continue monitoring her progress and adjust the care plan as needed. With these steps, the patient remained on track to effectively manage her hypertension and prevent further complications.

Section 4

One month later, the patient returned for her follow-up appointment, visibly optimistic about her progress. During the initial assessment, the nurse noted that the patient’s blood pressure remained stable at 122/78 mmHg, and her heart rate was a consistent 72 bpm. Her respiratory rate and temperature continued to be within normal limits. The patient reported feeling well overall, with increased energy levels and adherence to her dietary and exercise plan, which she now enjoyed as part of her daily routine.

However, the nurse observed that the mild edema in the patient's lower extremities persisted, although it had not worsened. Upon further inquiry, the patient reported experiencing occasional muscle cramps, particularly after her walks. Recognizing that these symptoms could be linked to her ongoing diuretic therapy, the nurse ordered another basic metabolic panel to reassess her electrolyte status. The lab results indicated that while the patient's serum potassium level slightly improved to 3.5 mEq/L, it remained on the lower side of normal, confirming the need to continue focusing on dietary potassium intake and possibly adjusting her medication regimen.

The nurse discussed these findings with the patient, emphasizing the importance of maintaining her current health practices and considering a consultation with her healthcare provider to explore potential adjustments in her medication to alleviate the cramps. The nurse also recommended incorporating additional potassium-rich foods and possibly a potassium supplement if advised by her doctor. With a plan in place to address these minor complications, the nurse scheduled another follow-up in six weeks to monitor the patient's progress and ensure her hypertension management remained effective.

Section 5

Six weeks later, the patient returned for her scheduled follow-up appointment. During the initial assessment, the nurse observed that the patient appeared content and motivated, a testament to her continued commitment to her health regimen. Her blood pressure reading was an impressive 120/76 mmHg, and her heart rate remained steady at 70 bpm. These vital signs suggested effective management of her hypertension. Her respiratory rate and temperature were also within normal limits. The patient reported that she had been following the nurse's advice by incorporating more potassium-rich foods, such as bananas, spinach, and sweet potatoes, into her diet.

Despite these positive changes, the patient mentioned that she occasionally still experienced mild muscle cramps, albeit less frequently than before. The nurse noted that the edema in her lower extremities had slightly decreased, indicating an improvement that correlated with the adjustments in her diet and medication adherence. To further investigate the ongoing issue with muscle cramps, the nurse ordered another basic metabolic panel. The results showed that the patient's serum potassium level had increased to 3.8 mEq/L, moving closer to the midpoint of the normal range. This improvement suggested that the dietary changes were beginning to take effect, but perhaps a further review of her diuretic therapy was necessary.

Based on these findings, the nurse recommended that the patient continue her current dietary practices and scheduled a consultation with the patient's healthcare provider to discuss the potential benefits of adjusting her diuretic dosage or switching to a potassium-sparing diuretic. The nurse also encouraged the patient to maintain her exercise routine, as it was contributing positively to her overall well-being. With these plans in place, the nurse scheduled another follow-up in four weeks to closely monitor the patient's progress and ensure her treatment plan remained optimal for managing her hypertension while addressing the minor complications.