HTN - Nursing Case Study

Pathophysiology

• Primary mechanism: Increased blood volume or cardiac output causes higher pressure on artery walls, often due to excess salt intake or fluid retention, making the heart work harder to pump blood.

• Secondary mechanism: Narrowing of the blood vessels (vasoconstriction) occurs due to overactive sympathetic nervous system or hormonal imbalances, increasing resistance and raising blood pressure.

• Key complication: Persistent high blood pressure can damage blood vessels and organs over time, leading to conditions like heart disease, stroke, and kidney damage.

Patient Profile

Demographics:

52-year-old female, office administrator

History:

• Key past medical history: Diagnosed with hypertension 6 months ago, no other significant medical history

• Current medications: Hydrochlorothiazide 12.5 mg daily

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Routine follow-up for hypertension management

• Key symptoms: Occasional mild headaches, otherwise asymptomatic

• Vital signs: Blood pressure 138/86 mmHg, heart rate 78 bpm, respiratory rate 16 breaths per minute, temperature 98.4°F

Section 1

Initial assessment findings reveal that the patient's blood pressure control, while improved, remains slightly above the target range, warranting further evaluation and patient education. During the routine follow-up appointment, the nurse conducts a comprehensive assessment, noting that the patient occasionally experiences mild headaches but has no other significant symptoms. The nurse observes that the patient appears well-nourished and in no acute distress, with skin warm and dry to the touch, and no signs of edema. The patient's blood pressure reading is 138/86 mmHg, which is a slight improvement from previous readings but still indicates the need for continued management and monitoring.

In discussing lifestyle habits, the patient admits to consuming a diet high in processed foods and not consistently engaging in physical activity, which may contribute to her hypertension. She reports drinking one to two cups of coffee daily and occasionally having a glass of wine with dinner. The nurse emphasizes the importance of dietary modifications, such as reducing sodium intake, increasing the consumption of fruits and vegetables, and gradually incorporating regular exercise into her routine. Additionally, the nurse reviews the proper technique for home blood pressure monitoring and encourages the patient to keep a log of her readings to track trends over time.

Based on these assessment findings, the nurse collaborates with the primary care provider to discuss potential adjustments to the patient's treatment plan, including possible medication adjustments or additional lifestyle interventions. The patient is scheduled for follow-up in three months, with instructions to contact the healthcare team if she experiences any new symptoms or significant changes in her health status. This plan aims to empower the patient with the knowledge and tools needed to manage her condition effectively and prevent further complications.

Section 2

Three months later, the patient returns for her follow-up appointment. During this visit, the nurse conducts another comprehensive assessment. The patient reports that she has made some dietary changes, including reducing her intake of processed foods and incorporating more fresh fruits and vegetables into her meals. She also mentions that she has started walking for 20 minutes three times a week as part of her exercise routine. Her home blood pressure log shows readings consistently around 130-135/82-84 mmHg, indicating further improvement since her last visit. The nurse notes that the patient's weight has decreased by 4 pounds, and her BMI is now slightly lower. The patient reports feeling more energetic overall and has not experienced any headaches in the past month.

Vital signs taken during the visit show a blood pressure reading of 130/82 mmHg, a heart rate of 72 beats per minute, and a respiratory rate of 16 breaths per minute. The patient's skin remains warm and dry, with no edema present. A recent set of lab results from her primary care provider show that her cholesterol levels have improved, with her LDL cholesterol slightly reduced and HDL cholesterol slightly increased. Her fasting blood glucose level is within normal limits, further supporting the positive impact of her lifestyle changes.

The nurse and the primary care provider discuss these findings with the patient, emphasizing the positive trend in her blood pressure and overall health status. They encourage her to continue with her current lifestyle modifications, highlighting the importance of consistency in her diet and exercise routine. The provider decides that medication adjustments are not necessary at this time, given the favorable response to lifestyle interventions. They schedule the patient for another follow-up in six months, reinforcing the plan to monitor her progress and make further adjustments if needed. The patient is advised to maintain her home blood pressure log and to reach out to the healthcare team with any concerns or questions.

Section 3

Three months later, the patient returns for her scheduled follow-up appointment, eager to share her continued progress with the healthcare team. During this visit, the nurse conducts a thorough assessment, noting that the patient's weight has decreased by an additional 3 pounds, bringing her total weight loss to 7 pounds since her initial diagnosis. Her BMI has decreased accordingly, now falling within the normal range. The patient expresses satisfaction with her dietary changes and exercise routine, mentioning that she has increased her walking time to 30 minutes, four times a week, and feels even more energetic throughout the day.

Vital signs recorded during this visit show a blood pressure of 128/80 mmHg, a heart rate of 70 beats per minute, and a respiratory rate of 16 breaths per minute, all indicative of stable cardiovascular status. The nurse observes that the patient's skin remains warm, dry, and without edema. During the discussion, the patient mentions experiencing occasional dizziness when standing up quickly, which prompts the nurse to assess for orthostatic hypotension. Upon evaluation, a slight decrease in blood pressure is noted when the patient transitions from sitting to standing, suggesting the need for caution in posture changes.

Additionally, the nurse reviews the latest lab results, which continue to show improvements in cholesterol levels, with LDL further reduced and HDL increased. The patient's fasting blood glucose remains within normal limits. The nurse and the primary care provider discuss these findings, reassuring the patient that her current lifestyle modifications are having a positive effect on her hypertension and overall health. They offer practical advice on preventing dizziness, such as rising slowly from a seated position and staying hydrated. The patient is encouraged to continue her efforts and is scheduled for another follow-up in six months, with the ongoing plan to monitor her condition and address any new complications that may arise.

Section 4

Three months later, the patient returns for her follow-up appointment, appearing more confident and enthusiastic about her health journey. During the initial assessment, the nurse notes that the patient has maintained her weight loss, with her BMI still within the normal range. Her vital signs reveal a blood pressure of 125/78 mmHg, a heart rate of 68 beats per minute, and a respiratory rate of 16 breaths per minute, indicating continued stability in her cardiovascular health. The patient's skin is warm and dry, and there are no signs of edema. The nurse listens attentively as the patient describes her adherence to a balanced diet and regular exercise, which now includes light resistance training twice a week to complement her walking routine.

The nurse also reviews the latest lab results, which show further improvement in the patient's lipid profile. Her LDL cholesterol has decreased to 90 mg/dL, while her HDL cholesterol has increased to 65 mg/dL. These results suggest that her lifestyle modifications are contributing positively to her cardiovascular risk reduction. Additionally, the patient's fasting blood glucose remains stable at 95 mg/dL, demonstrating good glycemic control. The nurse takes this opportunity to reinforce the importance of these lifestyle changes, commending the patient on her dedication and discussing the potential long-term benefits for her heart health.

However, the patient mentions experiencing more frequent bouts of dizziness, especially in the mornings. The nurse conducts a more thorough assessment for orthostatic hypotension, noting a drop in blood pressure to 115/75 mmHg when the patient stands up quickly from a lying position. The nurse educates the patient about the importance of moving slowly from lying to standing and ensuring adequate hydration throughout the day. They discuss strategies to manage this mild complication, such as incorporating small meals with adequate sodium and continuing to monitor her symptoms closely. An additional follow-up appointment is scheduled in three months to reassess her condition and ensure the dizziness does not interfere with her daily activities.

Section 5

Three months later, the patient returns for her scheduled follow-up appointment. She appears in good spirits, though she reports to the nurse that she continues to experience occasional dizziness, particularly upon rising in the morning. The nurse begins by conducting a thorough assessment, noting that the patient's blood pressure is 120/76 mmHg while seated, but it drops to 110/72 mmHg when she stands. Her heart rate remains steady at 70 beats per minute, and her respiratory rate is 16 breaths per minute. The patient’s skin remains warm and dry, indicating good overall circulation, and there is no sign of edema. The nurse is pleased to see that the patient’s BMI continues to be within the normal range, and she reports feeling more energetic overall despite the bouts of dizziness.

The nurse reviews the patient's latest lab results, which indicate continued improvement. Her LDL cholesterol has further decreased to 85 mg/dL, and her HDL cholesterol has increased slightly to 68 mg/dL. Her fasting blood glucose is stable at 93 mg/dL, suggesting sustained good glycemic control. These results reinforce the effectiveness of her ongoing lifestyle modifications. However, given the persistence of her dizziness, the nurse discusses with the patient the possibility of adjusting her dietary sodium intake slightly, under the guidance of her healthcare provider, to see if this helps stabilize her blood pressure fluctuations. The nurse also emphasizes the importance of continuing her exercise routine but reminds her to listen to her body and take breaks if she feels lightheaded.

As the visit concludes, the nurse arranges for another follow-up appointment in three months to monitor the patient’s progress and address any further issues with dizziness. Additionally, the nurse provides educational materials on managing orthostatic hypotension and encourages the patient to keep a symptom diary to track any patterns or changes in her dizziness episodes. This proactive approach aims to empower the patient to manage her health effectively and ensures that her journey towards better cardiovascular health continues smoothly.