What is the primary goal of lifestyle modifications in the management of stage 1 hypertension?

B) To reduce the risk of progression to more severe hypertension

A) To eliminate the need for antihypertensive medications

B) To reduce the risk of progression to more severe hypertension

C) To avoid all dietary restrictions

D) To cure hypertension permanently

Which lifestyle modification is most important to reinforce for a patient with stage 1 hypertension who reports occasional lapses in dietary adherence?

B) Adhere strictly to a low-sodium diet

A) Increase physical activity to 60 minutes daily

B) Adhere strictly to a low-sodium diet

C) Ensure 8 hours of sleep each night

D) Drink at least 8 glasses of water daily

Which lifestyle modification is most likely contributing to the patient's slight decrease in blood pressure?

B) Increased caffeine consumption

D) Increased alcohol consumption

What is the most appropriate initial nursing action when a patient reports dizziness upon standing?

C) Instruct the patient to rise slowly and dangle their feet before standing

A) Encourage the patient to stand up quickly to build tolerance

B) Advise the patient to sit down immediately and rest

C) Instruct the patient to rise slowly and dangle their feet before standing

D) Increase the patient's fluid intake to prevent dehydration

What is the primary reason for advising the patient to elevate her legs to alleviate ankle swelling?

B) To promote venous return and reduce fluid accumulation

A) To increase blood circulation in the lower extremities

B) To promote venous return and reduce fluid accumulation

C) To enhance arterial blood flow to the feet

D) To strengthen the muscles in the legs

A patient on Lisinopril for hypertension reports mild ankle swelling by the end of the day. Which of the following nursing actions is most appropriate to address this concern?

B) Recommend elevating the legs when resting to help alleviate swelling.

A) Advise the patient to decrease water intake to reduce swelling.

B) Recommend elevating the legs when resting to help alleviate swelling.

C) Suggest increasing the dosage of Lisinopril to manage fluid retention.

D) Instruct the patient to stop taking Lisinopril until the swelling resolves.

When educating a patient with mild edema about dietary modifications, which recommendation would be most appropriate to help reduce fluid retention?

B) Reduce sodium intake by choosing fresh fruits and vegetables

A) Increase intake of processed and pre-packaged foods

B) Reduce sodium intake by choosing fresh fruits and vegetables

C) Increase fluid intake without dietary changes

D) Avoid all physical activity to prevent further swelling

What dietary advice should the nurse provide to the patient to help manage her mild fluid retention?

B) Decrease sodium intake by avoiding processed foods.

A) Increase intake of pre-packaged meals.

B) Decrease sodium intake by avoiding processed foods.

C) Drink less water throughout the day.

D) Avoid eating fresh fruits and vegetables.

Hypertension - Nursing Case Study

Pathophysiology

• Primary mechanism: Increased Peripheral Resistance - The blood vessels, especially small arteries, become narrower (vasoconstriction), making it harder for blood to flow through, which raises blood pressure. This can occur due to factors like high sodium intake or stress, leading to prolonged vessel constriction.

• Secondary mechanism: Increased Blood Volume - Excessive sodium in the body can cause the body to retain more water, increasing blood volume. More blood volume means more pressure on the vessel walls, contributing to higher blood pressure.

• Key complication: Organ Damage - Over time, high blood pressure can damage vital organs like the heart, kidneys, and eyes, leading to complications such as heart disease, kidney failure, or vision problems.

Patient Profile

Demographics:

45-year-old female, office manager

History:

• Key past medical history: Diagnosed with stage 1 hypertension six months ago

• Current medications: Lisinopril 10 mg once daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Routine follow-up for hypertension management

• Key symptoms: Occasional mild headaches, otherwise asymptomatic

• Vital signs: Blood pressure 135/85 mmHg, heart rate 78 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F

Section 1

Initial Assessment Findings:

During the routine follow-up appointment, the nursing assessment focused on evaluating the patient's adherence to her medication regimen and lifestyle modifications recommended for managing stage 1 hypertension. The patient reports taking Lisinopril consistently but admits to occasional lapses in adhering to a low-sodium diet, particularly during periods of increased work-related stress. Despite these lapses, she has been engaging in regular physical activity, including walking for 30 minutes at least five times a week.

The physical examination reveals that the patient's blood pressure remains slightly elevated at 135/85 mmHg, indicating the need for continued monitoring and possible adjustment in management strategies. Her heart rate is stable at 78 bpm, with no irregularities detected during auscultation. The patient reports occasional mild headaches, which she attributes to work stress and manages with over-the-counter analgesics. The nursing assessment identifies the need for reinforced patient education on dietary modifications to reduce sodium intake and stress management techniques to help mitigate the potential impact on her blood pressure.

These findings suggest the importance of addressing lifestyle factors as part of the comprehensive management of hypertension. The nurse plans to collaborate with the patient to set realistic goals for sodium reduction, incorporate stress-reducing activities such as mindfulness or yoga, and schedule a follow-up appointment in three months to reassess her blood pressure and evaluate the effectiveness of the current management plan. This approach aims to prevent progression to more severe stages of hypertension and minimize the risk of long-term organ damage.

Section 2

During the next follow-up appointment, three months later, the patient presents with new diagnostic results that provide further insight into her hypertension management. Her blood pressure has decreased slightly to 132/82 mmHg, a positive indication of her improved adherence to lifestyle modifications. The patient has diligently reduced her sodium intake by preparing meals at home using fresh ingredients and choosing low-sodium options when dining out. She also reports practicing mindfulness exercises daily, which she finds beneficial in managing work-related stress.

Recent laboratory tests reveal normal renal function with a serum creatinine level of 0.9 mg/dL and an estimated glomerular filtration rate (eGFR) of 90 mL/min/1.73m², suggesting that there has been no significant impact on kidney function. Her lipid profile shows a total cholesterol level of 190 mg/dL and LDL cholesterol level of 110 mg/dL, both within acceptable ranges, although the nurse emphasizes the importance of maintaining these levels through continued dietary vigilance and physical activity.

The patient's occasional mild headaches have decreased in frequency, which she attributes to the incorporation of stress management techniques. The nurse praises the patient's efforts and encourages her to continue these practices while also suggesting the addition of yoga classes to further support her stress reduction goals. The nurse plans to maintain the current medication regimen, emphasizing the importance of consistent adherence to Lisinopril, and schedules the next follow-up appointment in another three months to monitor for any further improvements or necessary adjustments. This continued collaborative approach aims to solidify the patient's progress and prevent any escalation of her hypertension.

Section 3

Three months later, the patient returns for her scheduled follow-up appointment, presenting with a blood pressure reading of 130/80 mmHg, indicating further improvement in her hypertension management. During the initial assessment, the nurse notes that the patient appears more energetic and reports feeling less fatigued throughout the day. The patient explains that she has incorporated light jogging into her routine, which has contributed to her overall sense of well-being. Vital signs are stable, and her heart rate is 72 beats per minute with regular rhythm. The patient’s BMI has decreased slightly to 26 kg/m², reflecting her commitment to lifestyle changes.

The nurse conducts a thorough review of systems and discovers that the patient has been experiencing occasional dizziness, particularly when standing up quickly. This prompts the nurse to consider the possibility of orthostatic hypotension, a common side effect of antihypertensive medication like Lisinopril. The nurse decides to perform orthostatic blood pressure measurements, noting a drop in systolic pressure of 15 mmHg upon standing. This finding leads to a discussion about the importance of changing positions slowly and staying hydrated to alleviate symptoms.

To address this minor complication, the nurse collaborates with the primary care provider to adjust the patient’s Lisinopril dosage slightly, aiming to maintain optimal blood pressure control while minimizing adverse effects. The nurse educates the patient about recognizing symptoms of orthostatic hypotension and provides strategies to manage them effectively. The patient is encouraged to continue her lifestyle modifications and stress management practices while monitoring her symptoms closely. The nurse schedules a follow-up phone call in two weeks to reassess the patient’s response to the adjusted medication regimen and ensure continued progress in her hypertension management journey.

Section 4

Two weeks later, during the scheduled follow-up phone call, the nurse checks in with the patient to assess her response to the adjusted Lisinopril dosage. The patient reports that she has experienced a significant reduction in episodes of dizziness, especially when transitioning from sitting to standing. She expresses relief and satisfaction with the adjustment, noting that her day-to-day activities have become more manageable. The nurse documents the patient's blood pressure readings taken at home, which consistently hover around 128/78 mmHg, indicating that her blood pressure remains well-controlled.

In addition to monitoring blood pressure, the nurse inquires about any new symptoms or concerns. The patient mentions mild swelling in her ankles by the end of the day, which is a new development since the last visit. Upon further discussion, the nurse learns that the patient’s daily water intake has increased as part of her efforts to stay hydrated, possibly contributing to the fluid retention. The nurse advises the patient to elevate her legs when resting and to continue monitoring the swelling.

To ensure comprehensive care, the nurse arranges for a follow-up appointment at the clinic to evaluate the edema more thoroughly. During this visit, the nurse plans to review potential lifestyle or dietary adjustments that may help alleviate the swelling, such as reducing sodium intake or modifying fluid consumption. The nurse also considers the possibility of further medication adjustment if the swelling persists, collaborating with the healthcare team to maintain an optimal balance in the patient's hypertension management plan.

Section 5

Two weeks after the follow-up phone call, the patient arrives at the clinic for her scheduled appointment. During the initial assessment, the nurse observes that the patient appears well-groomed and in good spirits. The patient's vital signs are stable, with a blood pressure reading of 126/76 mmHg, a heart rate of 72 beats per minute, and a respiratory rate of 18 breaths per minute. The nurse notes mild pitting edema in the patient's ankles, which is slightly more pronounced than previously reported. This finding indicates mild fluid retention, but otherwise, the patient does not exhibit any signs of distress or discomfort.

As part of the comprehensive assessment, the nurse discusses the patient's dietary habits and fluid intake. The patient reveals that she has been enjoying more soups and pre-packaged meals recently, which may inadvertently have increased her sodium intake. Additionally, the patient admits to being less active due to a recent busy schedule, which could contribute to her fluid retention. The nurse educates the patient on the importance of maintaining a low-sodium diet and suggests incorporating more fresh fruits and vegetables to help manage her symptoms. The nurse also emphasizes the importance of regular physical activity to promote circulation and reduce swelling.

With these findings, the nurse collaborates with the healthcare team to decide on the next steps. The team opts to monitor the patient's condition closely while implementing these lifestyle changes. They schedule another follow-up visit in four weeks to reassess the edema and overall management of her hypertension. The nurse reassures the patient that with consistent lifestyle modifications and ongoing monitoring, her symptoms can be effectively managed, ensuring her blood pressure remains well-controlled and her quality of life is maintained.