What is the most appropriate initial nursing intervention for the patient with mild hypertension and occasional dizziness and fatigue?

C) Educate the patient about lifestyle modifications to manage hypertension.

A) Encourage the patient to increase sodium intake.

B) Advise the patient to stop taking Lisinopril.

C) Educate the patient about lifestyle modifications to manage hypertension.

D) Suggest the patient reduce fluid intake to prevent dizziness.

What is the most appropriate immediate nursing action for a patient with mild hypertension who is adhering to his medication regimen but presents with a blood pressure of 145/90 mmHg?

C) Reinforce adherence to the medication regimen and lifestyle modifications

A) Administer an additional dose of Lisinopril

B) Encourage the patient to increase physical activity

C) Reinforce adherence to the medication regimen and lifestyle modifications

D) Notify the healthcare provider immediately

Which of the following actions should the nurse recommend to a patient who experiences dizziness when standing up quickly?

C) Gradually change positions from lying to standing

A) Increase fluid intake significantly

B) Wear compression stockings all day

C) Gradually change positions from lying to standing

D) Take blood pressure medication only at bedtime

A patient with hypertension reports occasional dizziness, especially when standing up quickly. What is the most appropriate nursing intervention to help manage this symptom?

B) Encourage the patient to change positions slowly.

A) Advise the patient to increase their fluid intake significantly.

B) Encourage the patient to change positions slowly.

C) Suggest the patient avoid all physical activity.

D) Instruct the patient to consume more salt in their diet.

What is the primary reason for monitoring electrolyte levels in a patient taking a diuretic?

C) To detect any imbalances that could affect cardiac function

A) To assess for potential dehydration

B) To ensure diuretics are effectively lowering blood pressure

C) To detect any imbalances that could affect cardiac function

D) To monitor for signs of improved renal function

During a follow-up visit, a patient's potassium level is found to be slightly elevated at 5.2 mEq/L. Which of the following dietary modifications should the nurse recommend to help manage this condition?

B) Substitute potatoes with rice

A) Increase intake of bananas and oranges

B) Substitute potatoes with rice

C) Encourage consumption of spinach and tomatoes

D) Increase intake of avocados and nuts

abnormal vital signs - Nursing Case Study

Pathophysiology

• Primary mechanism: Dysregulation of homeostasis - The body's inability to maintain stable internal conditions, such as temperature, blood pressure, or heart rate, often due to illness or injury, can lead to abnormal vital signs. For example, infection can trigger fever as the body attempts to fight off pathogens.

• Secondary mechanism: Autonomic nervous system imbalance - Stress or damage to the autonomic nervous system can alter heart rate and blood pressure, common in conditions like anxiety or dehydration where the body struggles to maintain equilibrium.

• Key complication: Organ strain - Persistent abnormal vital signs can place undue stress on organs, such as the heart or kidneys, potentially leading to more serious conditions like heart failure or acute kidney injury if not addressed.

Patient Profile

Demographics:

45-year-old male, office worker

History:

• Key past medical history: Mild hypertension

• Current medications: Lisinopril 10 mg daily

• Allergies: None

Current Presentation:

• Chief complaint: Mild headache

• Key symptoms: Occasional dizziness, fatigue

• Vital signs: Blood pressure 145/90 mmHg, heart rate 82 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F, oxygen saturation 98% on room air

Section 1

Initial Assessment Findings:

During the initial assessment, the nurse conducts a thorough evaluation to better understand the patient's current condition. The patient, a 45-year-old male, presents with a mild headache and reports occasional dizziness and fatigue. His blood pressure remains elevated at 145/90 mmHg, consistent with his history of mild hypertension, despite adherence to his daily Lisinopril regimen. The patient's heart rate is stable at 82 bpm, and he exhibits a normal respiratory rate of 18 breaths per minute. His temperature is within normal limits at 98.6°F, and oxygen saturation is healthy at 98% on room air, indicating no immediate respiratory distress.

The nurse also performs a focused neurological assessment due to the patient's complaint of a headache and dizziness. Cranial nerve examination reveals no deficits, and the patient denies any visual disturbances or sensory changes. The cardiovascular assessment shows regular heart sounds with no murmurs, rubs, or gallops. Peripheral pulses are intact and equal bilaterally. There is no evidence of jugular venous distension, and the lungs are clear to auscultation, with no adventitious breath sounds detected. Overall, the initial assessment suggests that while the patient's vital signs reflect mild hypertension, there are no acute changes or significant organ dysfunction at this stage. The nurse plans to monitor the patient's symptoms closely and encourages him to maintain adequate hydration and adhere to his medication regimen, while considering the need for further evaluation of his blood pressure management.

Section 2

New Diagnostic Results:

Following the initial assessment, the nurse discusses with the physician the need for further evaluation of the patient's mild hypertension and associated symptoms. The physician orders a series of diagnostic tests, including a complete blood count (CBC), basic metabolic panel (BMP), and an electrocardiogram (ECG) to rule out any underlying issues that might be contributing to the patient's elevated blood pressure and symptoms of dizziness and fatigue.

The CBC results return within normal limits, indicating no signs of anemia or infection. The BMP reveals a slightly elevated creatinine level of 1.4 mg/dL, suggesting mild renal impairment, which could be contributing to the patient's hypertension. The serum electrolytes, including sodium and potassium, are within normal limits, ensuring that the current Lisinopril dosage is not causing any electrolyte imbalances. The ECG shows normal sinus rhythm with no evidence of ischemic changes, thereby ruling out any acute cardiac events.

These diagnostic results provide the healthcare team with further insight into the patient's condition. The mild renal impairment observed in the BMP prompts a discussion about potential adjustments to the patient's antihypertensive regimen or a nephrology consultation to prevent further kidney function decline. The nurse educates the patient about the importance of monitoring blood pressure regularly, maintaining a low-sodium diet, and adhering to lifestyle modifications such as regular exercise to support cardiovascular health. The team plans to continue close monitoring and reassess the patient's response to any potential treatment changes.

Section 3

Two weeks after the initial evaluation and adjustments to the patient's antihypertensive regimen, the nurse conducts a follow-up assessment. The patient reports adherence to the recommended lifestyle changes, including a low-sodium diet and regular moderate exercise, and mentions feeling slightly more energetic. However, the patient continues to experience occasional episodes of dizziness, particularly when standing up quickly. The current vital signs indicate a blood pressure of 138/88 mmHg, a slight improvement from the previous visit, and a heart rate of 78 bpm. The nurse notes that while the blood pressure remains slightly elevated, it is trending in the right direction.

In light of these observations, the nurse collaborates with the physician to evaluate the effectiveness of the current treatment plan. A repeat basic metabolic panel is ordered to monitor kidney function and ensure there are no worsening renal issues. The results return showing a creatinine level unchanged at 1.4 mg/dL, confirming stable but mild renal impairment. The patient’s serum electrolytes remain within normal limits. Given the persistent but manageable symptoms, the healthcare team discusses the possibility of introducing a low-dose diuretic to help further control blood pressure and alleviate dizziness by managing fluid balance.

The nurse takes this opportunity to reinforce the importance of gradual position changes to mitigate dizziness, and reminds the patient to continue monitoring their blood pressure at home. The patient is encouraged to maintain their current lifestyle adjustments while the team evaluates the effectiveness of the newly introduced medication. Regular follow-up appointments are scheduled to closely track the patient's progress and make further adjustments as necessary, ensuring a proactive approach to managing hypertension and supporting overall health.

Section 4

Two weeks after the introduction of the low-dose diuretic, the patient returns for a follow-up appointment. The nurse conducts an initial assessment, noting that the patient reports feeling less dizzy and more comfortable overall. The patient has maintained their commitment to lifestyle changes, including adhering to a low-sodium diet and engaging in regular exercise. Upon measuring the vital signs, the nurse observes a blood pressure of 130/84 mmHg and a heart rate of 76 bpm, indicating further improvement in blood pressure control. The patient’s weight is stable, and there are no signs of dehydration, such as dry mucous membranes or skin turgor changes.

In reviewing the patient's home blood pressure log, the nurse sees consistent readings within the target range, suggesting the addition of the diuretic has been beneficial. The patient expresses relief in having fewer episodes of dizziness and reports feeling more confident in their ability to manage their condition independently. The nurse commends the patient for their diligent efforts and encourages continued monitoring and adherence to prescribed medications and lifestyle modifications.

To ensure comprehensive care, the healthcare team orders another basic metabolic panel to re-evaluate the patient's renal function and electrolyte balance. The results show that the creatinine level remains stable at 1.4 mg/dL, with all electrolytes continuing to fall within normal limits. This stability suggests that the diuretic is well-tolerated, and has not adversely affected renal function. The nurse discusses the importance of regular follow-ups and reassures the patient that the current management plan is effective, setting the stage for the next phase in monitoring and supporting the patient's long-term health.

Section 5

During the next follow-up visit, the nurse conducts another thorough assessment to evaluate the patient's ongoing response to treatment. The patient continues to report feeling well, with no episodes of dizziness and a consistent energy level that supports their daily activities. The vital signs collected during this visit show a blood pressure reading of 128/82 mmHg and a heart rate of 74 bpm, further reinforcing the effectiveness of the current treatment regimen. The patient’s weight remains stable, and upon examination, their skin and mucous membranes are well-hydrated, confirming adequate fluid balance.

As part of routine monitoring, the healthcare team orders a repeat basic metabolic panel to ensure continued renal function stability and electrolyte balance. The results reveal a slight increase in potassium levels to 5.2 mEq/L, which is at the upper limit of normal. However, all other electrolytes and renal function markers, including creatinine, are within normal ranges. The nurse discusses these results with the patient, emphasizing the importance of maintaining dietary modifications and ensuring they do not consume excessive potassium-rich foods. The patient is advised to continue monitoring their blood pressure at home and to report any symptoms of weakness or palpitations that could indicate changes in potassium levels.

To address the slight rise in potassium, the nurse collaborates with the healthcare provider to adjust the patient's dietary plan and consider potential modifications to the medication regimen if necessary. The nurse educates the patient on identifying high-potassium foods and suggests alternative options to maintain a balanced diet. The patient is reassured that with these adjustments and continued adherence to lifestyle changes, they can effectively manage their condition and minimize the risk of complications. The nurse schedules the next follow-up appointment to reassess the patient's response and ensure ongoing support in their care journey.