A patient with chronic hypertension reports worsening headaches and dizziness, and presents with elevated blood pressure, mild jugular venous distention, and 1+ pitting edema. Lab results show a decline in renal function and mild hyponatremia. Which nursing intervention is most appropriate to address the potential fluid overload and prevent further complications?

B) Monitor daily weight and assess for signs of fluid retention

A) Encourage the patient to increase fluid intake to promote renal perfusion

B) Monitor daily weight and assess for signs of fluid retention

C) Advise the patient to reduce sodium intake to less than 2 grams per day

D) Administer an additional dose of the patient's current antihypertensive medication

A patient with chronic hypertension presents with worsening headaches, dizziness, elevated blood pressure, jugular venous distention, and bilateral pitting edema. Laboratory findings include increased serum creatinine, mild hyponatremia, and albuminuria. A chest X-ray shows mild cardiomegaly. Which nursing intervention is most appropriate to address the patient's current complications and prevent further target organ damage?

B) Advise the patient to reduce sodium intake and monitor daily weights to manage fluid retention.

A) Encourage the patient to increase fluid intake to manage hyponatremia.

B) Advise the patient to reduce sodium intake and monitor daily weights to manage fluid retention.

C) Suggest the patient engage in high-intensity exercise to improve cardiovascular health.

D) Recommend the patient discontinue antihypertensive medication temporarily to assess baseline renal function.

A patient with worsening systolic heart failure presents with fatigue, shortness of breath, and increased lower extremity edema. The healthcare provider plans to intensify diuretic therapy and consider a beta-blocker. Which nursing intervention is most critical to monitor this patient's response to the changes in her treatment plan?

A) Monitor daily weights and report any significant increases.

B) Encourage increased fluid intake to prevent dehydration.

C) Assess for signs of increased potassium levels.

D) Advise the patient to limit physical activity to prevent fatigue.

A nurse is reviewing the treatment plan for a patient with worsening systolic heart failure who has been experiencing fatigue, shortness of breath, and edema. Given the patient's current status and recent echocardiogram findings, which nursing intervention should be prioritized to address her symptoms and prevent further complications?

B) Educate the patient on the importance of adhering to a low-sodium diet.

A) Encourage the patient to increase fluid intake to prevent dehydration.

B) Educate the patient on the importance of adhering to a low-sodium diet.

C) Advise the patient to engage in daily vigorous exercise to improve cardiovascular function.

D) Recommend the patient reduce the frequency of follow-up appointments to decrease stress.

A patient on diuretic therapy and a beta-blocker for heart failure management presents with occasional dizziness upon standing, improved blood pressure, and persistent hyponatremia. What is the most appropriate nursing intervention to address the patient's dizziness related to orthostatic hypotension?

B) Advise the patient to perform slow positional changes from sitting to standing.

A) Encourage the patient to increase fluid intake to improve blood pressure.

B) Advise the patient to perform slow positional changes from sitting to standing.

C) Recommend the patient to take the beta-blocker dose at bedtime.

D) Suggest reducing sodium intake further to manage fluid retention.

A patient with heart failure has been experiencing occasional dizziness upon standing, likely due to orthostatic hypotension from her medication regimen. Her sodium level is persistently low at 130 mmol/L. Which nursing intervention is most appropriate to prioritize at this time?

B) Educate the patient about rising slowly from sitting or lying positions

A) Increase fluid intake to correct hyponatremia

B) Educate the patient about rising slowly from sitting or lying positions

C) Encourage the patient to consume high-sodium foods to improve sodium levels

D) Advise the patient to avoid all physical activity to prevent dizziness

A 65-year-old female patient with worsening heart failure presents with a persistent dry cough, increased fatigue, and mild abdominal swelling. Her laboratory results show a rise in serum creatinine, a low sodium level, and elevated BNP. Considering these findings, what is the most appropriate nursing intervention to prioritize at this time?

B) Monitor respiratory status closely and report any increase in wheezing or respiratory distress.

A) Encourage increased oral fluid intake to improve hydration and kidney function.

B) Monitor respiratory status closely and report any increase in wheezing or respiratory distress.

C) Advise the patient to maintain a low-sodium diet to manage potential fluid retention.

D) Educate the patient on the importance of daily weight monitoring to detect fluid changes.

A patient with heart failure presents with worsening symptoms, including a persistent dry cough, increased fatigue, and mild abdominal swelling. Vital signs show elevated blood pressure and a slight increase in respiratory rate. Laboratory results indicate a rise in serum creatinine and low sodium levels. The healthcare team proposes reducing the diuretic dosage and introducing a low-dose ACE inhibitor. What is the primary nursing action to take following this change in the patient's medication regimen?

C) Assess the patient for any new or worsening cough, as this may be a side effect of the ACE inhibitor.

A) Monitor the patient for signs of hyperkalemia, such as muscle weakness or arrhythmias.

B) Educate the patient about the importance of adhering to a low-sodium diet to manage fluid retention.

C) Assess the patient for any new or worsening cough, as this may be a side effect of the ACE inhibitor.

D) Encourage the patient to increase fluid intake to compensate for reduced diuretic dosage.

A patient with heart failure shows improvement in symptoms following an adjustment to her medication regimen. Given her current status, which nursing intervention would best support continued improvement in her condition?

C) Educate the patient on the importance of daily weight monitoring and reporting significant changes.

A) Encourage increased fluid intake to enhance renal function.

B) Advise the patient to maintain current sodium intake to prevent electrolyte imbalance.

C) Educate the patient on the importance of daily weight monitoring and reporting significant changes.

D) Suggest reducing physical activity to minimize fatigue and conserve energy.

A patient with heart failure has shown improvement in symptoms and laboratory results after a medication adjustment. Which nursing intervention is most important to implement at this time to ensure continued progress in the patient's condition?

B) Educate the patient on the importance of adhering to a sodium-restricted diet.

A) Encourage the patient to increase her daily fluid intake to prevent dehydration.

B) Educate the patient on the importance of adhering to a sodium-restricted diet.

C) Advise the patient to monitor her blood pressure at home twice daily.

D) Recommend the patient to perform vigorous exercise to improve cardiovascular health.

hypertension - Nursing Case Study

Pathophysiology

• Primary mechanism: Increased systemic vascular resistance due to narrowing of the blood vessels, often caused by endothelial dysfunction and increased sympathetic nervous system activity, leads to persistently elevated blood pressure.

• Secondary mechanism: Volume overload resulting from renal dysfunction, where impaired sodium excretion causes fluid retention, further raising blood pressure and creating a vicious cycle of hypertension.

• Key complication: Chronic hypertension can lead to target organ damage, such as left ventricular hypertrophy, which increases the risk of heart failure and other cardiovascular diseases.

Patient Profile

Demographics:

52-year-old female, office manager

History:

• Key past medical history: Hypertension diagnosed 5 years ago, borderline type 2 diabetes, family history of cardiovascular disease

• Current medications: Lisinopril 20 mg daily, Metformin 500 mg twice daily, Aspirin 81 mg daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent headache and occasional dizziness

• Key symptoms: Fatigue, blurred vision, shortness of breath on exertion

• Vital signs: Blood pressure 158/96 mmHg, heart rate 88 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F, BMI 31 kg/m²

Section 1

New Complications:

During a routine follow-up appointment, the patient reports worsening symptoms, including increased frequency and severity of her headaches and more pronounced episodes of dizziness. On physical examination, her blood pressure remains elevated at 162/98 mmHg despite adherence to her medication regimen. Notably, her heart rate has increased to 92 bpm, and she exhibits mild jugular venous distention, suggesting possible fluid overload. An examination of her lower extremities reveals 1+ pitting edema bilaterally. Concerned about these findings, the healthcare provider orders additional laboratory tests and a chest X-ray to further investigate potential complications.

The lab results reveal a serum creatinine level of 1.6 mg/dL, indicating a decline in renal function compared to her baseline of 1.2 mg/dL, and suggestive of hypertensive nephropathy. Her electrolytes show a mild hyponatremia with a sodium level of 134 mmol/L, and albuminuria is detected on urinalysis, further confirming renal involvement. The chest X-ray demonstrates mild cardiomegaly, consistent with left ventricular hypertrophy and suggesting early signs of congestive heart failure. These findings indicate that the patient's chronic hypertension is beginning to cause significant target organ damage, necessitating an urgent reevaluation of her management plan.

The healthcare team discusses potential adjustments to her treatment regimen, considering the need for more aggressive blood pressure control and renal protection. Options such as increasing the dose of her current antihypertensive medication, adding a diuretic to address fluid retention, or switching to a different class of antihypertensive agents are explored. The team also emphasizes the importance of lifestyle modifications, including dietary changes and increased physical activity, to help manage her hypertension and prevent further complications. The patient is scheduled for close follow-up and potential referral to a nephrologist for further evaluation of her renal function.

Section 2

New Complications:

During the patient's next follow-up appointment, approximately two weeks after initiating modifications to her treatment plan, she presents with new complaints of persistent fatigue and shortness of breath upon exertion. On physical examination, her blood pressure remains suboptimally controlled at 158/96 mmHg, and her heart rate has increased further to 98 bpm. The jugular venous distention observed previously appears slightly more pronounced, and her lower extremity edema has progressed to 2+ pitting bilaterally. Auscultation of her lungs reveals fine crackles at the bases, suggesting pulmonary congestion.

Given these concerning developments, the healthcare provider orders an echocardiogram, which reveals reduced left ventricular ejection fraction, indicating worsening systolic heart failure. The patient's serum creatinine has increased further to 1.8 mg/dL, and her sodium level has dropped to 132 mmol/L, reinforcing concerns about her renal function and fluid status. In response to these findings, the team decides to intensify her diuretic therapy to manage fluid overload while also considering the introduction of a beta-blocker to help control her heart rate and improve cardiac output.

The healthcare team closely monitors her response to these interventions, with the goal of stabilizing her cardiovascular and renal status. They emphasize the critical importance of adherence to her medication regimen and lifestyle modifications, particularly dietary sodium restriction and weight management, to mitigate the risk of further complications. The patient is scheduled for more frequent follow-ups to closely monitor her progress, and a referral to a cardiologist is made to optimize her heart failure management. These steps aim to address both her current symptoms and the underlying pathophysiological changes contributing to her deteriorating condition.

Section 3

Two weeks after the intensification of her diuretic therapy and the introduction of a beta-blocker, the patient returns for a follow-up visit. Upon initial assessment, her blood pressure has improved slightly, now measuring 150/90 mmHg, and her heart rate has decreased to 82 bpm. She reports feeling less fatigued and experiences reduced shortness of breath with mild exertion. However, she mentions a new symptom: occasional dizziness when standing up, which suggests possible orthostatic hypotension resulting from her medication regimen. Her jugular venous distention remains unchanged, but there is a notable decrease in her lower extremity edema, now 1+ pitting bilaterally. Lung auscultation reveals diminished crackles, indicating some improvement in pulmonary congestion.

The latest laboratory results show a stabilization of her kidney function, with serum creatinine holding steady at 1.8 mg/dL, but her sodium level remains low at 130 mmol/L. The healthcare team interprets these findings as a sign of persistent hyponatremia, likely secondary to her diuretic use, necessitating careful electrolyte monitoring. To address her dizziness and potential orthostatic effects, the team considers adjusting her diuretic dose and encourages her to rise slowly from sitting or lying positions. They reinforce the importance of maintaining a low-sodium diet to prevent further fluid retention and emphasize adherence to her heart failure management plan.

The patient expresses a commitment to her treatment plan and the lifestyle changes discussed. Her follow-up with the cardiologist is scheduled to further evaluate her heart function and optimize her medication regimen. The healthcare team remains vigilant, recognizing the need for ongoing monitoring to prevent additional complications, such as electrolyte imbalances or worsening heart failure. This proactive approach aims to stabilize her condition and improve her quality of life, setting the stage for her continued journey toward better health management.

Section 4

Two weeks later, during the next follow-up visit, the patient presents with new concerns. She reports a persistent dry cough that has worsened over the past few days, accompanied by increased fatigue and mild swelling in her abdomen. Upon examination, vital signs reveal a blood pressure of 148/92 mmHg, heart rate of 78 bpm, and a slight increase in respiratory rate to 22 breaths per minute. Her jugular venous distention remains unchanged, but there is a slight increase in lower extremity edema, now 2+ pitting bilaterally. Lung auscultation reveals scattered wheezes in addition to the previous crackles, suggesting potential bronchospasm or fluid retention.

Laboratory results show a slight rise in serum creatinine to 2.0 mg/dL, indicating a potential decline in kidney function. Her sodium level remains low at 129 mmol/L, and a new finding of elevated B-type natriuretic peptide (BNP) at 600 pg/mL suggests worsening heart failure. These findings prompt the healthcare team to evaluate the possibility of adjusting her current medication regimen, particularly considering the potential side effects of her beta-blocker and diuretic therapy. The team discusses the need to balance her medications to manage her heart failure symptoms while avoiding further kidney impairment and electrolyte imbalances.

In response to these findings, the healthcare team proposes a plan to temporarily reduce the diuretic dosage and introduce a low-dose ACE inhibitor to improve cardiac output and potentially alleviate some of her symptoms. They emphasize the importance of continued monitoring of her kidney function and electrolyte levels, as her regimen will be closely adjusted based on her response. The patient is advised to report any new or worsening symptoms promptly, as early intervention is crucial in preventing further complications. The proactive adjustment of her treatment plan aims to stabilize her condition and enhance her overall quality of life, preparing her for the next steps in her chronic condition management.

Section 5

Two weeks after the adjustment to her medication regimen, the patient returns for a follow-up visit. She reports a noticeable improvement in her dry cough, though she still experiences some fatigue. She notes that her abdominal swelling has decreased slightly, and she has been more vigilant with her daily weight monitoring, reporting a stable weight over the past week. During the physical examination, her vital signs reveal a blood pressure of 142/88 mmHg, a heart rate of 76 bpm, and a respiratory rate of 20 breaths per minute. Her lower extremity edema remains at 2+ pitting bilaterally, and lung auscultation reveals diminished wheezing with persistent mild crackles, suggesting some improvement in fluid retention.

Laboratory results indicate a modest improvement in kidney function, with serum creatinine decreasing to 1.8 mg/dL. Her sodium level has normalized to 132 mmol/L, and BNP levels have slightly decreased to 550 pg/mL, showing a positive response to the medication adjustments. The healthcare team is encouraged by these changes and discusses the importance of continuous monitoring to ensure her cardiac and renal function remains stable while optimizing her heart failure management.

The team decides to maintain the current medication regimen, with plans to gradually titrate the ACE inhibitor dose if her condition continues to stabilize. They emphasize the importance of regular follow-up appointments to closely monitor her progress and adjust her treatment plan as necessary. The patient is advised to continue monitoring her symptoms and to maintain adherence to her medication and lifestyle recommendations. This proactive approach aims to prevent further complications and improve her quality of life, while also preparing her for potential long-term management strategies.