Blood pressure - Nursing Case Study

Pathophysiology

• Primary mechanism: Blood pressure is primarily regulated by the heart's pumping ability and the resistance of blood vessels. The heart pumps blood into arteries, and when the arteries are narrow or stiff, it increases resistance, raising blood pressure.

• Secondary mechanism: The kidneys help control blood pressure by regulating blood volume. They filter blood and adjust how much water and salt is excreted or retained, affecting blood volume and pressure.

• Key complication: Elevated blood pressure, or hypertension, can lead to damage in the arteries, increasing the risk of heart attack, stroke, and kidney disease due to the extra strain placed on the heart and blood vessels.

Patient Profile

Demographics:

45-year-old female, office manager

History:

• Key past medical history: Mild hypertension diagnosed 6 months ago

• Current medications: Lisinopril 10 mg daily

• Allergies: None

Current Presentation:

• Chief complaint: Routine follow-up for blood pressure management

• Key symptoms: Occasional mild headaches, otherwise asymptomatic

• Vital signs: Blood pressure 130/85 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F

Section 1

During the follow-up visit, the nurse conducts an initial assessment of the patient, who continues to manage her mild hypertension with Lisinopril 10 mg daily. The patient reports occasional mild headaches, but no other significant symptoms. Her vital signs reveal a blood pressure of 130/85 mmHg, a heart rate of 72 bpm, a respiratory rate of 16 breaths per minute, and a temperature of 98.6°F. These findings suggest that the patient's blood pressure is reasonably controlled, though not yet at optimal levels. The nurse observes that the patient's body mass index (BMI) is slightly elevated at 27, which may be contributing to her hypertension.

The nurse reviews the patient's diet and exercise habits as part of the assessment, noting that the patient leads a relatively sedentary lifestyle due to her office job. The patient admits to consuming a diet moderately high in sodium and processed foods, which could be exacerbating her blood pressure issues. The nurse provides education on lifestyle modifications, emphasizing the importance of regular physical activity and a diet low in sodium and rich in fruits and vegetables. The nurse suggests a follow-up appointment to monitor progress and potentially adjust medication if lifestyle changes do not lead to improved blood pressure control.

Based on the assessment, the nurse collaborates with the patient to set realistic goals for lifestyle modifications, such as incorporating at least 30 minutes of moderate exercise most days of the week and reducing sodium intake. The nurse reinforces the importance of medication adherence and offers resources for dietary education. The patient expresses willingness to make these changes and agrees to a follow-up appointment in three months to assess the effectiveness of these interventions and consider any necessary adjustments to her care plan. This approach aims to empower the patient to take an active role in managing her hypertension and prevent potential complications.

Section 2

Three months later, the patient returns for her follow-up appointment. She has been diligent in following the lifestyle modifications discussed during her last visit. She reports engaging in brisk walking for 30 minutes, five days a week, and has made substantial changes to her diet by reducing sodium intake and incorporating more fresh fruits and vegetables. The patient notes that, since making these changes, her episodes of mild headaches have decreased in frequency.

During the assessment, the nurse records the patient's vital signs: a blood pressure of 125/80 mmHg, a heart rate of 70 bpm, a respiratory rate of 16 breaths per minute, and a temperature of 98.6°F. The patient's BMI has slightly decreased to 26.5, indicating a positive trend towards a healthier weight. These findings suggest an improvement in her blood pressure control, likely due to her enhanced lifestyle habits. The nurse is pleased with the patient's progress and commends her efforts, reinforcing the importance of maintaining these changes to achieve long-term benefits.

Based on the improved clinical data, the nurse and patient discuss continuing the current management plan, including medication adherence to Lisinopril 10 mg daily. The nurse encourages the patient to keep up with her exercise routine and dietary modifications. Additionally, the nurse provides information on stress management techniques, as stress can also impact blood pressure. The patient expresses satisfaction with her progress and remains motivated to continue her healthy lifestyle. The nurse schedules another follow-up appointment in six months to monitor the patient's ongoing progress and addresses any potential adjustments needed in her care plan. This approach supports the patient's active participation in managing her hypertension and promotes sustained health improvements.

Section 3

Six months later, the patient returns for her scheduled follow-up appointment. She continues to adhere to her lifestyle changes and medication regimen with Lisinopril 10 mg daily. During the visit, she reports feeling generally well but mentions occasional lightheadedness, particularly when standing up quickly. The nurse carefully records her vital signs: blood pressure is 118/76 mmHg, heart rate is 68 bpm, respiratory rate is 16 breaths per minute, and temperature is 98.4°F. The patient's BMI is now 25.8, indicating continued progress towards a healthier weight. While her blood pressure readings demonstrate effective control, the nurse recognizes the need to address the new symptom of lightheadedness.

To further investigate the cause of the patient's lightheadedness, the nurse performs an orthostatic blood pressure assessment. The readings reveal a slight drop in blood pressure upon standing, suggesting the presence of orthostatic hypotension, a potential side effect of her antihypertensive medication. The nurse discusses these findings with the patient, explaining the importance of rising slowly from sitting or lying positions and ensuring adequate hydration to mitigate these symptoms.

The nurse arranges for a follow-up consultation to reassess the patient's medication dosage, considering the possibility of adjusting her Lisinopril intake. The patient is encouraged to continue her healthy lifestyle practices and is educated about monitoring her symptoms. This proactive approach aims to maintain effective blood pressure control while minimizing any adverse effects, ensuring the patient's ongoing well-being and active participation in her health management.

Section 4

Two weeks after the initial follow-up, the patient returns to the clinic for a reassessment of her symptoms and medication regimen. During this visit, the nurse conducts a thorough review of the patient's current lifestyle habits, recent dietary intake, and hydration status. The patient reports that she has been diligent in maintaining her healthy diet and exercises regularly, but has occasionally skipped drinking enough water in the afternoons. She also mentions that she has been trying to stand up more slowly, which has slightly reduced the frequency of lightheaded episodes.

The nurse records the patient's vital signs: her sitting blood pressure is 120/78 mmHg and her pulse is 70 bpm. Upon standing, her blood pressure drops to 112/74 mmHg with a heart rate of 74 bpm, confirming the presence of mild orthostatic hypotension. The nurse also reviews recent lab results, which show normal electrolyte levels and renal function, suggesting that the Lisinopril is not adversely affecting her kidney function at this point.

Considering the mild nature of the orthostatic hypotension and the patient's overall stable health, the healthcare team decides to continue monitoring the patient's symptoms while maintaining her current Lisinopril dosage. The nurse emphasizes the importance of adequate hydration, particularly in the afternoons, and reminds the patient to continue monitoring her symptoms. The patient is scheduled for another follow-up in a month, with instructions to report any increase in the frequency or severity of her lightheadedness. This ongoing management plan aims to balance effective blood pressure control with the minimization of side effects, supporting the patient's journey towards improved cardiovascular health.

Section 5

A month later, the patient returns for her scheduled follow-up appointment. She reports feeling generally well but mentions occasional episodes of dizziness, particularly when transitioning from lying down to standing. She has been more conscious of her water intake, ensuring she drinks enough throughout the day. Her dietary habits remain consistent with her previous healthy regimen, and she continues to engage in regular physical activity.

During this visit, the nurse assesses her vital signs: her sitting blood pressure is 118/76 mmHg, and her pulse is 68 bpm. Upon standing, her blood pressure drops slightly to 110/72 mmHg with a heart rate of 72 bpm. The mild orthostatic hypotension persists, but her symptoms appear to be less frequent and less severe. A review of her latest lab results indicates stable renal function and normal electrolyte levels, supporting the continued use of Lisinopril without any adverse renal effects.

Given the patient's overall stable condition and the slight improvement in her symptoms, the healthcare team decides to maintain the current management plan. The nurse reiterates the importance of proper hydration and advises the patient to continue standing up slowly to minimize dizziness. The patient is encouraged to keep a symptom diary to help identify any patterns or triggers related to her dizziness. The team plans to reassess her in another month, emphasizing that she should seek immediate care if she experiences any significant changes in her condition. This approach aims to ensure ongoing effective management of her blood pressure while closely monitoring for any potential complications.