A patient with poorly controlled hypertension, chronic kidney disease stage 3, and hyperlipidemia is being evaluated for potential changes to their treatment plan. Based on the patient's diagnostic results and current condition, which of the following interventions should the nurse prioritize to address the patient's cardiac and renal health?

B) Increase the dose of Lisinopril to improve blood pressure control

A) Initiate a low-protein diet to reduce renal workload

B) Increase the dose of Lisinopril to improve blood pressure control

C) Encourage daily aerobic exercise to enhance cardiovascular function

D) Recommend dietary changes focusing on reducing LDL cholesterol levels

A patient with stage 3 chronic kidney disease, poorly controlled hypertension, and dyslipidemia has received lab results showing elevated serum creatinine, LDL cholesterol, and fasting blood glucose levels. Which nursing intervention is most appropriate to prioritize in the plan of care to address these findings?

C) Initiate a referral to a nephrologist for renal function monitoring and management.

A) Educate the patient on the importance of a low-sodium diet to manage hypertension.

B) Refer the patient to a diabetes educator for insulin administration training.

C) Initiate a referral to a nephrologist for renal function monitoring and management.

D) Encourage regular physical activity specifically to reduce LDL cholesterol levels.

A patient with hypertension and chronic kidney disease presents with increased serum creatinine and persistent elevated blood pressure despite current treatment. What is the most appropriate nursing action to address the patient's condition?

B) Educate the patient on the importance of reducing sodium intake

A) Increase the dose of Lisinopril to further manage blood pressure

B) Educate the patient on the importance of reducing sodium intake

C) Suggest the addition of a beta-blocker to the medication regimen

D) Prepare the patient for potential initiation of dialysis treatment

A patient with hypertension and chronic kidney disease is experiencing increased fatigue and shortness of breath despite modifications to her antihypertensive regimen and lifestyle changes. What is the most appropriate nursing intervention to address her current symptoms and prevent further complications?

B) Monitor the patient's daily weight and assess for signs of fluid overload, such as edema or lung crackles.

A) Educate the patient on the importance of adhering strictly to her prescribed diet and exercise regimen.

B) Monitor the patient's daily weight and assess for signs of fluid overload, such as edema or lung crackles.

C) Encourage the patient to increase her daily water intake to improve renal function.

D) Suggest the patient take her antihypertensive medications at night to better control her blood pressure.

A patient with hypertension and fluid overload has been started on a diuretic, resulting in a modest improvement in blood pressure and reduced symptoms of fluid overload. However, her renal function continues to decline. Which nursing intervention should be prioritized to address the patient's current clinical status?

B) Monitor the patient's serum potassium levels regularly.

A) Encourage increased fluid intake to improve renal perfusion.

B) Monitor the patient's serum potassium levels regularly.

C) Advise the patient to increase protein intake to support kidney function.

D) Educate the patient on the importance of maintaining a high-calcium diet.

A patient with hypertension and declining renal function has been started on a diuretic and is now being considered for addition of a beta-blocker. What nursing intervention is most important to implement when initiating the beta-blocker therapy?

B) Educate the patient on the importance of not abruptly stopping the medication.

A) Monitor the patient's blood glucose levels closely.

B) Educate the patient on the importance of not abruptly stopping the medication.

C) Assess the patient's respiratory rate and lung sounds frequently.

D) Ensure the patient increases their dietary potassium intake.

A patient with hypertension and chronic kidney disease was started on a beta-blocker two weeks ago. The patient now reports increased fatigue and dizziness upon standing. Blood pressure has improved to 138/85 mmHg, but the heart rate is 54 bpm, and laboratory tests show worsened renal function with elevated potassium levels. Which nursing intervention is most appropriate to address the patient's current symptoms and laboratory findings?

B) Inform the healthcare provider about the patient's symptoms and laboratory results to discuss possible medication adjustments.

A) Educate the patient to increase dietary potassium intake to counteract fatigue and dizziness.

B) Inform the healthcare provider about the patient's symptoms and laboratory results to discuss possible medication adjustments.

C) Advise the patient to discontinue the beta-blocker immediately to prevent further kidney damage.

D) Encourage the patient to drink more fluids to improve kidney function and reduce serum creatinine levels.

A patient with hypertension and declining renal function has been started on a beta-blocker. Two weeks later, she reports increased fatigue and dizziness, her blood pressure is 138/85 mmHg, heart rate is 54 bpm, serum creatinine is 2.5 mg/dL, GFR is 40 mL/min/1.73 m², and potassium level is 5.5 mEq/L. What is the most appropriate nursing action to address the patient's current symptoms and lab findings?

C) Recommend monitoring the patient closely for signs of hyperkalemia and adjusting diuretics.

A) Increase the dosage of the beta-blocker to improve blood pressure control.

B) Suggest discontinuing the beta-blocker due to bradycardia and worsening renal function.

C) Recommend monitoring the patient closely for signs of hyperkalemia and adjusting diuretics.

D) Advise adding an ACE inhibitor to the regimen to further protect renal function.

A patient with chronic kidney disease and hypertension has recently had her medication regimen adjusted to include an ACE inhibitor. Her latest laboratory results show a serum creatinine level of 2.4 mg/dL, GFR of 42 mL/min/1.73 m², potassium level of 5.4 mEq/L, and hemoglobin level of 10.5 g/dL. Considering these findings, which nursing intervention should be prioritized?

C) Collaborate with the healthcare provider to initiate treatment for hyperkalemia, such as a potassium binder.

A) Educate the patient on increasing dietary potassium intake to counteract her bradycardia.

B) Monitor the patient's blood pressure and heart rate regularly to assess the effectiveness of the ACE inhibitor.

C) Collaborate with the healthcare provider to initiate treatment for hyperkalemia, such as a potassium binder.

D) Encourage the patient to increase fluid intake to improve her renal function.

A patient with chronic kidney disease (CKD) and hypertension, who is currently on a reduced dosage of a beta-blocker and an ACE inhibitor, presents with persistent dizziness and a heart rate of 56 beats per minute. Her potassium level is 5.4 mEq/L, and her hemoglobin level has decreased to 10.5 g/dL. Which of the following nursing interventions should be prioritized to address potential complications associated with her current condition?

B) Educate the patient on dietary restrictions to manage hyperkalemia.

A) Instruct the patient to increase fluid intake to improve renal function.

B) Educate the patient on dietary restrictions to manage hyperkalemia.

C) Recommend the patient discontinue the beta-blocker to address bradycardia.

D) Administer erythropoiesis-stimulating agents to improve hemoglobin levels.

Hyppertension - Nursing Case Study

Pathophysiology

• Primary mechanism: Increased peripheral vascular resistance due to endothelial dysfunction, often from factors like chronic inflammation or oxidative stress, leads to sustained high blood pressure as blood flow meets resistance in the narrowed vessels.

• Secondary mechanism: Enhanced activity of the renin-angiotensin-aldosterone system (RAAS) results in vasoconstriction and sodium retention, further elevating blood pressure by increasing blood volume and systemic vascular resistance.

• Key complication: Prolonged hypertension can lead to damage of vital organs, particularly the heart, kidneys, and brain, increasing the risk of heart failure, renal impairment, and stroke.

Patient Profile

Demographics:

56, male, construction worker

History:

• Key past medical history: Hypertension diagnosed 5 years ago, borderline type 2 diabetes, mild hyperlipidemia

• Current medications: Lisinopril 20 mg daily, Metformin 500 mg twice daily, Atorvastatin 10 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 160/98 mmHg, heart rate 88 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F

Section 1

New Diagnostic Results:

Following the initial assessment, the healthcare team ordered a series of diagnostic tests to evaluate the extent of target organ damage due to the patient's poorly controlled hypertension and other underlying conditions. The lab results revealed elevated serum creatinine levels at 1.8 mg/dL, indicating potential renal impairment, with a glomerular filtration rate (GFR) of 55 mL/min/1.73 m², classifying the patient in Stage 3 chronic kidney disease. Additionally, a fasting blood glucose test displayed a level of 145 mg/dL, confirming poor glycemic control, while a lipid profile showed LDL cholesterol at 160 mg/dL, suggesting that hyperlipidemia remains suboptimally managed.

An electrocardiogram (ECG) was performed, which revealed left ventricular hypertrophy, a common cardiac adaptation to long-standing hypertension, which suggests that the heart is working harder than normal to pump blood against the elevated systemic vascular resistance. The echocardiogram further supported these findings by showing evidence of mild diastolic dysfunction, a precursor to heart failure, indicating that the heart's ability to relax and fill properly is becoming compromised.

These diagnostic results underscore the need for a comprehensive review and adjustment of the patient's treatment plan. The construction worker's current regimen may require intensification, such as increasing the dose of Lisinopril or adding another antihypertensive agent to better control blood pressure and protect renal function. Additionally, addressing lifestyle factors such as diet, exercise, and weight management will be crucial to improving overall cardiovascular health and preventing further progression of complications. The healthcare team must prioritize multidisciplinary care, engaging a dietitian and possibly a diabetes educator, to provide targeted interventions that address both the hypertension and borderline diabetes, as well as the mild hyperlipidemia.

Section 2

Change in Patient Status:

Several weeks after the adjustment of her treatment plan, the patient returned for a follow-up visit. During this period, her antihypertensive regimen had been modified to include an increased dose of Lisinopril, with the addition of Amlodipine, a calcium channel blocker, to better control her blood pressure. Moreover, she had been working with a dietitian to adopt a heart-healthy diet and had started a moderate exercise routine. Despite these efforts, the patient's blood pressure during this visit remained elevated at 160/95 mmHg, indicating that her hypertension was still suboptimally managed.

Further evaluation revealed a troubling change in her renal function. Her latest laboratory tests showed an increase in serum creatinine to 2.1 mg/dL, with a corresponding decrease in GFR to 48 mL/min/1.73 m², suggesting progression to Stage 3b chronic kidney disease. These findings raised concerns about the adequacy of her current treatment strategy and the potential need for more aggressive management. Additionally, the patient's fasting blood glucose levels remained elevated, hovering around 150 mg/dL, despite dietary modifications, indicating persistent poor glycemic control.

Clinically, the patient reported increased fatigue and occasional episodes of shortness of breath on exertion, suggestive of worsening cardiac function. Given the persistence of elevated blood pressure and the progression of renal impairment, the healthcare team considered the introduction of a diuretic to manage fluid overload and further protect renal function. This change in patient status underscored the need for ongoing monitoring and potential referral to a nephrologist and cardiologist to address the complex interplay of her comorbid conditions. The team emphasized the importance of medication adherence, lifestyle changes, and regular follow-up appointments to mitigate the risk of further complications.

Section 3

Following the introduction of a diuretic to the patient's regimen, there was a notable shift in her clinical status during a subsequent follow-up visit. The patient's blood pressure showed a modest improvement, now measuring at 150/90 mmHg, but still not at the optimal target. However, the addition of the diuretic seemed to have a positive impact on her symptoms of fluid overload; she reported a reduction in shortness of breath and a slight increase in energy levels. Despite these improvements, the clinical team remained concerned about her renal function, as her serum creatinine had further increased to 2.3 mg/dL, and her GFR had declined to 45 mL/min/1.73 m². These laboratory findings indicated a continued deterioration of her kidney function, necessitating close monitoring and potential adjustment of her treatment plan.

In addition to monitoring her renal function, the team conducted a more comprehensive cardiovascular assessment. An echocardiogram revealed mild left ventricular hypertrophy, a common consequence of long-standing hypertension, which could be contributing to her cardiac symptoms. This finding emphasized the need for more aggressive blood pressure control to prevent further cardiac remodeling and potential progression to heart failure. Given the persistent elevation in blood pressure and the new cardiovascular findings, the team contemplated the possibility of adding a beta-blocker to help manage both her hypertension and cardiac workload.

The patient was counseled on the importance of strict adherence to her medication regimen and lifestyle modifications. The healthcare team discussed the potential benefits of further dietary adjustments, possibly incorporating a low-sodium diet to aid in managing her blood pressure and fluid status. They also scheduled a referral to a nephrologist to provide specialized care for her advancing kidney disease and consider additional interventions that might preserve renal function. This comprehensive approach aimed to address the multifaceted nature of her condition and prevent the onset of more severe complications.

Section 4

Two weeks after the introduction of the beta-blocker to the patient's regimen, the clinical team conducted a follow-up visit to assess her response to the intervention. During this visit, the patient reported feeling more fatigued than usual and experiencing episodes of dizziness, particularly upon standing. Her blood pressure had decreased further to 138/85 mmHg, indicating an improvement towards target levels. However, her heart rate was noted to be bradycardic at 54 beats per minute, suggesting a potential adverse effect of the beta-blocker.

Laboratory tests showed that her serum creatinine had increased slightly to 2.5 mg/dL, and her GFR had further declined to 40 mL/min/1.73 m². These results continued to reflect a worsening renal function, which raised concerns about whether the current medication regimen was exacerbating her kidney issues. The patient’s potassium levels were also elevated at 5.5 mEq/L, possibly indicating an imbalance related to her diuretic use or declining kidney function.

Given these findings, the healthcare team faced a critical decision: how to balance the benefits of blood pressure and cardiac workload reduction with the need to stabilize her renal function and manage side effects. They discussed the possibility of adjusting the dosage of her medications or exploring alternative antihypertensive agents that might be less impactful on her renal status. The team emphasized the importance of monitoring her symptoms closely and maintaining regular follow-up appointments to quickly identify and address any further complications. This nuanced approach underscored the need for careful clinical reasoning to optimize her treatment plan and address the interconnected nature of her cardiovascular and renal conditions.

Section 5

Two weeks after the clinical team adjusted the patient's medication regimen by reducing the dosage of the beta-blocker and introducing an ACE inhibitor to better protect her renal function, the patient returned for another follow-up appointment. During this visit, she reported that her fatigue had slightly improved, but she continued to experience occasional dizziness. Importantly, her blood pressure was now 135/82 mmHg, a further improvement in controlling her hypertension. However, her heart rate remained bradycardic at 56 beats per minute, and the team noted the persistence of renal function concerns.

New laboratory results indicated that her serum creatinine level had stabilized at 2.4 mg/dL, and her GFR had improved marginally to 42 mL/min/1.73 m². Despite these slight improvements, her potassium level remained elevated at 5.4 mEq/L, necessitating close monitoring to prevent hyperkalemia-related complications. The team also discovered a new development: the patient’s hemoglobin level had decreased to 10.5 g/dL, which could suggest the onset of anemia, potentially linked to her chronic kidney disease.

Given these mixed results, the healthcare team focused on refining her treatment strategy. They discussed the potential benefits of adding a potassium binder to manage her hyperkalemia and considered the introduction of erythropoiesis-stimulating agents to address her anemia. The team recognized the complexity of her condition and the necessity for a multidisciplinary approach, involving a nephrologist and a cardiologist, to ensure comprehensive care. They emphasized the importance of patient education, encouraging her to report any new or worsening symptoms promptly and adhere to her follow-up schedule to facilitate timely interventions.