hypertension - Nursing Case Study

Pathophysiology

• Primary mechanism: Increased blood volume or cardiac output - When the heart pumps more blood than usual or retains excess fluid, it increases the pressure against blood vessel walls, raising blood pressure.

• Secondary mechanism: Vascular resistance - Narrowing or stiffening of arteries (due to factors like high sodium intake or genetic predisposition) makes it harder for blood to flow, which increases blood pressure.

• Key complication: Organ damage - Prolonged hypertension can strain blood vessels, leading to damage in organs such as the heart, kidneys, and eyes, contributing to conditions like heart disease and kidney failure.

Patient Profile

Demographics:

45-year-old female, office manager

History:

• Key past medical history: Diagnosed with hypertension 1 year ago, no other significant medical history

• Current medications: Low-dose hydrochlorothiazide

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Routine check-up

• Key symptoms: Occasional mild headaches, no other symptoms reported

• Vital signs: Blood pressure 135/85 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F

Section 1

Initial Assessment Findings:

During the routine check-up, the nursing assessment focused on evaluating the patient's cardiovascular system and potential risk factors associated with hypertension. The patient's body mass index (BMI) was calculated to be 28, indicating a slightly overweight status, which is a modifiable risk factor for hypertension. Dietary habits were reviewed, revealing a preference for processed foods high in sodium, which could contribute to elevated blood pressure. The patient mentioned a sedentary lifestyle, largely due to her desk job as an office manager, and expressed interest in starting a mild exercise regimen.

Upon physical examination, the nurse noted no signs of acute distress, and the patient's skin appeared well-perfused with a normal capillary refill time. Heart sounds were regular with no murmurs, and lung fields were clear upon auscultation. Peripheral pulses were strong and equal bilaterally, with no edema observed in extremities. An eye examination was conducted, revealing no signs of hypertensive retinopathy, which can occur with prolonged elevated blood pressure. The nurse discussed the importance of lifestyle modifications, including dietary changes and increased physical activity, as part of the management plan to prevent further complications.

The patient's blood pressure reading of 135/85 mmHg was consistent with her diagnosis of hypertension, albeit still at a manageable level. The nurse reinforced the significance of medication adherence with hydrochlorothiazide, emphasizing its role in managing blood pressure by reducing fluid retention. Education focused on self-monitoring of blood pressure at home, recognizing early signs of complications, and scheduling regular follow-ups to monitor her condition. This assessment set the stage for a collaborative approach to managing her hypertension, mitigating risk factors, and preventing potential organ damage in the future.

Section 2

Response to Interventions

Two months after the initial assessment, the patient returned for a follow-up appointment to evaluate her response to lifestyle modifications and medication adherence. The patient reported that she had successfully incorporated moderate physical activity into her daily routine, including brisk walking for 30 minutes on most days of the week. She had also made conscious efforts to reduce her sodium intake by choosing fresh produce and preparing meals at home, significantly cutting down on processed foods. Her commitment resulted in a modest weight loss of 5 pounds, bringing her BMI down to 27, a positive step toward a healthier weight.

Upon re-evaluation, the patient's blood pressure reading showed improvement, registering at 128/82 mmHg. This reduction was an encouraging indicator of her progress in managing her hypertension. Laboratory results revealed normal electrolyte levels and kidney function, suggesting that the hydrochlorothiazide therapy was effective and well-tolerated. Additionally, the patient reported no adverse effects from the medication, demonstrating good compliance with her treatment regimen.

The nurse praised the patient's efforts and reinforced the importance of maintaining these lifestyle changes as part of her long-term health strategy. The patient expressed feeling more energetic and motivated to continue her new habits. The nurse scheduled the next follow-up in three months and encouraged the patient to continue monitoring her blood pressure at home, remaining vigilant for any signs of complications. This progress marked a positive trajectory in the patient's health management, setting the foundation for sustained improvement and reduced risk of hypertension-related complications.

Section 3

Three months later, the patient returned for her scheduled follow-up appointment. This visit was crucial in evaluating her continued response to lifestyle modifications and medication. The patient reported feeling consistent energy levels and had successfully integrated her healthy habits into her daily life. She maintained her physical activity routine and further refined her dietary choices by incorporating more fruits and vegetables, which contributed to an additional weight loss of 3 pounds. Her BMI now stood at 26, further reducing her risk of hypertension-related complications.

During the assessment, the nurse observed a blood pressure reading of 126/80 mmHg, indicating continued improvement. The patient's heart rate was stable at 72 beats per minute, and her respiratory rate was normal at 16 breaths per minute. Her laboratory results remained within normal limits, with a serum potassium level of 4.1 mEq/L and a serum creatinine level of 0.9 mg/dL, confirming the absence of any electrolyte imbalances or renal impairment. The patient's cholesterol levels had also improved, with total cholesterol now at 190 mg/dL, LDL at 110 mg/dL, and HDL at 50 mg/dL, reflecting the benefits of her dietary changes.

The nurse commended the patient on her continued success and discussed the importance of maintaining these lifestyle modifications as a lifelong commitment. The patient was encouraged to keep monitoring her blood pressure at home and to stay alert for any unusual symptoms, such as headaches or dizziness. The nurse also emphasized the importance of regular follow-up appointments to ensure ongoing management and prevention of any potential complications. As the patient left the clinic, she felt empowered and confident in her ability to manage her health, setting a strong foundation for future wellness.

Section 4

Six months later, the patient returned for another routine follow-up appointment. During this visit, the nurse noted a slight change in the patient’s status. While the patient continued to adhere to her lifestyle modifications and medication regimen, she reported experiencing occasional mild headaches and episodes of lightheadedness, particularly in the mornings. Despite these symptoms, her energy levels remained stable, and she had no issues with her daily activities.

During the assessment, the patient's blood pressure was recorded at 138/86 mmHg, which was slightly elevated compared to her previous readings. Her heart rate remained steady at 74 beats per minute, and her respiratory rate was unchanged at 16 breaths per minute. Laboratory tests indicated a slight increase in her serum creatinine level to 1.1 mg/dL, suggesting the need for careful monitoring of renal function. Her serum potassium level was stable at 4.0 mEq/L, and her cholesterol levels remained well-controlled.

The nurse discussed these findings with the patient, explaining that the mild increase in blood pressure and occasional symptoms could be related to the body's adjustment to changes or possible medication side effects. The nurse recommended that the patient continue her home blood pressure monitoring and keep a symptom diary to track any patterns or triggers. Additionally, the nurse suggested a follow-up appointment in one month to reassess her condition and potentially adjust her treatment plan if necessary. The patient left the clinic reassured and determined to maintain her efforts, understanding the importance of ongoing vigilance in managing her hypertension.

Section 5

Four weeks later, the patient returned for her follow-up appointment as planned. Upon arrival, she reported that the mild headaches and episodes of lightheadedness had decreased in frequency, though they were not entirely resolved. She had been diligent in maintaining her symptom diary and noted that these occurrences seemed to correlate with periods of stress at work and inconsistent sleep patterns. Her home blood pressure monitoring showed readings consistently around 135/85 mmHg, with occasional spikes during stressful days.

During the clinical assessment, the nurse found the patient's blood pressure to be 136/84 mmHg, and her heart rate remained stable at 72 beats per minute. The nurse also performed a basic neurological assessment, which was unremarkable, confirming no signs of neurological changes or deficits. The patient's weight remained stable, and she continued to engage in regular physical activity, adhering to her dietary recommendations and medication schedule.

Laboratory tests conducted during this visit revealed that her serum creatinine level had stabilized at 1.0 mg/dL, indicating an improvement in renal function. Her potassium level was unchanged at 4.0 mEq/L, and her cholesterol profile continued to be well-managed. Based on these findings, the nurse commended the patient for her efforts in adhering to her treatment plan and emphasized the importance of stress management and consistent sleep. The nurse suggested incorporating relaxation techniques and possibly discussing sleep hygiene strategies. A follow-up appointment was scheduled for three months later, with instructions to continue monitoring her blood pressure and maintaining the symptom diary, preparing for any necessary adjustments to her care strategy.