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NUR 102 Hypertension Case Study- George Thomas
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NUR 102 Hypertension Case Study- George Thomas
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NUR II102 IIHypertension IICase IIStudy- IIGeorge IIThomasHypertension
Meet IIthe IIClient: IIGeorge IIThomas
A IIgroup IIof IInursing IIstudents IIis IIconducting IIblood IIpressure IIand IIcholesterol IIscreenings IIoutside IIa
IIlocal Ihome IIimprovement IIstore IIon IISaturday IImorning IIfor IIits IIcommunity IIservice IIproject. IIGeorge
IIThomas, IIa I52-year-old IICaucasian IImale IIstops IIby IIthe IIbooth IIto IIhave IIhis IIblood IIpressure IIand
IIcholesterol IIchecked.IHe IItells IIthe IIstudents IIthat IIhe IIis IIa IIconstruction IIforeman.
Assessment:
George’s IIblood IIpressure IIis II189/110. I I His IILDL IICholesterol IIis II200 IImg/dL. I I He IIasks IIthe IIstudent IInurse IIif
IIhisIblood IIpressure IIis IIsomething IIhe IIshould IIbe IIconcerned IIabout
1. How IIshould IIthe IIstudent IIrespond?
A. Your IIblood IIpressure IIis IIvery IIhigh. I I You IIneed IIto IIsee IIyour IIhealthcare IIprovider IItoday.
B. You IIhave IIhypertension. IIYou IIneed IIto IIstart IImaking IIsome IIlifestyle
IIchanges. IIC. I I Please IIsit IIquietly IIfor IIa IIfew IIminutes. I I I IIneed IIto IIrecheck IIyour
IIblood IIpressure.
D. I I I IIneed IIyou IIto IIremain IIseated. I I I IIam IIgoing IIto IIcall IIfor IIthe IIemergency IIsquad.
*I IIchose IIC IIbecause IIyou IIalways IIwant IIto IIrecheck IIthe IIBP IIif IIit’s IIrunning IIhigh, IIand IIit IIcould’ve IIalso IIbeen
Ielevated IIto IIGeorge IIbeing IIstressed IIor IIsome IIrecent IIphysical IIactivity.
The IIstudent IInurse IIasks IIGeorge IIabout IIhis IIhealth IIhistory. IIGeorge IIis II6 IIfeet IItall II(182.88cm) IIand IIhis
IIweight IIis II190 IIpounds II(86.18 IIkgs). IIGeorge IIstates IIthat IIhe IIhas IIlost IIa IIlot II of IIweight IIrecently. IIHe IIalso
IIreports IIfeelingIa IIlot IIof IIstress IIat IIwork IIand IIthat IIhe IIoften IIgoes IIout IIwith IIthe IIcrew IIafter IIwork II to IIhave
IIseveral IIbeers. IIHe IIreports IIthat IIhis IImother IIwho II had II Diabetes IIMellitus IIpassed IIaway IIrecently IIwhich
IIhas IIalso IIcontributed II to IIhis IIemotional IIhealth. I I He IIbelieves IIhis IImom IIalso IIhad IIhypertension. I I George
IIsmokes IIa IIpack IIof IIcigarettes IIa IIday IIand IIdrinks II4 IIto II5 IIcups IIof IIcoffee IIa IIday IItoo.
2. What IIsignificant IIrisk IIfactors IIfor IIhypertension IIdoes IIthe IInursing IIstudent IIidentify IIfor
IIGeorgea I ccording IIto IIhis IIreported IIhealth IIhistory? I I SELECT IIALL IITHAT IIAPPLY
A. Family IIhistory IIof
IIDiabetesIB. I I Alcohol
IIConsumption
C. I I Smoking
ID. I I Stress
E. I I Caffeine IIconsumption
*I IIchose IIalcohol IIconsumption, IIsmoking, IIand IIstress IIbecause IIthese IIare IIall IIrisk IIfactors IIfor IIhypertension.
IIAf
I amily IIhistory IIof IIdiabetes IIisn’t IIimportant IIin IIthis IIscenario, IIand IIcaffeine IIis IInot IIa IIrisk IIfactor IIfor
IIhypertension.
The IIstudent IIretakes IIGeorge’s IIblood IIpressure IInow IIthat IIGeorge IIhas IIbeen IIsitting IIquietly IIfor IIa IIfew IIminutes.
IHis IIblood IIpressure IIis II180/106 IImmHg.
3. According IIto IIthe IIassessment IIof IIthis IIclient, IIwhich IIrecommendation IIis IImost IIimportant IIfor
IItheIstudent IInurse IIto IIprovide IIGeorge?
,NUR II102 IIHypertension IICase IIStudy- IIGeorge IIThomas
A. See IIyour IIHealthcare IIProvider IIas IIsoon IIas IIpossible IIwithin IIthe IInext IIweek IIfor IIa IIblood
IIpressurec I heck.
B. Limit IIhis IIsalt IIintake IIand IIstart IIa IIweight IIloss IIprogram.
C. Attend IIa IIstress IIreduction IIseminar IIoffered IIin IIhis IIcommunity.
D. Learn IIabout IIhigh IIfiber IIfoods IIand IIadd IImore IIfiber IIto IIhis IIdiet.
*I IIchose IIto IIhave IIhis IIBP IIrechecked IIbecause IIthe IIprevious IItwo IIwere IItaken IIin IIthe IIsame IIday, IIand IItaking
Ianother IIBP IIin IIa IIfew IIdays IIwould IIbe IIa IIbetter IIand IIaccurate IIindicator IIof IIGeorge IIhaving IIhypertension.
The IIstudent IInurse IIcontinues IIto IItalk IIto IIGeorge IIabout IIhis IIblood IIpressure IIresults. I I He IIstates IIthat IIhe IIfeels
Igreat IIphysically IIand IIdoes IInot IIsee IIwhy IIhe IIneeds IIto IIsee IIhis IIDoctor.
4. Which IIis IIthe IIbest IIresponse IIthe IIstudent IInurse IIcan IIgive IIto IIGeorge IIabout IIthe IIurgent IIneed IIto
IIsee IIaIHealthcare IIProvider II(HCP)?
A. Your IIblood IIpressure IIis IIdangerously IIelevated. I I You IIcould IIhave IIa IIheart IIattack IIor IIstroke IIat
IIanyItime.
B. While IIoften IIthere IIare IIno IIsymptoms, IIhigh IIblood IIpressure IIcan IIdamage IImany IIorgans.
C. Hypertension IIis IIcalled IIthe IIsilent IIkiller. I I I IIam IIsure IIyou IIdo IInot IIwant IIto IIdie IIat IIyour IIyoung IIage.
D. It IIis IIalways IIbetter IIto IItreat IIhigh IIblood IIpressure IIbefore IIyou IIstart IIhaving IIsymptoms.
*Hypertension IIcould IIcause IImajor IIorgan IIdamage IIto IIan IIindividual, IIbefore IIthey IIstart IIto IIexperience
Isymptoms, IIso IIit IIis IIimportant IIfor IIus IIto IIdiagnose IIasap.
A IIweek IIlater, IIGeorge IIhas IIan IIappointment IIwith IIhis IIHCP. I I After IIthe IIexam IIthe IIHCP IIexplains IIto IIGeorge
IIthatIhe IIhas IIstage II2, IIprimary, II(essential) IIhypertension.
5. Which IIinformation IIobtained IIduring IIthe IIassessment IIsupports IIthis IIdiagnosis?
A. Blood IIPressure IIof II184/98 IImmHg
B. Family IIhistory IIof IIHypertension
C. Irregular IIpulse IIrate IIof II110 IIbeats/min.
D. A IIauscultated IIheart IImurmur
*Stage II2 IIhypertension IIis IIclassified IIas IIa IIsystolic IIreading IIof II140 IIor IIhigher, IIand IIa IIdiastolic IIreading IIof II90 IIor
Ihigher, IIso IIGeorges IIreading IIhelps IIus IIfurther IIunderstand IIthat IIhe IIhas IIstage II2 IIhypertension.
The IIHCP IIinforms IIGeorge IIthat IIhe IIneeds IIto IIbe IIon IIa IIlow IIsalt IIdiet, IIstop IIsmoking, IIlimit IIhis IIalcohol
IIintake, IIdecrease IIhis IIstress IIlevel, IIand IIstart IItaking IIChlorothiazide II(Diuril) IIand IIAtenolol II(Tenormin). IIThe
IInurse IIenters IIthe IIroom IIto IIgive IIGeorge IIhis IIprescriptions IIand IIspends IIsome IItime IIteaching IIhim IIabout IIhis
IIcare IIandImedications. IIWhen IIspeaking IIwith IIthe IInurse, IIGeorge IIexpresses IIsome IIconcern IIthat IIthe IIHCP
IIdid IInot IIprescribe IIany IIadditional IItests. I I He IIasks, II“Shouldn’t IIthe IIHCP IIfind IIout IIwhy III IIhave
IIhypertension?
Hypertension
Assessment of the Client with Hypertension
II II II II II
History
Note IIthe IIfollowing IIpoints IIwhen IIinterviewing IIthe IIhypertensive IIclient:
, NUR II102 IIHypertension IICase IIStudy- IIGeorge IIThomas
• Family IIhistory IIof IIhypertension, IIdiabetes IImellitus, IIcardiovascular IIdisease,
IIhyperlipidemia, II or II renal II disease; II smoking; II stress; II obesity; II or II sedentary
II lifestyle
• Previous II documentation II of II high II blood II pressure, II including II age II at II onset,
II level II ofIelevation, IIand IIcurrently IIprescribed IImedical IIregimen
• History IIof IIall IIprescribed IIand IIover-the-counter IImedications II and II the IIclient's IIexact
IIcompliance I I with I I taking I I the II medications. I I NOTE: II Medications II that I I may II either
II raiseIb lood IIpressure II or II interfere II with II the IIeffectiveness IIof II antihypertensive
II medications
include IIoral II contraceptives, II steroids, II nonsteroidal II anti-inflammatory II drugs, II nasal
Idecongestants, II appetite II suppressants, II cyclosporine, II tricyclic II antidepressants,
IImonoamine IIoxidase IIinhibitors, IIand IIerythropoietin
• History I I of I I any I I disease I I or I I trauma II to I I target I I organs
• Results I I and I I side I I effects I I of I I previous I I antihypertensive I I therapy
• Clinical I I manifestations I I of I I cardiovascular I I disorders, I I such I I as I I angina,
I I dyspnea, I I orIc laudication
• History IIof IIor IIrecent IIweight IIgain, IIexercise IIactivities, IIsodium IIintake, IIfat IIintake,
IIalcoholIu se, IIand IIsmoking
• Psychosocial II and IIenvironmental II factors II(e.g., IIemotional IIstress, IIcultural
IIfoodIp ractices, IIeconomic IIstatus) IIthat IImay IIinfluence IIblood IIpressure
IIcontrol
Physical II Examination
Physical I I assessment I I should I I include I I an I I accurate I I determination I I of I I blood I I pressure I I as
I I well I I asIa n IIevaluation IIof IItarget IIorgans:
• Vital I I signs I I and I I weight
• Blood IIpressure—because IIblood IIpressure IIis IIvariable IIand IIcan IIbe IIaffected IIby IImultiple
Ifactors, IIit IIshould IIbe IImeasured IIso IIthat IIreadings IIare IIrepresentative IIof IIthe IIclient's
usual II level; II the II following IItechniques II are II strongly II recommended: II The II client
II should IIbe IIseated IIwith IIthe IIarm IIbared, IIsupported, IIand IIpositioned IIat IIheart IIlevel.
IIThe IIclient IIshould II not II have II smoked II tobacco II or II ingested IIcaffeine II within II the
II previous II 30 IIminutes. II Measurement IIshould IIbegin IIafter II at IIleast II5 II minutes IIof
IIquiet IIrest. IIThe IIclient's IIback IIshould IIbe IIsupported, IIand IIboth IIfeet IIshould IIbe II flat
IIon II the II floor IIwith IItheIl egs II uncrossed. II The II client II should II not II speak II while II the
II blood IIpressure II is II being IImonitored.
Use IIof IIthe II appropriate IIcuff IIsize II will IIensure II an IIaccurate II measurement. IIThe IIrubber IIbladder
IIshould I I encircle I I at I I least II 80% I I of I I the I I limb I I being I I measured. I I The I I bladder's I I width I I should II be
I I one-Ithird IIto IIone-half IIthe IIcircumference IIof IIthe IIlimb. IISeveral IIsizes IIof IIcuffs II(e.g., IIchild, IIadult,
IIlarge II adult) IIshould IIbe IIavailable.
• Measurements IIshould IIbe IItaken IIwith IIa IImercury IIsphygmomanometer, IIa IIrecently
Ic alibrated IIaneroid IImanometer, IIor IIa IIvalidated IIelectronic IIdevice.
• Postural IIblood IIpressures IIshould IIbe IImeasured IIand IIrecorded IIaccording IIto IIposition IIand
Iarm IIused, IIincluding IIlying, IIsitting, IIand IIstanding IImeasurements IIfrom IIboth IIarms.
• Both I I systolic II and I I diastolic I I blood I I pressures I I should I I be I I recorded. I I The
I I disappearance I I ofs I ound II (phase II V) II should II be II used II for I I the II diastolic II reading. II Two
II or II more II readings IIshould IIbe II averaged. II If II the II first II two II readings II differ II by II more
II than II5 II mm II Hg, II additional
readings I I should I I be I I obtained.
• Funduscopic IIexamination II for IIretinal II arteriolar IInarrowing, IIhemorrhages,
IIexudates,Ia nd IIpapilledema
• Examination IIof II the II neck II for IIdistended II veins, IIcarotid II bruits, IIand IIenlarged II thyroid
• Auscultation IIof IIthe IIheart IIfor II increased IIheart II rate, IIdysrhythmias,
IIenlargement,Ip recordial IIimpulses, IImurmurs, IIand IIS3 IIand IIS4 IIheart IIsounds
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