Adult1- Hypertension Case Study
1. What risk factors for hypertension does R.L. have?
R.L.’s ethnicity and family history of hypertension are primary risk factors for hypertension. This is because African Americans develop hypertension at an earlier age, with increased severity, and have a higher prevalence of stroke, heart disease, and end-stage renal disease compared with whites. His alcohol consumption, smoking, age, and gender are also risk factors for hypertension.
2. What evidence of target organ damage is present?
Target organ damage is evident in the retina, as manifested by the early retinal changes (retinopathy); the heart, as manifested by left ventricular hypertrophy; and the kidneys, as manifested by proteinuria and a slightly elevated serum creatinine level.
3. What misconceptions about hypertension should be corrected?
R.L. should be taught that hypertension is a “silent killer” because it usually does not cause symptoms. In addition, symptoms do not reliably indicate blood pressure (BP) levels. Despite his absence of symptoms, organs throughout his body are being significantly damaged by the hypertension. He also needs to be informed that hypertension is not related to a “hyper” personality but, rather, is an elevation of BP. Not all antihypertensive medications cause sexual dysfunction, and it should be explained that if erectile dysfunction or decreased libido occurs, he should consult with his health care provider about changing drugs or dosages.
4. Priority Decision: What are the nursing priorities for R.L.?
Nursing priorities for R.L. include BP measurement and teaching. R.L. needs information regarding the following topics:
• His current BP measurement and his goal BP; home BP monitoring
• Dangers of uncontrolled hypertension and need for long-term control
• Lifestyle modifications necessary to control his BP, especially stopping smoking, limiting alcohol consumption to 1 oz/day, restricting sodium intake, maintaining adequate potassium and calcium intake, engaging in at least 30 minutes of moderately intense aerobic activity on most days of the week, and maintaining or reducing weight, if appropriate.
• DASH diet (diet history may be suggested)
• His drug therapy, reviewing with him the action, dosage, and side effects of hydrochlorothiazide and instructing him to develop a regular and convenient schedule for taking the medication, not to discontinue the drug abruptly, not to double dose if a dose is missed, and not to change the dosage without consulting his health care provider; more than likely a second drug (e.g., ACE inhibitor, β-blocker) will be added to R.L.’s regimen since his BP reflects stage 2 hypertension
5. Delegation Decision: What activities can be delegated to NAP?
The nurse could ask NAP to take R.L.’s vital signs, including orthostatic BPs.
6. Priority Decision: Based on the assessment data, what are the priority nursing diagnoses?
Nursing diagnoses: ineffective self health maintenance; ineffective renal perfusion; risk for decreased cardiac tissue perfusion; risk for ineffective cerebral tissue perfusion
7. What are the collaborative problems?
Collaborative problems: retinopathy, renal insufficiency, left ventricular failure