Reference no: EM133257242
Cardiovascular Case Study -
Description - Client Profile - Mr. B's employers sponsored a free blood pressure (BP) screening program for its employees. Mr. B's BP is 100/60mmHg when measured with a large BP cuff. The nurse observes that the client is overweight. The nurse assesses the client for risk factors for hypertension (HTN) and learns that the client sits at a desk all day answering telephone calls from customers with questions about the use of company's computer software. He does not exercise regularly and admits that the he does not follow a special diet stating."My wife is a great cook. I'll eat anything she puts on the table. At night like to have a snack while I watch the television." The client denies any use of recreational drugs /tobacco and reports drinking socially. "I have four or five beers on the weekend watching the football game." The client does not take any prescription medication or herbal supplement but indicated he takes over the counter Tylenol for headache. The nurse records the client BP and gives him the reading materials with instructions to make n appointment with his primary care provider (HCP) as soon as possible for thorough assessment and to discuss treatment options.
Case Study - The client calls his HCP to schedule an appointment. Prior to the appointment, the client goes to a local laboratory to have series of blood test drawn. AT his appointment with HCP, weight is 225 pound and height is 5 feet and 9 inches, BP 166/92mmhg in the right arm and 168/96 mmHg in the left arm, HR is 84 beats per min, respiration 18 and afebrile. Cholesterol is 260mg/dL. During health history and assessment, the HCP noticed that the client drinks at least four six-ounce of cups of regular coffee per day, and that his father has a coronary artery disease (CAD) and HTN. The client denies feeling stress because of his job, relationship with his wife and family, or other factors. "I am a pretty laid-back guy. I am not worked up or excited about much. I leave the worrying to my wife." The HCP notes that the client carries the majority of his weight in his upper body. He has an increased amount of subcutaneous fat around his waist and in his abdomen. The HCP prescribes hydrochlorothiazide daily for the client and asks the nurse to provide the client and spouse with instructions regarding the medication and lifestyle modifications. A follow up appointment is scheduled for one month.
Questions -
1. Briefly explain what the systolic and diastolic BP readings indicate.
2. According to the Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of high BP (JNC7), what is the definition of prehypertension, stage 1 HTN, and stage 2 HTN? Describe primary and secondary HTN. Based on the client's clinical manifestations and history, how would you classify his HTN, and does he have primary or secondary HTN.
3. Generate at least five questions the nurse should ask the client in order to assess for the possible symptoms of HTN.
4. Identify the client's risk factors for HTN. Indicate which of the client's risk factors are non- modifiable and modifiable.
5. The client asks "Is my cholesterol really that bad? What should my numbers be? How should the nurse respond?
6. The HCP prescribes hydrochlorothiazide for him. Discuss the benefits of monotherapy with hydrochlorothiazide to treat the client's HTN.
7. What are the most common adverse effects of hydrochlorothiazide that he should monitor, and what he should do if he forgets to take his daily dose?
8. The nurse warns the client not to discontinue the medication abruptly. Briefly explain why the nurse offers this precaution.
9. What are the lifestyle modifications to help reduce the client's HTN? Identify at least two points of discussion the nurse will include in the teaching plan.
10. What are the clinical decision, client needs and form hypothesis for this patient.