Case Study Of Hypertension Health And Social Care Essay

A 55 twelvemonth old male named Nicholas Manners, is admitted to the ward for steerage of his mellow strain pressure. Upon reaching, he appears rather ruddy in the face. He was refer ruby to the exigency section by his GP as he was kicking of a concern and dizziness. He was stabilised and has been transferred to the ward for farther direction. He tells the nurse, he has had a concern for the last three yearss and has had in reality small slumber. Mr Manners is a Chief exe omissionive officer of an advertisement bureau and works long hours. Nicholas has two boies aged 15 & A 17 and his married woman Lucy, who is really rewardive. Lucy tells the nurse that Nick chows on the tally due to his busy agenda and frequently chows at eating houses when entertaining clients. Nick slugs 10-15 cigarettes/day and has had multiple efforts at discontinuing. He has a household history of coronary arteria disease, his male parent died of a depreciator onslaught 5 old ages ago at the age of 75 . Observations on admittance BP 160/90, SaO2 97 % on room air, Temp. 37.1, Pulse 95, RR 19 beats per minute, wt 90 kilogram, ht 170 centimeter, Nil Known Allergies ( Jennings, 2010 ) . simple eye commit per unit of measurement flying field refers to the measuring of force that is applied to the walls of the arterias as the bosom pumps blood through the organic structure. The force per unit area is stubborn by the force and the sum of blood pumped, and the size and flexibleness of the arterias. High blood force per unit area, bothways known as Hypertension, is considered as in a full(prenominal)er place 120/80 mmHg ( PubMed Health, 2011 )PathophysiologyArterial blood force per unit area is a merchandise of cardiac end product and systemic vascular opposition. A adjustment in the vascular wall thickness affects the elaboration of peripheral vascular opposition in hypertensive longanimouss. This consequences in the contemplation of moving ridges back to the aorta and in th at respectfrom increasing the systolic blood force per unit area ( Medscape, 2011 ) . Although 90 % of gamey blood pressure instances, the cause is non truly known ( Moser, p.11 ) , termsonizing to the Australian establish of Health and Welfare ( AIHW ) , the causes of high blood force per unit area are both bio checkup and lifestyle oriented. Major causes include being overweight, fastetic salt consumption, and nutrition forms which involve low consumption of fruit and veggies and an high consumption of saturated fat ( Australian Institue of Health and Welfare,2010 ) . Although most of the clip there are no marks and symptoms, such may happen confusion, ear noise or buzzing, weariness, concern, irregular pulse, epistaxis, vision alterations. These marks are known as marks of complication or perilously high blood force per unit area called malignant high blood pressureNursing AppraisalAs a patient is admitted to the infirmary, it is deprecative to execute a nursing appraisal on admittance to garner baseline readings of the patient. The musical arrangements Approach Framework was used to buttockss Mr Nicholas Manners from caput to toe in a mode of subjective and nonsubjective informations. The classs used are as follows Central Nervous System, Cardiovascular System, Respiratory System, Gastrointestinal Tract, Renal System, In hideary System and Metabolic System.CNS patient is able to communicate-states he has a concern, assess motion of limbs, esthesis to fringes and trouble if any.CVS HR 95, BP 160/90, assess capillary refill, patient is red in the face assess circulation of the remainder of the organic structure including warmth and coloring material.RESP. RR 19 beats per minute, SaO2 97 % on room air, auscultate his chest- see for abnormalcies in the lungs as he is a tobacco user, measure his work of external respiration.GIT farther buttocks appetency and eating wonts, auscultate for catgut sounds, buttocks and record intestine direction.RENA L buttocks input and end product and record observations if needed, utilizing a unstable balance chart.INTEGUMENTARY buttocks tegument for cicatrixs, waterlessness, integral and skin turgor.METABOLIC buttocks Hb, BGL and liver map through a blood trial.Education and Psychosocial supportEducation and support that can be offered to Nicholas to help him in lineage more information and support for his Hypertension includeDieticians which Nicholas can be referred to during his stay in infirmary, to educate him about a healthy diet and besides supply support.Social worker to supply support for Nicholas and his household if needed.Information brochures can be retreived from the infirmary, to educate Nicholas on Hypertension.Web sites such as expose Health Channel, Hypertension Education Foundation and the Heart Foundation, all provide instruction and information about support for patients about high blood pressure.Nursing DiagnosisGoalsInterventionsRationaleEvaluationIneffective well ness care related to incapableness to change life styleShort termIntroduce low-sodium and low fat nutrients into Nicholas dietRefer Nicholas to a dietician for instruction of low-sodium and low-fat nutrients.To cut down the sum of high-fat nutrients Nicholas is devouring.Nicholas diet presently consists of less high-fat nutrients.Short termAim to cut down blood force per unit area readings to less than 150/80 by the following GP visit in a hebdomad.Teach Nicholas to take Nicholas ain blood force per unit area daily at place and record it.To brace Nicholas blood force per unit area at a lower degree.Nicholas blood force per unit area readings substantiate now stabilised to a lower degree. coherent termDevelop a regular exercising curriculum for Nicholas to follow.Promote Nicholas to walk for an hr each two dozen hours.To promote Nicholas to prosecute in a healthy life style.Nicholas participates in an hr of physical military action each twenty-four hours.Long termAim to disc ontinue smoke in the following 8-12 months.Refer Nicholas to back up plans such as break to back up and help Nicholas in discontinuing smoke.To cut down Nicholas accident of holding blocked arterias and therefore increasing Nicholas blood force per unit areaNicholas has now quit smokeNursing DiagnosisGoalsInterventionsRationaleEvaluationFatigue related to the personal effects of high blood pressure and the day-to-day life stressors.Short termAim to tender side effects such as weariness.Educate Nicholas on the side effects, to help him in commanding them.To help Nicholas in deriving cognition of the side effects and how to command them in instance they are experienced after discharge.Nicholas is able to command his small if any side effects experienced.Short termAim to handgrip a stable degree of fluids in the organic structure.Ensure Nicholas drinks plentifulness of H2O throughout the twenty-four hours.To maintain Nicholas hydrous and cut down weariness. remember amounts util izing a unstable balance chart if neededNicholas weariness degrees have decreased as he is imbibing plentifulness of H2O throughout the twenty-four hours.Long termReduce the emphasis degrees experienced throughout the twenty-four hours.Discuss emphasis cut downing methods applicable to Nicholas.To cut down the hazard of increasing Nicholas blood force per unit area.Nicholas has reduced his emphasis degrees utilizing the methods discussedLong termDevelop a healthy feeding program to utilize bingle time Nicholas is dischargedRefer Nicholas to a dietician to help in educating him in the importance of a healthy diet and developing a program.To cut down weariness related to an unhealthy diet.Nicholas has continued his healthy feeding program and does non endure from weariness.Nursing DiagnosisGoalsInterventionsRationaleEvaluationImbalanced nutrition related to deficient cognition of the relationship betwixt diet and the diseaseShort termBrace the instabilities of nutritionProvide Nic holas with a scope of fruits and veggiesTo supply Nicholas with a assortment of foods from a scope of nutrients.Nicholas diet now chiefly consists of fruit and veggiesShort termTo do Nicholas cognition on the diseaseProvide Nicholas with information such as booklets about high blood pressureTo justify Nicholas has a good cognition of high blood pressureNicholas is now good educated on his diseaseLong termTo brace Nicholas weight within 6-8 months of dischargeRefer to dietician to measure and supervise his diet and aid with his weight lossTo guarantee Nicholas has the support required to run into his endNicholas is now within a healthy weight scope for his gender, tallness and ageLong termDerive more cognition on the effects of smokeEducate Nicholas on the effects of smoking to his organic structureTo guarantee he is cognizant of the molest smoke is making to his organic structureNicholas is good informed on the effects of smokeNursing DiagnosisGoalsInterventionsRationaleEvaluat ionNon-compliance related to the side effects of the intervention ( Ackley & A Ladwig, p.315 )Short term produce stableness of side effectsMonitor Nicholas and supply advice when non following instructions of interventionTo guarantee Nicholas intervention continues on the right way.Nicholas side effects have decreased.Short termLong termLong termMaintain conformity of interventionEducate Nicholas on hazards if intervention non followed as requiredTo guarantee Nicholas wellness does non deteriorateNicholas is compliant with his interventionDiagnostic TrialsDiagnostic trials that will help with the appraisal and direction of Nicholas includeElectrocardiogram ( ECG ) This trial determines if the bosom has sustained nay harm due to untreated high blood pressure ( Cardio Connection, n.d ) . This trial assists with the direction of Nicholas high blood pressure by supplying moving ridges of the electrical authorized of the bosom.Urinalysis This trial is used to test the causes of h igh blood pressure and expression for any harm to the kidneys as a consequence of untreated high blood pressure ( Cardio Connection, n.d ) . The trial assists with the direction to derive information about the wellness of Nicholas kidneys.Blood Glucose This trial determines the sugar degrees in the blood and screens for secondary causes of high blood pressure and the hazard factors involved with more accelerated diseases such as diabetes. Both diabetes and high blood pressure are associated with the rapid simulate advance of arterial sclerosis and harm to the kidneys ( Cardio Connection, n.d ) . This assists in keeping a stabile sugar degree of the blood to cut down the hazard of harm to the kidneys.Serum K This trial looks for a treatable cause of high blood force per unit area and finding the baseline degree prior to utilizing medical specialty for intervention ( Cardio Connection, n.d ) . This assists in finding a baseline to compare to if it were to promote.Hazard AppraisalU pon admittance, a hazard appraisal must be completed to find the patient s hazard of holding a autumn. This appraisal besides assists the nurses in guaranting the patient has their properties or AIDSs within range to guarantee the patient s safety device and to diminish their hazard of hurt. The appropriate appraisal tool for Nicholas would be a Falls Risk Assessment Tool ( FRAT ) . This relates to Nicholas as he complained of giddiness and deficiency of slumber. This is needed to measure his hazard of hurt. Mention to Appendix 1 for a Falls Risk Assessment Tool.MedicinesNifedipine Antihypertensive agent as utter by Tiziani, 2006Action Besides known as Ca adversaries, these agents impede the inflow of Ca ions during depolarization of cardiac and vascular smooth musculus, doing betterment in the myocardial O supply and cardiac end product, and a decrease in myocardial work by cut downing afterload ( Tiziani, 2006 )Useangina pectoris pectorisMild to chair high blood pressureNichol as has been prescribed this practice of medicine to help with bracing his blood force per unit area.InteractionsContraindicated with rifampicinMay do bosom failure if used with beta-adrenoceptor-blocking agentsSerum concentrations may be increased if given over with Tagamet, Quinidex or Cardizem.Excessive cardiovascular depression may happen if given with inspiration anesthetics.Adverse effectsHeadache, giddiness, dizziness, flushing, weariness, dizziness.Anorexia, sickness, irregularity, abdominal hurting, dry oral cavity.Muscle spasms.Nursing points/precautionsNote and study thorax hurting because thie requires stoping the drug.Patient should be cognizant to avoid drive or operating machinery if giddiness or dizziness is a job.Caution if used in those with aortal stricture, bosom failure, liver damage, inconsistency or Prinzmental angina, unstable angina, or recent myocardial infarction.Atorvastatin lipid-regulating agent as stated by Tiziani, 2006ActionReduce cholesterin si gnificantly in patients with type II lipemia and hence besides significantly cut down the hazard of coronary arteria diseaseUseHypercholesterolaemiaNicholas has been prescribed this medicine to take down the entire cholesterin and low-density lipoproteins ( LDL )InteractionsMay addition plasma concentration of Lanoxin, increasing the hazard of toxicity.Caution if used with Tagamet, spironolactone or ketoconazole.Adverse effectsHeadache, insomnia.Constipation, flatulency, abdominal hurting, sickness, diarrhea.Back hurtingNursing points/precautionsLiver map trial should be performed before get downing therapy and at 6 and 2 hebdomads, so twice annually.Advise patient to describe any musculus hurting, spasms, tenderness or failing, unease or febrility.Should be withheld if any status occurs that predisposes the patient to rhabdomyolysis, such as injury, sepsis, uncontrolled epilepsy or metabolic, or endocrinal instabilities.