Case Study Of Hypertension Health And Social Care Essay

A 55 twelvemonth old male named Nicholas Manners, is admitted to the ward for caution of his utmost tide rip pressure. Upon reaching, he appears rather ruddy in the face. He was referred to the exigency piece by his GP as he was kicking of a upkeep and lightheadedness. He was stabilised and has been transferred to the ward for farther counselor. He tells the nurse, he has had a concern for the last three yearss and has had re onlyy small slumber. Mr Manners is a Chief exe skip overive officer of an advertisement bureau and works grand hours. Nicholas has two boies aged 15 & A 17 and his married fair sex Lucy, who is really supportive. Lucy tells the nurse that Nick chows on the tally due to his crabby agenda and frequently chows at eating houses when entertaining clients. Nick slews 10-15 cigarettes/ twenty-four hour period and has had multiple efforts at discontinuing. He has a household history of coronary thrombosis arteria distemper, his male parent died of a dispa rager onslaught 5 old ages ago at the age of 75. Observations on admittance BP one hundred sixty/90, SaO2 97 % on room air, Temp. 37.1, Pulse 95, RR 19 beats per minute, wt 90 kilogram, ht 170 centimeter, Nil K promptlyn Allergies ( Jennings, 2010 ) .Blood great power per unit country refers to the measuring of depict that is applied to the walls of the arterias as the bosom pumps origination through the ingrained bodily structure. The specialty per unit vault of heaven is de marginined by the take in and the measure of consanguinity pumped, and the size and flexibleness of the arterias. High blood hug per unit body politic, to a fault know as Hypertension, is con nervered as above long hundred/80 mmHg ( PubMed Health, 2011 )PathophysiologyArterial blood personnel office per unit region is a trade in of cardiac end product and systemic vascular opposition. A mutation in the vascular wall thickness affects the elaboration of peripheral vascular opposition in hype rtensive diligents. This consequences in the contemplation of contemptible ridges rear end to the aorta and hence increasing the systolic blood force per unit area ( Medscape, 2011 ) . Although 90 % of luxuriously blood pressure instances, the cause is non truly known ( Moser, p.11 ) , harmonizing to the Australian Institute of Health and Welfare ( AIHW ) , the causes of gamy blood force per unit area are both biomedical and spiritednessstyle oriented. study causes include being overweight, fodderetic salt consumption, and feed forms which involve small consumption of fruit and veggies and an juicy consumption of saturated fat ( Australian Institue of Health and Welfare,2010 ) . Although most of the clip there are no mark and symptoms, such may bechance confusion, ear noise or buzzing, weariness, concern, randomized pulse, epistaxis, vision alterations. These marks are known as marks of branching or perilously last blood force per unit area called malignant high blood pressureNursing AppraisalAs a patient is admitted to the infirmary, it is critical to follow up a nursing appraisal on admittance to garner baseline readings of the patient. The Systems Approach Framework was used to loafers 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, integumentary 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 each.CVS HR 95, BP 160/90, assess capillary vessel 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- listen for abnormalcies in the lungs as he is a tobacco user, measure his work of external respiration.G IT farther buttocks appetency and eating wonts, auscultate for gut sounds, buttocks and record intestine direction.RENAL buttocks input and end product and record observations if needed, utilizing a unstable balance chart.INTEGUMENTARY buttocks tegument for cicatrixs, waterlessness, integral and disrobe turgor.METABOLIC buttocks Hb, BGL and liver map through a blood test.Education and Psychosocial supportEducation and support that can be offered to Nicholas to answer him in deriving much information and support for his Hypertension includeDieticians which Nicholas can be referred to during his preventive in infirmary, to educate him about a hearty diet and too 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 Better Health Channel, Hypertension Education Foundation and the Heart Foundation, all provide instruction and info rmation about support for patients about high blood pressure.Nursing DiagnosisGoalsInterventionsRationaleEvaluationIneffective wellness care link to incapableness to change life style piffling termIntroduce low-sodium and low fat nutrients into Nicholas diet observe Nicholas to a dietitian for instruction of low-sodium and low-fat nutrients.To sunburn mastered the sum of high-fat nutrients Nicholas is devouring.Nicholas diet presently consists of less high-fat nutrients.Short termAim to undercut down blood force per unit area readings to less than cl/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 lour degree.Nicholas blood force per unit area readings consume now stabilised to a lower degree. foresighted termDevelop a regular exercising course for Nicholas to follow.Promote Nicholas to walk for an hr each twenty-four hours.To promote Nich olas to wage in a healthy life style.Nicholas participates in an hr of personal activity each twenty-four hours.Long termAim to snap off smoke in the following 8-12 months.Refer Nicholas to back up plans such as QUIT to back up and help Nicholas in discontinuing smoke.To cut down Nicholas risk of infection of holding blocked arterias and therefore increasing Nicholas blood force per unit areaNicholas has now quit smokeNursing DiagnosisGoalsInterventionsRationaleEvaluationFatigue related to the set up of high blood pressure and the day-to-day life stressors.Short termAim to command side do such as weariness. make 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 keep a stable degree of fluids in the organic structure.Ensure Nicholas drinks plentifuln ess of water passim the twenty-four hours.To maintain Nicholas hydrous and cut down weariness. translate amounts utilizing a unstable balance chart if neededNicholas weariness degrees have decreased as he is imbibing plentifulness of H2O end-to-end 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 profess of increasing Nicholas blood force per unit area.Nicholas has trim down his emphasis degrees utilizing the methods discussedLong termDevelop a healthy eating program to utilize one 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 defi cient cognition of the relationship between diet and the diseaseShort termBrace the instabilities of nutritionProvide Nicholas with a oscilloscope 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 attempt Nicholas has a good cognition of high blood pressureNicholas is now good educated on his diseaseLong termTo brace Nicholas weight inwardly 6-8 months of dischargeRefer to dietician to measure and supervise his diet and aid with his weight departureTo take on 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 fasten he is cognizant of the harm smoke is making to his organic structureNicholas is good informed on the effects of smokeNursing DiagnosisGoalsInterventionsRationaleEvaluationNon-compliance related to the side effects of the intervention ( Ackley & A Ladwig, p.315 )Short termMaintain 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 residency 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 p ressure by supplying moving ridges of the electrical current of the bosom.Urinalysis This trial is used to test the causes of high 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 swag 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 patterned advance of arterial sclerosis and harm to the kidneys ( Cardio Connection, n.d ) . This assists in keeping a stabile prick degree of the blood to cut down the hazard of harm to the kidneys. blood serum K This trial looks for a treatable cause of high blood force per unit area and going the baseline degree prior to utilizing medical specialty for intervention ( Cardio Connection, n.d ) . This assists in finding a baseline to differentiate to if it were to promote.Hazard AppraisalUpon 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 and to diminish their hazard of hurt. The appropriate appraisal bastard for Nicholas would be a Falls Risk sound judgment Tool ( fraternity ) . 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 stated by Tiziani, 2006 fulfill in addition known as Ca adversaries, these agents impede the inflow of Ca ions during depolarisation of cardiac and vascular smooth musculus, doing betterment in the myocardial O supply and cardi ac end product, and a decrease in myocardial work by cut downing afterload ( Tiziani, 2006 )UseAngina pectoris crackers to chair high blood pressureNicholas has been prescribed this 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 attached 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 spontaneous cavity.Muscle spasms.Nursing points/precautionsNote and study thorax hurting because thie requires stoping the drug. long-suffering should be advised 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, discrepancy or Prinzmenta l angina, unstable angina, or upstart myocardial infarction.Atorvastatin lipid-regulating agent as stated by Tiziani, 2006ActionReduce cholesterin significantly in patients with type II lipoidaemia 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, Aldactone or ketoconazole.Adverse effectsHeadache, insomnia.Constipation, flatulency, abdominal hurting, sickness, diarrhea.Back hurtingNursing points/precautionsliver-colored map trial should be performed before get downing therapy and at 6 and 2 hebdomads, so twice annually.Advise patient to discover any musculus hurting, spasms, tenderness or failing, unease or febrility.Should be withheld if any status occurs that predisposes the patient to rhab domyolysis, such as injury, sepsis, uncontrolled epilepsy or metabolic, or endocrinal instabilities.