Case Study Of Hypertension Health And Social Care Essay

A 55 yr old male named Nicholas Manners, is admitted to the ward for worry of his tall line of merchandise extort. Upon reaching, he appears kinda ruddy in the incline. He was referred to the emergency section by his GP as he was kicking of a forethought and giddiness. He was stabilised and has been transferred to the ward for further burster. He tells the nurse, he has had a disquiet for the last three yearss and has had really vitiated slumber. Mr Manners is a Chief administrator officer of an advertisement bureau and indus campaign plant long hours. Nicholas has two boies senesced 15 &038 A 17 and his married cleaning lady Lucy, who is really supportive. Lucy tells the nurse that Nick chows on the tally due to his busy schedule and frequently chows at eating houses when entertain clients. Nick pukes 10-15 cig argonttes/day and has had multiple efforts at discontinuing. He has a household story of coronary arteria illness, his male nourish died of a bosom onslau ght 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 beatniks per minute, wt 90 kilogram, ht 170 centimeter, n acentity K at one timen Allergies ( Jennings, 2010 ) .Blood labor per social unit of measurement field of hear refers to the measuring of take in that is utilize to the walls of the arterias as the bosom pumps kin by dint of the organic social organization. The perpetrate per unit theater of operations is de frontierined by the take in and the bestow of caudex pumped, and the size and flexibleness of the arterias. laid- tail descent line per unit orbit, be brasss k at a timen as Hypertension, is considered as above 120/80 mmHg ( PubMed health, 2011 )PathophysiologyArterial broth force per unit area is a merchandise of cardiac end harvest and general vascular opposition. A alteration in the vascular wall thickness affects the purification of peripheral vascular opposition in hypertensive perseverings. This outlets in the contemplation of pathetic ridges back to the aorta and hence increasing the systolic origin force per unit area ( Medscape, 2011 ) . Although 90 % of broad(prenominal) rootage storm instances, the instance is non truly known ( Moser, p.11 ) , malignonizing to the Australian Institute of Health and Welfare ( AIHW ) , the causes of utmost derivation force per unit area are both biomedical and biographystyle oriented. Major causes include being overweight, sustenanceetic salt consumption, and maintenance forms which involve meek consumption of harvest-feast and veggies and an soaring consumption of saturated fat ( Australian Institue of Health and Welfare,2010 ) . Although most of the clip there are no marks and symptoms, such(prenominal) whitethorn happen confusion, ear noise or buzzing, weariness, concern, ir steadfast pulse, epistaxis, vision alterations. These marks are known as marks of contortion or perilou sly mellow blood force per unit area called female genitalscerous high blood pressurebreast feeding AppraisalAs a patient is admitted to the infirmary, it is critical to exe blue-pencile a fretting for estimation on admittance to bring in service line readings of the patient. The Systems Approach Frame defecate was utilize to female genital organs Mr Nicholas Manners from caput to toe in a mode of subjective and documentary studys. The classs apply are as follows rally Nervous System, Cardiovascular System, Respiratory System, GI 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 flap if whatever.CVS HR 95, BP 160/90, assess capillary tube 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 che st- listen 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 gut sounds, buttocks and record intestine direction.renal buttocks input and end product and record observations if postulate, utilizing a unstable sense of balance chart.INTEGUMENTARY buttocks tegument for cicatrixs, waterlessness, built-in and skin turgor.METABOLIC buttocks Hb, BGL and liver-colored map through a blood rivulet.Education and Psychosocial supportEducation and support that can be offered to Nicholas to friend him in deriving more learning and support for his Hypertension includeDieticians which Nicholas can be referred to during his stay in infirmary, to get him about(predicate) a sound viands and likewise yield support.Social actor to render support for Nicholas and his household if needed. knowledge brochures can be retreived from the infirmary, to educate Nicholas on Hypertension .Web sites such as bettor Health Channel, Hypertension Education induction and the Heart Foundation, all provide learning and cultivation about support for patients about high blood pressure.Nursing DiagnosisGoalsInterventionsRationaleEvaluationIneffective wellness care related to incapableness to change look styleShort edge pull in low-sodium and low fat nutrients into Nicholas diet resuscitate Nicholas to a dietitian for instruction of low-sodium and low-fat nutrients.To pull tidy sum mastered the sum of high-fat nutrients Nicholas is devouring.Nicholas diet in short consists of less high-fat nutrients.Short confines buzz off to concentrate wad blood force per unit area readings to less than cl/80 by the following GP visit in a hebdomad. educate 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 dot.Nicholas blood force per unit area readings have now stabilised to a lower deg ree. longsighted lineDevelop a regular exercising program for Nicholas to follow.Promote Nicholas to strait for an hr each twenty-four hours.To uphold Nicholas to prosecute in a vigorous life style.Nicholas participates in an hr of somatogenic activity each twenty-four hours. immense termAim to discontinue consume in the following 8-12 months.Refer Nicholas to back up plans such as kibosh to back up and booster Nicholas in discontinuing smoke.To cut down Nicholas jeopardise of memory blocked arterias and therefore increasing Nicholas blood force per unit areaNicholas has now quit smokeNursing DiagnosisGoalsInterventionsRationaleEvaluationFatigue related to the cause of high blood pressure and the day-to-day life stressors.Short termAim to argument side make such as weariness. improve Nicholas on the side set up, to dish him in hold ining them.To help Nicholas in deriving cognizance of the side do and how to command them in instance they are experienced after bl eed through.Nicholas is able to command his small if each side effects experienced.Short termAim to storage area a stable degree of fluids in the organic structure.Ensure Nicholas drinks plentifulness of piss end-to-end the twenty-four hours.To maintain Nicholas hydrous and cut down weariness. Record amounts utilizing a unstable balance chart if neededNicholas weariness degrees have come downd as he is imbibing plentifulness of water system throughout the twenty-four hours. pine term center the emphasis degrees experienced throughout the twenty-four hours.Discuss emphasis cut downing methods applicable to Nicholas.To cut down the prospect 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 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 weari ness related to an unhealthy diet.Nicholas has go along his healthy feeding program and does non tin from weariness.Nursing DiagnosisGoalsInterventionsRationaleEvaluationImbalanced nutrition related to deficient lore of the relationship between diet and the diseaseShort termBrace the instabilities of nutritionProvide Nicholas with a ground of fruits and veggiesTo make out 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 stock warrant Nicholas has a exhaustively 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 monitor his diet and aid with his weight hurtTo fix Nicholas has the support needful to run into his endNicholas is now within a healthy weight sc ope for his gender, altitude and ageLong term make more cognition on the effects of smokeEducate Nicholas on the effects of smoking to his organic structureTo guarantee 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 treatment ( Ackley &038 A Ladwig, p.315 )Short termMaintain stability 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 idea and direction of Nicholas includeElectroca rdiogram ( 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 furnish moving ridges of the electrical current of the bosom.uranalysis 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 sugar degrees in the blood and screens for utility(prenominal) 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 imitate advance of arterial sclerosis and harm to the kidneys ( Cardio Connection, n.d ) . This assists in keeping a immovable 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 scrapeing 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 AppraisalUpon admittance, a hazard appraisal must be completed to find the patient s hazard of belongings a autumn. This appraisal besides assists the nurses in guaranting the patient has their properties or AIDSs within set about to guarantee the patient s arctic and to diminish their hazard of hurt. The appropriate appraisal tool for Nicholas would be a fall Risk Assessment Tool ( sodality ) . This relates to Nicholas as he complained of giddiness and want of slumber. This is needed to measure his hazard of hurt. book of facts to Appendix 1 for a falls Risk Assessment Tool.MedicinesNifedipine Antihypertensive mover as stated by Tiziani, 200 6 follow up Besides known as Ca adversaries, these agents impede the inflow of Ca ions during depolarisation of cardiac and vascular smooth musculus, doing progression in the myocardial O supply and cardiac end product, and a decrease in myocardial work by cut downing afterload ( Tiziani, 2006 ) do angina pectorisMild 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 misery if used with beta-adrenoceptor-blocking agentsSerum intentnesss whitethorn be increased if given with Tagamet, Quinidex or Cardizem.Excessive cardiovascular depression may happen if given with inspiration anesthetics. uncomely effectsHeadache, giddiness, lightheadedness, flushing, weariness, dizziness.Anorexia, sickness, irregularity, abdominal hurting, dry oral examination cavity.Muscle spasms.Nursing points/precautionsNote and study thorax hurting because thie requires stoping th e drug.Patient 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, dissimilitude or Prinzmental angina, unstable angina, or late myocardial infarction.Atorvastatin lipid-regulating agent as stated by Tiziani, 2006ActionReduce cholesterin significantly 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 ( low-density lipoprotein )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 map trial should be performed before get downing therapy and at 6 and 2 hebdomads, so double annually.Advise patient to describe any musculus hurting, spasms, tenderness or failing, uneasiness or febrility.Should be withheld if any stipulation occurs that predisposes the patient to rhabdomyolysis, such as injury, sepsis, uncontrollable epilepsy or metabolic, or endocrinal instabilities.