Nursing Case Study

Case Study Questions

Understanding the Disease and Pathophysiology

1.Define arterial blood pressure and explain how it is measured.

Arterial blood pressure is the force exerted by the blood on the lumen of the arteries. The use of a sphygmomanometer measures it. The cuff sphygmomanometer is wrapped around the brachial artery, and a stethoscope is used to listen to the beats until they disappear. This provides the systolic blood pressure. The stethoscope is used again to hear when the beat will be clear again, thus providing diastolic blood pressure. Thus, arterial blood pressure has two values: systolic and diastolic blood pressure.

2.Discuss briefly the mechanisms that regulate arterial blood pressure, including the sympathetic nervous system, renin-angiotensin-aldosterone system, and renal function.

The sympathetic nervous system regulates arterial blood pressure by causing vasoconstriction when activated, thus causing an increase in arterial blood pressure. The renin-angiotensin-aldosterone system regulates arterial blood pressure by increasing water and sodium reabsorption and controlling vascular tone. When the RAAS is activated, the arterial blood pressure increases. In the case of renal function, it regulates arterial blood pressure by controlling blood volume through water and sodium balance, ensuring that extracellular fluid volume is balanced. When water and sodium retention increase, extracellular fluid volume increases, thereby elevating arterial blood pressure.

3.What is essential hypertension? What is the etiology

Essential hypertension is the abnormal increase in blood pressure above the normal range not associated with any medical condition. Its etiologies can be obesity, high alcohol intake, and sedentary lifestyle.

4.What are the common symptoms of essential hypertension?

Some of the common symptoms are dizziness, blurry vision, and headaches. Some people might also develop chest pain.

5.Using the JNC 8 guidelines, how is the diagnosis of hypertension made? What blood pressure readings are used to identify normal BP, stage 1 hypertension, and stage 2 hypertension?

According to the JNC 8 guidelines, hypertension is diagnosed when the person has a systolic blood pressure of greater than or equal to 140mmHg or a diastolic blood pressure of greater than or equal to 90mmHg. Normal blood pressure readings are systolic blood pressure of 110 mmHg to 139 mmHg and diastolic blood pressure of 60 mmHg to 89 mmHg. Stage 1 hypertension readings are systolic blood pressure of 140-159mmHg and diastolic blood pressure of 90-99mmHg. Stage 2 hypertension readings are systolic blood pressure of greater than or equal to 160mmHg and diastolic blood pressure of greater than or equal to 100mmHg.

6.List the risk factors for developing hypertension. What risk factors does Mrs. Moore currently have? Discuss the contribution of ethnicity to hypertension, especially for African Americans.

The risk factors for developing hypertension are family history of hypertension, excessive alcohol intake, older age, high salt intake, and being overweight. The risk factors that Mrs. Moore has are excessive sodium intake and being overweight. Ethnicity predisposes African Americans to hypertension based on their lifestyle and genetics, thus putting most of them at high risk of developing hypertension.

7.What are the four major modes of treatment for hypertension?

The modes of treatment for hypertension are the use of calcium channel blockers, angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, and the use of diuretics.

8.Dr. Evans indicated in his note that he would rule out metabolic syndrome. What is metabolic syndrome?

Metabolic syndrome is a group of conditions that cumulatively increase the risk of an individual developing cardiovascular diseases.

9.What factors in the medical and social history are pertinent for determining Mrs. Moore’s coronary heart disease risk category?

The essential factors are the diagnosis of stage 2 essential hypertension, alcohol use, where she consumes 2-4 beers per week, and a history of tobacco use, which she quit 1 year ago.

10.How is hypertension related to other cardiovascular disorders? What are the possible complications of uncontrolled or untreated hypertension?

Hypertension affects the endothelial system of the blood vessels, which puts one at high risk of developing peripheral arterial disease and coronary artery disease, making one susceptible to atherosclerotic disease. The complications of untreated hypertension are heart failure, stroke, and renal failure.

Understanding the Nutrition Therapy

1.Briefly describe the DASH eating plan and discuss the major nutrients that are components of this nutrition therapy.

Dietary Approaches to Stop Hypertension is an eating plan that is developed to assist in preventing and controlling hypertension. It also assists in reducing cholesterol levels. The major nutrients for this nutrition therapy are whole grains, vegetables, fruits, lean meats, fish, and poultry.

2.Using the 2015 Dietary Guidelines, describe why decreased sodium intake is targeted as a focus to improve the health of Americans.

Sodium is targeted because increased sodium intake increases the risk of Americans developing hypertension. So, it has to be reduced in all food components to enhance the health of Americans.

3.What do the current literature and the Evidence Analysis Library indicate regarding sodium intake's role in controlling hypertension? Is there a significant correlation between sodium intake and cardiovascular risk?

The literature presents that sodium intake increases the retention of water in the body, thus increasing the extracellular fluid volume, which puts one at a high risk of developing hypertension. Thus, its intake should be reduced to decrease the fluid volume in the system. There is a clear correlation between sodium intake and cardiovascular risk, as increased sodium intake increases the risk of one to develop hypertension.

4.What is the Mediterranean diet? How might this dietary approach be appropriate for Mrs. Moore? Would this be culturally appropriate for her?

The Mediterranean diet is plant-based, mainly vegetables, herbs, fruits, whole grains, nuts, and beans. This diet will be appropriate for Mrs. Moore as it will assist her in reducing her cholesterol level and controlling her weight. It will be culturally appropriate because it does not violate her beliefs.

5.Lifestyle modifications reduce blood pressure, enhance the efficacy of antihypertensive medications, and decrease cardiovascular risk. List lifestyle modifications that have been shown to lower blood pressure.

Lifestyle modification entails eating a healthy diet, exercising regularly, reducing stress, limiting alcohol intake, quitting smoking, and reducing salt.

Nutrition Assessment

1.What are the health implications of Mrs. Moore’s body mass index (BMI)?

The BMI of Mrs. Moore affects every aspect of her health by putting her at a higher risk of developing diabetes and some cancers like breast cancer, esophageal cancer and endometrial cancer.

2.Calculate Mrs. Moore's energy and protein requirements

Identify the major sources of sodium and saturated fat in Mrs. Moore’s diet. Compare her typical diet to the components of the DASH diet.

The sodium sources are from her lunch, comprising around 350mg from the saltines and 870mg in the soup. The major sources of saturated fats are from her dinner, which is composed of foods with a lot of butter, glazed carrots, and baked potatoes. Mrs. Moore's diet complies with the DASH eating plan, but the sizes are larger than the required ones. The 24-hour recall of Mrs. Moore also does not include fruits. Besides, she regularly takes 2 glasses of wine, and the DASH eating plan does not recommend alcohol intake.

3.What dietary assessment tools that target nutrients associated with hypertension and CVD risk might be useful in assessing Mrs. Moore's diet?

It is the food-related history, medical tests, and biochemical data. The diet should be aligned to increase potassium, calcium, magnesium, and fiber. Besides, it reduces sodium intake, thus aiding in regulating CVD and hypertension. Medical tests and biochemical data will assist in finding inadequate and excess nutrients in Mrs. Moore's diet.

4.From the information gathered within the intake domain, list possible nutritional problems using the diagnostic terms.

There is dyslipidemia as the high-density lipoprotein cholesterol levels are below the reference range and the low-density lipoprotein levels are above the normal range. This shows that Mrs. Moore is at high risk of developing heart disease.

5.Dr. Evans ordered the laboratory tests listed in the following table. Complete the table with Mrs. Moore’s values from 6/25 and the potential cause of any abnormalities.

Go to http://cvdrisk.nhbli.nih.gov/. Using this online calculator, determine Mrs. Moore’s risk of CVD based on her lipid profile. Are there other factors that contribute to her CVD risk?

The major risks for CVD that Mrs. Moore has are her previous history of smoking cigarettes, hypertension, and dyslipidemia.

6.How do Mrs. Moore's labs change between 6/25 and 3/15? What factors in her history may have made an impact on these?

Mrs. Moore's cholesterol level was between 6/25 and 3/15, which dropped but was still higher than the reference range. Her glucose level at 6/25 was higher than the reference range, but 3/15 showed that her glucose level decreased below the reference range. The triglyceride levels also returned to the required range of reference. The HDL levels were still below the reference range. Factors contributing to it are increased workout frequency, adherence to a healthier diet, and smoking cessation.

7.Indicate the pharmacological differences among the antihypertensive agents listed below.

8.What are the most common nutritional implications of taking hydrochlorothiazide?

Hydrochlorothiazide inhibits the reabsorption of chloride, sodium, and potassium. Its major side effect is dehydration following excessive fluid loss. Muscle aches and dizziness can also occur.

9.Mrs. Moore’s physician has decided to prescribe an ACE inhibitor and an HMG-CoA reductase inhibitor (Zocor). What Changes to Mrs. Moore’s labs between 6/25 and 3/15, if any, would you attribute to Zocor use?

Zocor is recommended because it assists in decreasing the lipoproteins levels. Its combination with ACE inhibitors decreases blood pressure by enhancing vasodilation and increasing fluid loss.

10.List possible nutrition problems using the diagnostic terms from information gathered within the clinical domain.

From the medications that the patient is using, some issues that can arise from increased fluid loss are diarrhea and constipation. Besides, abdominal pains and muscle weakness can also occur.

Nutrition Diagnosis

1.Select 2 nutritional problems and complete the PES statement for each

First, there is a deficit in nutrition-related knowledge because of the high consumption of lipids, as seen in the 24-hour recall and poor concerns in eating habits. Second, poor nutrition, as seen in the high-calorie diet seen in the 24-hour recall.

Nutrition Intervention

1.When you talk to Mrs. Moore on 3/15, you ask how much weight she would like to lose. She tells you that she would like to weigh 125 lbs, which she has for most of her adult life. Is this reasonable? What is a goal for weight loss, Mrs. Moore? How quickly should Mrs. Moore lose this weight?

Based on Mrs. Moore's weight, the goal should be a gradual loss of weight over six months. As a result, she has lost around 13.7 lbs. This makes the goal acceptable, but it will take time.

2.For each of the PES statements that you have written, establish an ideal goal (based on the signs and symptoms) and appropriate intervention (based on the etiology)

The first goal is to enhance Mrs. Moore's nutritional education. This will assist in a decrease in lipid intake. It can be done by choosing food products with lower fats, like milk. The second goal is to reduce salt consumption in her diet by prohibiting the added salt in her meals.

3.List your major recommendations for dietary substitutions and/or other changes that would help Mrs. Moore's medical nutritional therapy goals to be consistent with the DASH diet and sodium intake guidelines.

She should adhere to her meals and strive to take three meals daily. This will assist her in regulating high-calorie and high-fat fat in her life. Interventions to assist her in reducing sodium, cholesterol, and fat include eliminating olive oil from her diet. She is also supposed to adhere to the right quantity of food groups taken per day.

4.Your appointment with Mrs. Moore on 3/15 is concluded. What would you want to reevaluate in her next follow-up meeting?

It is recommended to reassess Mrs. Moore's cholesterol levels as they are high. Her weight should also be monitored to be in the right range. 24-hour food recalls should be monitored consistently, and nutritional education should be offered to the patient.

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