A 55 twelvemonth old male named Nicholas Manners, is admitted to the ward for direction of his high blood pressure. Upon reaching, he appears rather ruddy in the face. He was referred to the exigency section by his GP as he was kicking of a concern and giddiness. 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 really small slumber. Mr Manners is a Chief executive 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 supportive. 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 smokes 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 bosom 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 ) .
Blood force per unit area 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 determined by the force and the sum of blood pumped, and the size and flexibleness of the arterias. High blood force per unit area, besides known as Hypertension, is considered as above 120/80 mmHg ( PubMed Health, 2011 )
Arterial blood force per unit area is a merchandise of cardiac end product and systemic vascular opposition. A alteration in the vascular wall thickness affects the elaboration of peripheral vascular opposition in hypertensive patients. This consequences in the contemplation of moving ridges back to the aorta and hence increasing the systolic blood force per unit area ( Medscape, 2011 ) . Although 90 % of high 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 high blood force per unit area are both biomedical and lifestyle oriented. Major causes include ; being overweight, dietetic 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 pressure
As a patient is admitted to the infirmary, it is critical to execute a nursing appraisal on admittance to garner baseline readings of the patient. The Systems 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, 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 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- 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 intestine 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 skin turgor.
METABOLIC – buttocks Hb, BGL and liver map through a blood trial.
Education and Psychosocial support
Education and support that can be offered to Nicholas to help him in deriving more information and support for his Hypertension include:
Dieticians 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 Better Health Channel, Hypertension Education Foundation and the Heart Foundation, all provide instruction and information about support for patients about high blood pressure.
Ineffective wellness care related to incapableness to change life style
Introduce low-sodium and low fat nutrients into Nicholas ‘ diet
Refer Nicholas to a dietitian 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.
Aim 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 have now stabilised to a lower degree.
Develop a regular exercising program for Nicholas to follow.
Promote Nicholas to walk for an hr each twenty-four hours.
To promote Nicholas to prosecute in a healthy life style.
Nicholas participates in an hr of physical activity each twenty-four hours.
Aim to discontinue 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 ‘ hazard of holding blocked arterias and therefore increasing Nicholas blood force per unit area
Nicholas has now quit smoke
Fatigue related to the effects of high blood pressure and the day-to-day life stressors.
Aim to command 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.
Aim to keep 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. Record amounts utilizing a unstable balance chart if needed
Nicholas ‘ weariness degrees have decreased as he is imbibing plentifulness of H2O throughout the twenty-four hours.
Reduce 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 discussed
Develop a healthy feeding program to utilize one time Nicholas is discharged
Refer 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.
Imbalanced nutrition related to deficient cognition of the relationship between diet and the disease
Brace the instabilities of nutrition
Provide Nicholas with a scope of fruits and veggies
To supply Nicholas with a assortment of foods from a scope of nutrients.
Nicholas ‘ diet now chiefly consists of fruit and veggies
To do Nicholas ‘ cognition on the disease
Provide Nicholas with information such as booklets about high blood pressure
To guarantee Nicholas has a good cognition of high blood pressure
Nicholas is now good educated on his disease
To brace Nicholas ‘ weight within 6-8 months of discharge
Refer to dietician to measure and supervise his diet and aid with his weight loss
To guarantee Nicholas has the support required to run into his end
Nicholas is now within a healthy weight scope for his gender, tallness and age
Derive more cognition on the effects of smoke
Educate Nicholas on the effects of smoking to his organic structure
To guarantee he is cognizant of the harm smoke is making to his organic structure
Nicholas is good informed on the effects of smoke
Non-compliance related to the side effects of the intervention ( Ackley & A ; Ladwig, p.315 )
Maintain stableness of side effects
Monitor Nicholas and supply advice when non following instructions of intervention
To guarantee Nicholas ‘ intervention continues on the right way.
Nicholas ‘ side effects have decreased.
Maintain conformity of intervention
Educate Nicholas on hazards if intervention non followed as required
To guarantee Nicholas ‘ wellness does non deteriorate
Nicholas is compliant with his intervention
Diagnostic trials that will help with the appraisal and direction of Nicholas include:
Electrocardiogram ( 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 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 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 patterned 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.
Upon 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 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.
Nifedipine – Antihypertensive agent – as stated by Tiziani, 2006
Action: 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 )
Mild to chair high blood pressure
Nicholas has been prescribed this medicine to help with bracing his blood force per unit area.
Contraindicated with rifampicin
May do bosom failure if used with beta-adrenoceptor-blocking agents
Serum concentrations may be increased if given with Tagamet, Quinidex or Cardizem.
Excessive cardiovascular depression may happen if given with inspiration anesthetics.
Headache, giddiness, dizziness, flushing, weariness, dizziness.
Anorexia, sickness, irregularity, abdominal hurting, dry oral cavity.
Note and study thorax hurting because thie requires stoping the 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, discrepancy or Prinzmental angina, unstable angina, or recent myocardial infarction.
Atorvastatin – lipid-regulating agent – as stated by Tiziani, 2006
Reduce cholesterin significantly in patients with type II lipemia and hence besides significantly cut down the hazard of coronary arteria disease
Nicholas has been prescribed this medicine to take down the entire cholesterin and low-density lipoproteins ( LDL )
May addition plasma concentration of Lanoxin, increasing the hazard of toxicity.
Caution if used with Tagamet, Aldactone or ketoconazole.
Constipation, flatulency, abdominal hurting, sickness, diarrhea.
Liver 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.