Case study - Hypertension: Nursing

Nurse Tom works at a primary care clinic and is caring for Mahlik, a 62-year-old patient who is being seen for a wellness check. After settling Mahlik in the exam room, Nurse Tom goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Mahlik’s care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes. 

First, Nurse Tom recognizes important cues, including temperature 99.4 F or 37.5 C, pulse 75 beats per minute; respirations 16 breaths per minute; blood pressure of 156/89 mmHg, and oxygen saturation 97% on room air.  

Next, Nurse Tom asks Mahlik about his history.  

Nurse Tom: Do you usually have high blood pressure? Do any of your family members have high blood pressure? 

Mahlik: My dad and older brother do. My job is stressful, so maybe that’s contributing. I’ve checked my blood pressure at the drug store, and it’s been high, but with work, I haven’t had time to come in and have it checked. 

Nurse Tom: Stress can contribute to high blood pressure, and family members with high blood pressure can increase your likelihood of having it too. What foods do you usually eat? 

Mahlik: I mostly eat fast food because I’m always on the go.  

Nurse Tom: Can you tell me about how often you smoke, drink alcohol, and exercise? 

Mahlik: I don’t smoke, never have. I drink maybe 1 to 2 beers a week on average, and honestly, I don’t exercise as much as I should. I’m just so busy with work.  

Nurse Tom analyzes these cues. He reviews the electronic health record, or EHR, and notes Mahlik’s body mass index, or BMI, is 28 kg/m2. Nurse Tom alerts the health care provider to Mahlik’s blood pressure and history. They diagnose Mahlik with stage 1 primary hypertension and prescribe an oral antihypertensive medication. Nurse Tom realizes Mahlik needs effective blood pressure management. 

Using the information gathered along with Mahlik’s history, Nurse Tom chooses a priority hypothesis of elevated blood pressure. He then generates solutions to address Mahlik’s blood pressure including pharmacologic and nonpharmacologic interventions and establishes the expected outcome that after intervening, Mahlik’s blood pressure will be 130/80 mmHg or below at his next follow-up appointment.