Case study - Primary hypertension: Nursing

Nurse. Tom works at a primary care clinic and is caring for Mali a 62 year old who's being seen for a Wellness check in collaboration with the registered nurse, RN Jenny.

Nurse. Tom goes through the steps of the clinical judgment measurement model to make clinical decisions about Mali's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.

First, nurse tomm recognizes important cues including temperature, 99.4 °F or 37.5 °C P 75 BPM, respirations, 16 breaths per minute.

BP of 1 56/89 millimeters of mercury and oxygen saturation, 97% on room air. Next, nurse Tom asks Moli about his history.

Do you usually have high BP? Do any of your family members have high BP?

My dad and older brother do. My job is stressful.

So maybe that's contributing to it. I've checked my BP at the drug store and it's been around 1 50/90.

But with work, I haven't had time to come in and have it checked. Stress can contribute to high BP and having family members with high BP can increase your likelihood of having it too.

What foods do you usually eat? I mostly eat fast food because I'm always on the go.

Can you tell me about how often you smoke, drink alcohol and exercise? I don't smoke.

Never have. I drink maybe one or two 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 E hr and notes Malik's body mass index or BMI is 28 kg per meter squared.

Nurse Tom knows that BP is determined by factors like peripheral vascular resistance or the force the heart needs to overcome to pump blood into circulation and the total volume of blood circulating in the body.

And he knows if these increase BP can also increase nurse. Tom also understands Mali's BP could be affected by stress hormones like catecholamines that can cause vasoconstriction and increase peripheral vascular resistance and by Mali's fast food diet, which is likely high in sodium that can lead to fluid retention and increased blood volume.

Nurse, Tom also identifies Mali's other risk factors for hypertension including a family, history of hypertension and increased BMI and sedentary lifestyle.

Nurse. Tom realizes Molik needs effective BP management.

Then nurse Tom alerts the health care provider and RN Jenny to Mali's BP and history, the health care provider diagnoses mali with stage one primary hypertension and prescribes an oral anti hypertensive medication.

Next, nurse Tom and RN Jenny choose a priority hypothesis of elevated BP. Then they generate solutions to address Mali's BP and they establish the expected outcome that after intervening Mali's BP will be 1 30/80 millimeters of mercury or below at his next follow up appointment.

Then nurse Tom and RN Jenny take action to implement these solutions. R and Jenny teaches Moli about hypertension and the prescribed antihypertensive medication.

Nurse Tom then enters Malik's room to go over his after visit. Summary.

Hi, Mollic. I have a printout of everything.

RN Jenny and your health care provider discussed with you today. Ok.

I remember they said I should pick up a medication called Losartan from my pharmacy which will help lower my BP. But there was a lot of other information.

Can you remind me what else I'm supposed to do to help lower my BP? Sure, you should try to get at least 2.5 hours a week of moderate exercise like walking, you don't drink alcohol very much.

So continue with alcohol in moderation though, eliminating it can be more helpful. Also try to avoid foods high in sodium like fast food.

If you do go out to eat, try selecting other options like a salad with low fat dressing or fruit. Ok.

I'll also try packing my lunch to take to work. But if I run out of time, I'll look for healthier fast food options and I can start by going for a walk a few times a week.

Those are great ideas. Next nurse Tom obtains a home BP machine for Malik and reviews how Malik can measure his BP at home.

Nurse. Tom then makes an appointment for Malik to return to the clinic in three weeks.

Three weeks later, Malik returns for his follow up appointment and nurse Tom evaluates the outcome of his actions. He measures Malik's BP which is 1 28/76 millimeters of mercury.

All right. As a quick recap, nurse, Tom recognized and analyzed cues related to Moo's newly diagnosed hypertension and in collaboration with R and Jenny prioritized hypotheses and generated solutions to address this problem.

Nurse, Tom and RN Jenny then implemented non pharmacologic interventions and evaluated Mali's outcomes and compared them to the expected outcome.

Since Mali's BP was under 1 30/80 millimeters of mercury following interventions. They determined the plan of care was