Denise Boone returns to her physician’s office 2 weeks later for hypertension fo

Question

Denise Boone returns to her physician’s office 2 weeks later for hypertension follow up. Her blood pressures for the last 2 weeks range between 150s/80s and 190s/90s. She takes her blood pressure at home twice a day. Ms. Boone reports a moderate headache for 4 to 5 days that is nonstop, with blurred vision, flashes of light in her visual field that is unrelieved by ibuprofen. She has been taking 1000mg of ibuprofen 4 to 5 times a day with minimal relief, have felt nausea but not vomited. She feels “off” and weak. She noticed yesterday that she has difficulty lifting things with her left hand and she has been tripping over her feet. She has difficulty focusing and her left foot feels numb. Ms. Boone also noticed difficulty swallowing yesterday and is coughing and choking whenever she tries to drink or eat. Her vital signs reading when the medical assistant roomed her was: BP 210/102, HR 76, RR 18, temp 98.1, SaO2 97% on RA. The MA immediately notifies the RN (you) of Ms. Boone's status and the RN enters the room to evaluate Ms. Boone.

a. What additional assessments should be performed for Ms. Boone based on her presenting symptoms? Include physical assessments, lab, imaging, additional questions, etc.

b. What possible perfusion problem does Ms. Boone’s current status/change indicate and why? What role/influence does chronic uncontrolled hypertension have on the development of CHF?

c. What is her current hypertensive status: hypertensive urgency or emergency? Give evidence to support your rationale for why you chose the hypertensive.

d. What other concept(s) could have contributed and may be affected by Ms. Boone’s high blood pressure? What are the nursing priorities?

Explanation / Answer

a) Ms. Boone is having symptoms of stroke or Congestive heart disease due to high blood pressure. The additional assessment that can be done is to rule out the risk. They are :Blood tests may be considered to assess risk factors for heart disease and stroke as well as looking for complications of hypertension. These include complete blood count (CBC), electrolytes, BUN (blood urea nitrogen), and creatinine and GFR (glomerular filtration rate) to measure kidney function. A fasting lipid profile will measure cholesterol and triglyceride levels in the blood.

Electrocardiogram (ECG) may help evaluate heart rate and rhythm. It is a screening test to help assess heart muscle thickness.

Echocardiogram is an ultrasound examination of the heart It is used to evaluate the anatomy and the function of the heart. A cardiologist is required to interpret this test and can evaluate the heart muscle and determine how thick it is, whether it moves appropriately, and how efficiently it can push blood out to the rest of the body. The echocardiogram can also assess heart valves, looking for narrowing (stenosis) and leaking (insufficiency or regurgitation). A chest X-ray may be used as a screening test to look for heart size, the shape of the aorta, and to assess the lungs.

Doppler ultrasound is used to check blood flow through arteries at pulse points in your arms, legs, hands, and feet. This is an accurate way to detect peripheral vascular disease, which can be associated with high blood pressure. It also can measure blood flow in the arteries to both kidneys and sometimes depicts narrowings that can lead to high blood pressure in a minority of patients.

CT and MRI scan of brain.

b)Perfusion is the passage of fluid through the circulatory system or lymphatic system to an organ or atissue, usually referring to the delivery of blood to a capillary bed in tissue. So here blood is not adequately supplied to heart.

HIgh blood pressure may also bring on heart failure by causing left ventricular hypertrophy, a thickening of the heart muscle that results in less effective muscle relaxation between heart beats. This makes it difficult for the heart to fill with enough blood to supply the body’s organs, especially during exercise, leading your body to hold onto fluids and your heart rate to increase.

C) It is a hypertensive emergency because patient shows high blood pressure with organ failure symptoms mainly heart failure. A hypertensive emergency is a condition in which elevated blood pressure (BP) results in target organ damage. [1] The systems primarily involved include the central nervous system (CNS), the cardiovascular system, and the renal system.

d) If left untreated or uncontrolled, high blood pressure can cause many health problems. These conditions include heart failure, vision loss, stroke, and kidney disease. From two weeks her BP was not under control and she neglected the symptoms like severe headache, blurred vision. This symptoms would be due to high blood pressure and end organ damage due that. So it may aggregated her condition.

Atherosclerosis can be another cause of high blood pressure and CHF. So may be she already developed it. Which would have leaded to CHF.

Nursing Priorities

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