Question

A couple in their 50s is shopping in a mall where a health fair is set up. You are a nurse participating at a booth offering blood pressure readings. After much coaxing, the woman persuades her husband to have his blood pressure taken. You obtain a reading of 168/94 mm Hg. The wife reacts strongly, saying, “I told you that your lack of exercise and overeating would catch up with you one day. How am I going to manage being a widow at such an early age?” The husband responds by saying, “Don’t worry about me. I’m just as healthy as ever, and I plan to live until I’m 99 years old. I’m sure there’s something wrong with that machine.” Both of them turn to you. The wife says, “Tell him it’s not the machine and that he isn’t taking care of himself!”

   1.   Identify possible interpretations of an isolated blood pressure reading of 168/94 mm Hg. List factors that may have affected the reading’s accuracy.

   2.   Analyze the man’s reaction to this situation. Indicate the teaching points about blood pressure that may be appropriate at this time.

   3.   Outline potential ways to deal therapeutically with the wife’s anxiety, describing possible verbal and nonverbal interactions.  

Answer 1

1.Identify possible interpretations of an isolated blood pressure reading of 168/94 mm Hg. List factors that may have affected the reading’s accuracy.

1. Hypertension

Hypertension is the persistent elevation of the systolic BP above 140 mm of Hg and diastolic blood pressure BP above 90 mm of Hg. For adults of any age, blood pressure between 120/80 and 139/89 mm Hg is considered prehypertension.

2. It may be due to coronary artery diseases also.

Arteriosclerosis - Loss of elasticity of the arteries intimal layer.

Artherosclerisis - Accumulation in the arteries of fatty plaque made of lipids.

3. White Coat effect

Some clients demonstrate higher recorded blood pressure in the doctors or physicians office than in the natural environment/ home setting.

Factors affect the readings accuracy

1. Stress

Anxiety, fear, pain, and emotional stress results in sympathetic stimulation, which increases heart rate, cardiac out put, and peripheral vascular resistance. Effects of sympathetic stimulation increases blood pressure.

2. Measuring BP when a client has just eaten

Older adults often experience 5-10 mm of Hg fall in blood pressure about 1 hour after eating.

3. Age

An adults blood pressure increase with advancing age. Older adults may have rise in body temperature due to a decreased vessel elasticity.

4. Ethnicity

Incidence more in African Americans than in European Americans.

5. Gender

After puberty males tend to have high BP than females and after menopause woman tend to have high BP than the men of same age

6. Diurnal variation

BP typically lowest in the early morning gradually rises during the morning and afternoon and peaks in late after noon or evening.

7. Medications

Antihypertensives, opioid analgesics,which can lower blood pressure.

8. Stimulants

Coffee or tea intake also increases BP

9. Other factors

Causes of false high BP

Physicians room environment, after an exercise, pain, anxiety, client with a full bladder.

Equipment or fauty technique related false high reading BP due to

Deflating cuff too slowly,venous congestion, unsupported arm, back unsupported, legs dangling, arm below heart level, cold hands or stethoscope, viewing meniscus from below eye level cuff too narrow,wrapping cuff unevenly or loosely,

Cause of false low BP

Environmental noise, reading taken at inspiration (in selected high-risk clients, COPD, pulmonary embolus,hypovolemic shock).

Faulty technique.

Failing to pump cuff up high enough, cuff too wide, arm above heart level,releasing valve too rapidly, physicians or doctors or nurses hearing deficit, ear pieces fitting poorly, stethoscope tubing too long,viewing meniscus from above eye level.

2.   Analyze the man’s reaction to this situation. Indicate the teaching points about blood pressure that may be appropriate at this time.

He is not as much as concerned about his own health. Mans reaction represents lack of seriousness regarding his health condition. According to his wife he is overeating and not having any proper exercise.

Teaching point

Age, high fat diet, lack of exercises are some risk factors associated with obesity. The man has precontemplation also, after coaxing and the woman persuades only he checked his BP. More than healthy lifestyle he relay optimistically that he will live up to 99 years of age.

1. Ask the patient to take an average of two or more blood pressure reading rather than relaying on single abnormal reading.

2. Measuring blood pressure regularly and keeping a record of it and bringing it to the doctor’s office.

3. Start exercise programme

4. Reduce high fat diet and stop over eating. Include omega 3 fatty acid containing food.

5. Limiting sodium

No more than 1,500 mg per day (According to recommendations of American Heart Association)

3. Quit alcohol and smoking

4. Reduce caffeine in diet

5.Immediatly start an exercise program

3.Outline potential ways to deal therapeutically with the wife’s anxiety, describing possible verbal and nonverbal interactions.  

Deal the wife's anxiety with a reassuring approach. Ask her about the need of an average reading for the proper diagnosis of hypertension.

' Do not worry we can confirm after taking 2 or 3 blood pressure assessment"

Reassure her and remember her about over anxiety will affect her BP also. Talk leaning slightly towards her and facing her squarely will build trust .  Keeping good eye contact and maintaining an open and relaxed posture also need to practice while communicating effectively with the client.

After coaxing and persuading only her husband agreed to check the B.P. She worried about her husband's lifestyle feared a about his death in an early age.