Question

Case Scenario # 2

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

Ans.1. According to the relatively new guidelines, that is classified as “Stage 2,” both because of the Systolic BP of 168, and the Diastolic BP of 94.

Acutely, you have to worry about a stroke, and depending on other risk factors, a heart attack. Chronically, you can develop kidney failure, blindness, erectile dysfunction, and an enlarged but weakened heart called cardiomyopathy.

Ans.2. I would suggest him following up with his PCP to obtain another BP reading and confirm the reading aswell as to inform him of the risks associated with high BP and lifestyle modifications that can lower blood pressure such as exercise, diet, and possibly medications. Possibly suggest he purchase a home BP cuff to monitor his own readings.

Ans. 3. I would comfort her and explain that this reading was just one isolated reading and that there are many variables that can influence your blood pressure. I would explain that high blood pressure could be controlled by lifestyle modifications. I would encourage her to provide him with positive feedback for diet and lifestyle modifications such as going for walks and eating a balanced diet. I would show compassion for the wife’s distress and comfort her while educating and providing resources regarding blood pressure readings.