Question

History:

Margaret Spezia is a married, 49-year-old Italian American with eight children whose ages range from 3 to 18 years. For the past 2 months, Mrs. Spezia has had frequent morning headaches, and occasional dizziness and blurred vision. At her annual physical Assessment 1 month ago, her blood pressure was 168/104 and 156/94. She was instructed to reduce her fat and cholesterol intake, to avoid using salt at the table, and to start walking for 30 to 45 minutes daily. Mrs. Spezia returns to the clinic for follow-up.

ASSESSMENT

While escorting Mrs. Spezia to the Assessment room and obtaining her weight, blood pressure, and history, Lisa Christo RN, notices that Mrs. Spezia seems restless and upset. Ms.Christos says, “You look upset about something. Is everything OK?” Mrs. Spezia responds, “Well, my head is throbbing, and I’m sort of dizzy. I think I’m just overdoing it and not getting enough rest. You know, raising eight children is a lot of work and expense. I just started working part time so we wouldn’t get behind in our bills. I thought the extra money might relieve some of my stress, but I’m not so sure that’s really happening. I’m not getting any better and I’m worried that I’ll lose my job or become disabled and that my husband won’t be able to manage the children by himself. I really need to go home, but first, I want to get rid of this awful headache. Would you please get me a couple of aspirin or something?” Mrs. Spezia’s history shows a steady weight gain over the past 18 years. She has no known family history of hypertension.

Physical findings include:

• height 63 inches (160 cm)
• weight 225 lb (102 kg)
• T 99° F (37.2° C)
• P 100 regular
• R 16
• BP 180/115 (lying)
• 170/110 (sitting)
• 165/105 (standing)
• Skin cool and dry
• capillary refill 3 seconds right hand, 3 seconds left hand.

Mrs. Spezia’s total serum cholesterol is 245 mg/dL (normal< 200 mg/dL). All other blood and urine studies are within normal limits. Based on analysis of the data, Mrs. Spezia is started on captopril 12.5mg twice daily and hydrochlorothiazide 12.5 mg and placed on a low-fat low-cholesterol, no-added 2gm sodium diet.

Highlight the data in the history and the assessment that needs to be addressed. Read the brief history and identify: concerning

1) subjective/objective data,

2) potential/actual problems,

3) what interventions,

4) Education

5) follow-up would be suggested.

6). Explain the prioritization of problems.

History and Assessment Data	Possible problem	Potential Action (How you as a nurse can address this)
Frequent Complaints of blurred vision.	Possible damage to eyes (vascular changes) due to continued hypertension	Ask physician for referral to opthamologist.

How would you prioritize these problems? Which two would you address first?   Why

Answer 1

Hypertension is the eleveated blood presure more than 140/90 mm of HG.it is the one of the leading causes of disease and death. it is due to so many causes. it is caused by increased activity of renin angiotensin aldosterone and that caues increases extracellular fluid volume and systemic artreial resistence stress that causes sympathetic system over activity which causes hypertension

Hypertension can be staged into mild, moderate, severe, profound.

hypertension canbe classied into primary and secondary hypertension.

history and asssessment data	potential problems	interventions
subjective data: throbbing headache	due to coconstrictive blood vessels that could damge brain	monitor her blood pressure administer antihypertensive as prescribed explain the need to continue of medication reduce her salt intake 2gm/day and explain the taste of salt ill be adjusted within 3 months exercise daily for 30-40 minutes to reduce her weight monitor her intake and output as she is provided with hydrochlorothizide monitor her weight
objevtive data: Blood pressure 180/115 mm of Hg(lying), 170/110 mm of Hg(sitting), 165/105 mm of Hg (standing
Subjective data : blurred vision	due to constrction of blood vessls of eyes that causes damage retina	explain the need of continuing medication explain about relaxation therapy that could bring down blood pressure refer her to opthamlaogist to assess her retina
objective data: Height is 160 cm weight is 102 kg BMI:39.8	Cause and build up hypertension due to her increased weight	assess her weight daily arrang a dietcian to plan diet to her eight advise her to do daily aerobic exercise for 30-45 minutes plan and provide her diet which reduces her weight
Objective data: cholesterol is 245mg/dl	is one of risk factor that causes hypertension na dcoronary artery disease	assess her blood cholesterol provide her cholesterol reducing diet low fat and lo choleterol diet explain the need of exercise advise her to increase fruits and vegetable

Education:

1. explain about hypertension and management which is prescribed for to control her hypertension.
2. explain about how the hypertensionill affect other systems like hypertension induced retinopathy, nephropathy, heartdisease, stroke.
3. encourage her to particpate in support groups for stress reducation
4. educate her about rebound hypertension if medication is stopped suddently
5. educate about medication related problem.

follow up:

• explain about follow- up that is necessary for monitoring her blood pressure
• educate her about her follo up visist include assessment and physical assessment to assess her blood pressure
• educate about her side effcets of medication

Priortize

1. headache is the first priority which is need to be addressed immediately. because hypertension shoulb be bring down to prevent hemorrhgic stroke due to rupture of blood vessels as a results of persistent headache. persistent hypertension that damage various ogans include kidney, eyes, heart

2. blurred vision is sign o of hypertension induced retinal changes. hypertension that damage the retina due to narrowing blood vessels and persistent hypertension.