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

1) subjective data - frequent morning headaches, and occasional dizziness and blurred vision.

objective data - High blood pressure, weight gain, high cholestrol levels but no family history of hypertension.

2) potential problems - Chronic hypertension, heart problem or stroke, peripheral vascular disease.

actual problems - Fatigues due to hypertension, stress due to daily life problems, imbalanced nutrition, ineffective health maintenance and deficient knowledge of prescribed treatment.

3) what interventions - captopril 12.5mg twice daily to treat hypertension, hydrochlorothiazide 12.5 mg daily to control blood pressure and bring it to less than 150/90 by the next visit, include low sodium and low fat diet to control fluid retention, provide appropriate dietary instructions and cholestrol levels in the body and prepare a plan of regular exercise for the patient.

4) Education - Educate her to check her blood pressure on daily basis and keep a record of that for the follow-up visit, make her understand about the action, proper dose and side effect of the medication, encourage her to walk and do some physical activities on daily basis, teach her about various techniques to reduce the stress level, techniques for weight loss and refer to a dietitian for consultation.

5) follow-up would be suggested - Definitely a follow up visit would be suggested as it important to track and keep a record of her blood pressure and cholestrol levels and ensure they does not reache to a dangerously higher level. Monitoring the progress is very crucial in her condition.

6). Explain the prioritization of problems - Priority would be to monitor and control her blood pressure level first and prevent the potential condition like severe hypertension, fluid retention or atherosclerosis. Second in the list would be to control her cholestrol levels by intervening her diet and encouraging physical exercise regualrly. The last priority would be to avoid or eliminate the stress causing factors that are effecting her quality of life by appropriate techniques and therapy.