Question

a. Alice Jacobs, 48 year old African American female with BMI=30. ½ ppd smoker. Initial blood pressure: 180/76

1. Describe the assessment and diagnosis of hypertension. Prioritize at least three main interventions for hypertensive clients?
2. Create a 24 hour diet recall for your patient. Analyze diet according to calories, proteins, fats, carbohydrates. Now create a diet to promote normotension in your patient.
3. Create an exercise profile for your patient. Discuss current activity. Now prescribe an exercise program designed to promote normotension in your patient
4. Create a medication profile for your patient. Identify at least one antihypertensive to help promote normotension. Discuss why your chosen medication would be appropriate for your specific patient.

Answer 1

Hypertension is the elevation of systolic and diastolic pressure more than normal range. The assessment and diagnosis of hypertension include:

* Regular monitioring of BP atleast for three different and separate appointments.

* Check BP of both arms to see any difference in values of both arm, if yes then report to the physician.

* 24-hour blood pressure monitoring device called ambulatory BP monitoring can be done to check average BP and any changes in value at home.

* Collect all medical history, past surgical history, family history, environmental and occupational history, and diet pattern to determine the predisposing and precipitating factors.

* Physician may prescribe for urine analysis, blood test, cbc, cholesterol level test and ecg to determine any complication of hypertension.

INTERVENTIONS OF HYPERTENSION ARE:

* Assess the general condition of client, check vitals at three intervals, check weight and BMI and determine the causative factors.

* Assess the diet pattern and salt intake amount of client and collaborate with dietician and recommend about DASH diet to the client. Advice to eat more fruits and vegetables, limit salt intake, drink plenty of fluids.

* Advice client to bring lifestyle modifications such as cut off from smoking, involve in weight reduction program, do some physical activities and proper regimen of antihypertensives.

24 HOUR DIET PLAN HYPERTENSIVE CLIENT:

TOTAL CALORIES REQUIRED- 2000cal/day

SALT AMOUNT LIMITED TO; 2300 mg/day

PROTIEN: 1.5gm/kg/day

BREAKFAST - 1 serving of slice seeded bread with raw vegetables+ 1 glass of juice( 250cal + 35gn CHO+ 8gm protein+6gm fat)

SNACKS: 1cup of grapes

LUNCH: half tuna sandwich topped with cucumber and tomatoes slice no added salt, 1 glass milk with no fat or yogurt.

SNACKS: 1 cup nuts/almonds/ cracker / green tea

DINNER: 1 serving of chicken pasta, mixed green salad, 2 sliced bread.

EXERCISE PROGRAME: engage in moderate intensity exercises with aerobic exercises 5-7day/week, supplemented by resistance exercise 2-3day/week, and flexibility exercise 3-5day/week. This can be done by performing:

* 10 minutes of brisk walking three times per day.

* 30 minutes of stationary cycle/ day

*20 minutes of desk treadmilling one time in a day

*20 minutes of swimming

*10 minutes of hiking.

MEDICATION PROFILE:

CALCIUM CHANNEL BLOCKER - example AMLODEPINE.

Tjey help in relaxing the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for older people and people of African heritage than do ACE inhibitors alone.