1.Ms. C is a 42-year-old black American woman with a 7-year history of hypertension first diagnosed during her last pregnancy. Her family history is positive for hypertension, with her mother dying at 56 years of age from hypertension-related cardiovascular disease (CVD). In addition, both her maternal and paternal grandparents had CVD.
At physician visit one, Ms. C presented with complaints of headache and general weakness. She reported that she has been taking many medications for her hypertension in the past, but stopped taking them because of the side effects. She could not recall the names of the medications. Currently she is taking 100 mg/day atenolol and 12.5 mg/day hydrochlorothiazide (HCTZ), which she admits to taking irregularly because “… they bother me, and I forget to renew my prescription.” Despite this antihypertensive regimen, her blood pressure remains elevated, ranging from 150 to 155/110 to 114 mm Hg. In addition, Ms. C admits that she has found it difficult to exercise, stop smoking, and change her eating habits. Findings from a complete history and physical assessment are unremarkable except for the presence of moderate obesity (5 ft 6 in., 150 lbs), minimal retinopathy, and a 25-year history of smoking approximately one pack of cigarettes per day. Initial laboratory data revealed serum sodium 138 mEq/L (135 to 147 mEq/L); potassium 3.4 mEq/L (3.5 to 5 mEq/L); blood urea nitrogen (BUN) 19 mg/dL (10 to 20 mg/dL); creatinine 0.9 mg/dL (0.35 to 0.93 mg/dL); calcium 9.8 mg/dL (8.8 to 10 mg/dL); total cholesterol 268 mg/dL (< 245 mg/dL); triglycerides 230 mg/dL (< 160 mg/dL); and fasting glucose 105 mg/dL (70 to 110 mg/dL). The patient refused a 24-h urine test.
A- What is the appropriate teaching about life styles modifications to maintain BP under control.
B-Mention at least 2 pharmacological treatment (medications) to treat Hypertension.
1-Ms. Burke is an obese 55-year-old with a history of osteoporosis. Her healthcare provider (HCP) has recommended that she have a total left hip replacement. There is no other medical history known. Ms. Burke is scheduled for preoperative instructions and information in 3 days at the HCP’s office. The LPN/LVN begins the preoperative examination by taking Ms. Burke’s vital signs for the RN. Which vital signs require follow-up by the LPN/LVN?
-BP of 160/88
-Pulse of 68
-Respirations of 14
-Temperature of 97 F
2-Ms. Burke is an obese 55-year-old with a history of osteoporosis. Her
healthcare provider (HCP) has recommended that she have a total left hip
replacement. There is no other medical history known.
Ms. Burke is scheduled for preoperative instructions and information in 3
days at the HCP’s office. The LPN/LVN reviews Ms. Burke’s preoperative
lab test results, which were obtained earlier in the week.
Which serum lab value require follow-up action by the LPN/LVN
-Sodium 135 mEq/L
-Creatinine 0.8 mg/dl
-Hemoglobin 14 g/dL
3-Ms. Burke is an obese 55-year-old with a history of osteoporosis. Her healthcare provider (HCP) has recommended that she have a total left hip replacement. There is no other medical history known. Ms. Burke is scheduled for preoperative instructions and information in 3 days at the HCP’s office. The LPN/LVN notifies the RN of Ms. Burke’s vital signs and lab values. The RN informs the client and the LPN/LVN that the healthcare provider plans to evaluate Ms. Burke and review the data later in the day. The LPN/LVN reviews with Ms. Burke what to expect the day of surgery and during the immediate postoperative period. The LPN/LVN reinforces instructions regarding deep breathing exercises. Ms. Burke performs a return demonstration by breathing in through her mouth deeply and exhaling through pursed lips forcefully and rapidly. What is the best action for the LPN/LVN to implement first?
-Advise the client to avoid pursing her lips when exhaling
-Remind the client to exhale slowly and steadily
-Demonstrate the deep breathing and coughing technique again
-Document unsuccessful completion of the return demonstration
Expert Solution Preview
In this scenario, we are presented with case studies involving two different patients. Ms. C is a 42-year-old black American woman with a history of hypertension, while Ms. Burke is an obese 55-year-old woman with a history of osteoporosis. We will address the questions related to each patient separately.
To maintain blood pressure under control through lifestyle modifications, the appropriate teaching should include the following:
1. Weight management: Ms. C should aim for a healthy body weight by adopting a balanced and nutritious diet that is low in sodium and saturated fats. This should be combined with regular physical activity, such as brisk walking or aerobic exercises, for at least 150 minutes per week.
2. Sodium restriction: Limiting sodium intake to less than 2,300 milligrams per day (or 1,500 milligrams per day for individuals with more severe hypertension or other cardiovascular risk factors) is important. Avoiding processed and packaged foods, which are often high in sodium, can help in achieving this goal.
3. Tobacco cessation: Ms. C should be encouraged to quit smoking completely, as smoking is a major risk factor for hypertension and cardiovascular disease. She can be referred to smoking cessation programs or provided with appropriate resources and support to quit smoking.
4. Limit alcohol consumption: Moderate alcohol consumption should be advised, which means up to one drink per day for women. However, Ms. C may need to further reduce alcohol intake or avoid it altogether with the presence of uncontrolled hypertension.
5. Stress management: Techniques like deep breathing exercises, meditation, and yoga can be recommended to help manage stress levels, which can contribute to elevated blood pressure.
6. Regular monitoring: Emphasize the importance of regular check-ups with the healthcare provider to monitor blood pressure and overall health.
Two pharmacological treatment options for hypertension that could be considered are:
1. Angiotensin-converting enzyme (ACE) inhibitors: Medications in this class, such as lisinopril or enalapril, work by blocking the conversion of angiotensin I to angiotensin II, a hormone that causes blood vessels to constrict. By relaxing and widening blood vessels, ACE inhibitors help lower blood pressure.
2. Calcium channel blockers: Medications like amlodipine or diltiazem are calcium channel blockers that prevent calcium from entering the smooth muscle cells of the heart and blood vessels. This action relaxes and widens blood vessels, leading to reduced blood pressure.
It is important to note that selection of antihypertensive medications should be tailored to individual patient characteristics and may require consideration of additional factors, such as comorbid conditions and potential medication interactions.
Among the vital signs mentioned, the blood pressure reading of 160/88 mm Hg would require follow-up by the LPN/LVN. While the diastolic blood pressure (88 mm Hg) is within the normal range (60-80 mm Hg), the systolic blood pressure (160 mm Hg) is elevated. This elevated systolic blood pressure should be reported to the healthcare provider for further evaluation and potential intervention before proceeding with the total left hip replacement.
Among the serum lab values mentioned, the WBC count of 14,000/mm3 would require follow-up action by the LPN/LVN. The normal range for WBC count varies slightly depending on the laboratory reference values; however, a count of 14,000/mm3 is higher than the usual range (4,000-11,000/mm3). Elevated WBC count may indicate an infection or an inflammatory response in the body, which needs further evaluation and monitoring to ensure it does not interfere with the planned surgery.
The best action for the LPN/LVN to implement first would be to remind the client to exhale slowly and steadily. It is important for the client to exhale fully and not to hold their breath while exhaling during deep breathing exercises. This technique can prevent the collapse of alveoli in the lungs, improve oxygenation, and enhance the expulsion of secretions. Therefore, reminding the client about the correct exhalation technique ensures optimal lung function and overall effectiveness of the deep breathing exercises.
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