[Expert Solution]: HTN Case Study Adapted from Lewis VCE…

HTN Case Study Adapted from Lewis VCE Patricia Newman, 61 admitted with dyspnea at rest, cough, and fever Smoker x 45 years; 2ppd Multiple hospitalizations for pneumonia in past 2 years Osteoporosis x 8 years HTN x 15 years Divorced x 15 years; 2 adult children live out of state Mother d at 63 of MI; father d at 59 of stroke Sleeps on 2 pillows at night Emphysema for 12 years Frequent cough productive of moderate amount of yellow sputum Short of breath when walking 20 feet HTN well controlled on meds; no other known cardiovascular problem Objective: T – 101.1; B/P – 162/90; R – 26, regular, slightly labored; P – 108, regular, Weight 100-120 lbs. O2 sat 89% on room air Lungs – coarse crackles throughout lungs; using accessory muscles to breathe Mental status – alert oriented to person, place, time; cranial nerves intact; PERRLA Abomen flat, nontender; bowel sounds active; pulse 2+ all extremities Health Promotion Does not always have money to pay for her medications Patient states “I cannot work when I am sick, so sometimes I do not have a lot of money.” WBC 16,000, RBC 4.9, Hgb 15, Hct 45, MCV 90, Platelets 250,000 Glucose 78,Na- 140, K+ 3.2, Cl- 101, Creatinine 0.8, BUN 18 ABG: PaO2 – 70; PaCO2 – 56; pH – 7.30; HCO3 – 26 Sputum for culture and sensitivity – pending IV – 0.9% normal saline; add 40 mEq KCl to every liter of IV fluid O2 per nasal cannula to keep O2 sat > 88% Cefotetan 1 gram IV every 12 hours Ipratropium bromide MDI – 2 puffs three times per day Albuterol inhaler – 1-2 puffs every 6 hours as needed Continue home medications: Calcium carbonate 600 mg 4 times per day Estrogen patch twice a week Chlorothiazide 500 mg daily Atenolol 50 mg daily Regular diet; no salt Ambulate 3 times a day increasing distance as patient tolerates VS every 4 hours Daily weights I & O every 4 hours Peak flow measurements every day Physical therapy and occupational therapy consult 1. Identify and describe classifications of blood pressure as presented in your textbook. 2. How long has Patricia been diagnosed with HTN? What is HTN? 3. Define Primary (essential) HTN and secondary HTN. 4. List the risk factors for primary HTN. l. diagnosed with HTN 15 years ago. What risk factors for HTN does she have? 7. Chlorothiazide has been prescribed to manage Patricia Newman’s hypertension. What classification, action, and side effects pertain to it? 8. Patricia has been prescribed atenolol. A nurse recognizes that the medication should be held if the systolic blood pressure is less than _________ or the heart rate is less than __________. 9. When planning care, a nurse must recognize that which of the following imbalances may occur as a result of administering chlorothiazide? a. Hyperkalemia b. Hypokalemia c. Hyponatremia d. Hypouricemia The nurse discusses HTN with Patricia. 10. Which of Patricia’s clinical manifestations can be attributed to HTN? Current VS are temp 102.0, RR 32, Sats, 90%, BP 168/94, P 112 11. Is her prescribed antihypertensive medication effectively treating her hypertension at this point? 12. Based on her most recent BP readings, in which of the following BP classification would you place Patricia in? a. Normal Systolic b. Prehypertension c. Hypertension, stage 1 d. Hypertension, stage 2 13. What may be contributing to Patricia’s elevated BP at this point? 14. What indicates that this patient is in need of further teaching regarding HTN? 15. What additional educational goals would be appropriate for Patricia? 16. Patricia indicates that she does not participate in any exercise programs. Which of the following recommendations concerning exercise have been identified to reduce HTN? 17. Patricia indicates she does not exercise because she fee