Case Study: Hypertension And Chest Pain

Background

Hypertension is the condition when a person has high blood pressure. Arteries become hardened and the blood and oxygen flow to the heart decreases due to high pressure (Nurse Labs, 2022). This can cause chest pain, heart attacks, heart failure and strokes. This case study is explaining the scenario of the 66-year-old patient suffering from chest pain. She was diagnosed with hypertension. She was experiencing chest pain along with excessive sweating from last night. Several tests were performed and after observing the lab reports it was found that she was suffering from hypertension and heart disease. In this report, nursing diagnoses and the plan of care including medication is discussed.

The patient in this case is admitted to the hospital with chest pain. After giving the primary care and observation it was found that the patient is suffering from hypertension.

Background– Ms. Jessica 66 year’s old female was admitted to the hospital. She was diagnosed with hypertension.  The patient has a previous episode of chest pain also. She has experienced angina attacks twice a month especially when she does exertion. For this, she takes sublingual GTN to relieve the pain but this time the pain didn’t go even after taking medicine (Drevenhorn, 2018). Ms. Jessica was diagnosed with hypertension 7 years ago and has been on medication since then. Her father also had hypertension and is passed away.

Situations and facts– The patient was alert and cooperative and the patient’s BP was 190/110 mm Hg,

Skin color – pink,

Temperature- 37°

Respiratory pattern – abnormal,

Pain location – chest.

As the blood pressure is higher than 180/120 it is a condition of hypertensive care.

The symptoms of hypertension include headaches, fatigue, nausea, anxiety, chest pain, irregular heartbeats etcetera. Excessive intake of sodium, obesity and genetic alteration are the major factors that lead to hypertension. When caring for a patient with hypertension it is important to carefully monitor the blood pressure at regular intervals (Gorina, Limonero, & Alvarez, 2018). Patients should be encouraged to consult a dietician which will help in developing a plan for improving nutrition intake. The Nurse should help in assisting the patient to develop and follow regular appropriate exercise. The Nurse should emphasize to increase the consumption of vegetables and fruits. The Nurse should encourage the patient to drink a lot of liquids.  Nursing Diagnosis & Plan Of Care Case Study

As it was found from the data collected by the patient’s record, the blood pressure was extremely high and it is the condition of hypertensive care. If it is not treated carefully it may result in failure of heart or other body organs (Jiang, & Wang, 2019). An abnormal heartbeat may result in a heart attack. The patient has lost his appetite due to fatigue and anxiety so a proper diet is given to the patient with a lot of liquid intakes.

The first nursing diagnosis for hypertension used will be Decreased Activity Tolerance, which generally happens because of the alterations in cardiac output and the side effects caused by the antihypertensive medication.

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Situations And Facts

There are some common factors related to decreases activity Tolerance like weakness, improper balance between oxygen supply and demand. As the blood pressure of the patient is high and the heart rate was abnormal and fatigue was observed. Various activities have performed that aim at the patient participation, identification, and involvement in the activities.

The second nursing diagnosis for hypertension used will be Acute pain. When resting blood pressure is elevated as in this case it means a progressive reduction in sensitivity (Khademian, Ara, & Gholamzadeh, 2020). The common factors that are used for nursing diagnosis are increased cerebral vascular pressure. This results in the relief from pain (Silva, & Mercês, 2018). The patient will be able to explain the methods that provide relief from pain. In this diagnosis the patient’s attitude towards pain was observed. The effects of medications provided to relieve pain was also observed.

The plan of care for the patient will be as follows:

1. Patient will be instructed to use a chair when showering, sitting while brushing, combing and performing all daily life activities at a slow pace. These are all energy- saving techniques and are used to reduce energy expedition, so it helps in maintaining the balance between supply and demand of oxygen (Monakali, et al., 2018).
2. Help and assistance will be provided only when it is needed as it encourages independence in performing various activities.
3. The patient will be encouraged to rest to promote relaxation. It is recommended to perform nonpharmacological techniques to relieve headaches and chest pain.
4. The patient will be provided liquids to promote comfort.

The medication will include the medicines written below:

• Lisinopril
• Amlodipine

Lisinopril is used to treat high blood pressure. It should be taken once a day. It tightens the blood vessels by decreasing certain chemicals so as to allow the blood to flow smoothly. It may cause some side effects like dizziness, headache, nausea, weakness, rashes etcetera but these side effects may or may not occur it totally depends from person to person. Lisinopril is a medication that helps in managing hypertension, but it is not a cure (Naseem, et al., 2018). It is recommended not to discontinue taking lisinopril without consulting physician.

Amlodipine is also used to treat high blood pressure and is given to patients to treat chest pain (angina). Calcium channel blockers, such as amlodipine, are a type of drug (Neuraz, et al., 2020). Blood arteries are relaxed with the help of low blood pressure that helps the blood to pump effectively. The increased blood flow is helpful in alleviating the chest pain. The regular use of Amlodipine is helpful in reducing the chest pain. It has to be taken once a day.  Common side effects of Amlodipine are dizziness, headache, nausea, weakness, rashes etcetera. Amlodipine is a medication that helps in treating high blood pressure, angina, and coronary artery disease, but it does not cure them.

As per the patient’s report and the data collected it is observed that the blood pressure is extremely high. It is 180/120 mm Hg which is a condition of hypertensive. If it is not treated carefully it may lead to heart failure and heart attack and may damage other organs of the body (Tanz & et al., 2020). To maintain a normal blood pressure proper medications and modifications in life style is required, timely and routine checkup is recommended. Regular medication, proper diet, healthy lifestyle all should be maintained.

Conclusion

It can be concluded from this report that hypertension is the major cause of early death. In this case study the patient which is 66-year-old lady has a condition of hypertensive. The patient has high BP and abnormal heart rate. The data collected through various reports have been observed and the nursing diagnosis were given. This report also discussed what is hypertension and its causes. The patient is given the plan of care, medicines to treat the disease. It is recommended that the patient should follow proper medication that is prescribed by the doctor and along with that healthy diet with low sodium consumption is advised. This report also discussed various factors that increase the risk of having hypertension. The signs and symptoms of the disease have been discussed and a proper plan of care is given. This report explains the cause, symptoms, cure and treatment of hypertension.

References

Drevenhorn, E. (2018). A proposed middle-range theory of nursing in hypertension care. International journal of hypertension, 2018.

Gorina, M., Limonero, J. T., & Alvarez, M. (2018). Effectiveness of primary healthcare educational interventions undertaken by nurses to improve chronic disease management in patients with diabetes mellitus, hypertension and hypercholesterolemia: A systematic review. International journal of nursing studies, 86, 139-150.

Jiang, J., & Wang, F. (2019). Comprehensive nursing on postpartum complications and negative emotions of patients with pregnancy induced hypertension syndrome. Int J Clin Exp Med, 12(9), 11982-11989.

Khademian, Z., Ara, F. K., & Gholamzadeh, S. (2020). The effect of self care education based on orem’s nursing theory on quality of life and self-efficacy in patients with hypertension: a quasi-experimental study. International journal of community based nursing and midwifery, 8(2), 140.

Monakali, S., Goon, D. T., Seekoe, E., & Owolabi, E. O. (2018). Prevalence, awareness, control and determinants of hypertension among primary health care professional nurses in Eastern Cape, South Africa. African Journal of Primary Health Care & Family Medicine, 10(1), 1-5.

Naseem, S., Sarwar, M. H., Afzal, M., & Gilani, S. A. (2018). Knowledge attitude and practice towards hypertension among adult population in a rural area of Lahore, Pakistan. Int J Sci Eng Res, 9(5), 1674-1679.

Neuraz, A., Lerner, I., Digan, W., Paris, N., Tsopra, R., Rogier, A., … & AP-HP COVID CDR Initiative. (2020). Natural language processing for rapid response to emergent diseases: case study of calcium channel blockers and hypertension in the COVID-19 pandemic.  Nursing Diagnosis & Plan Of Care Case Study