Person-Centered Approach In Nursing Care

Discuss About The Management Cardiovascular Disease Morbidity.

Researchers are of the opinion that person centered approach is the most suitable approach in providing nursing care to patients where things are thought and done in ways that puts the patient sing the social as well as the health services as equal partners. The nurses make sure that they take care of the patients in ways by which the patients feel included in planning, developing as well as monitoring in their own services. This in turn ensures patient satisfaction and patient compliance with the care services (Jafar et al., 2016). At the same time, nurses should also ensure the use of the clinical reasoning cycle by which they can collect cues, process the information and thereby come to an understanding of the patients’ problem, plan and implement interventions that bring the best outcome of the patients ensuring safety and good health (Douglas et al., 2014). The case study that is provided here shows the patient has number of social and psychological issues that result in a number of biological imbalances in the body of the client. Lipidemia and hypertension would be the nursing priorities of the healthcare professional following that the care interventions should be proposed.

Beryl is a 50-year-old woman who works as an HR manager in the executive position and states that she remains busy throughout the day due to excessive work pressure. In the rest of the time, she remains highly engaged in the activities that include her children. She has three children who go to schools and need her support in her activities. Therefore, all these result in creating severe stress on her that leaves her with very few times when she can take care of herself. She is separated from her husband and after her divorce with him; she has taken the responsibility of the children full time. Management Cardiovascular Disease Morbidity Discussion Paper Therefore, it remains a pressure on her where she has to handle both the office work and the children at the same time. This gives her no time to cook food for herself and she therefore buys take in food.

After the different diagnosis and collection of information from the patient, it is seen that her blood pressure was very high which accounted for about 160/95. Her weight          is found to be 105kg and her weight is 150cms. This accounts to a Basal metabolic index of about 46.7 that shows that the patient lies in the obese category. Moreover, her lipid rates were also assessed. Her low-density protein was seen to be 3.1 mmol/L that is slightly higher than the normal low-density protein rate. Researchers are of the opinion that the rate should be below 3mmol/L (Morton et al., 2017). Again, her high-density lipid is found to be 0.8mmol/L. Researchers are of the opinion that high density lipid also called the good cholesterol should be 102 mmol/l or higher than that. However, in case of the patient, the level is quite low than the normal level. Therefore, the diagnosis states that she is suffering from lipidemia and this level should be treated. Journal articles suggest that professionals should start treatment when the total cholesterol should be above 5.8mmol/l. since in this case, the total cholesterol is 6mmol/l therefore and it becomes nursing priority for the client. The client is also seen to be suffering from hypertension as her blood pressure was found to be 160/95. This might lead to a number of severe life threatening physiological imbalances resulting in damage to arteries, heart, brain as well as kidneys (Auserhofer et al., 2014). Hence, taking care of her blood pressure level will be another nursing priority on the patient.

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Hyperlipidemia: Nursing Priorities And Interventions

A number of causes result in development of hyperlipidemia in adults. The common ones that are also the cause of the occurrence of the disorder in case of the client are poor diet and other factors. Researchers are of the opinion that when the body takes in lot of unhealthy food high in calories, it results in deposition of fat. When body fails to remove such a he amount of fat, it builds up in the blood and over the course of time, causes damage in the arteries and other internal organs of the body (Blom et al., 2014). This results in development of heart disorders. Other causes of hyperlipidemia are obesity as well as excessive consumption of alcohol. In case of the patient, her BMI suggests that she is obese and her drinking wine on a regular basis shows the cause of her development of hyperlipidemia. Moreover, eating foods which contain saturated as well as trans fat, animal protein like meat and dairy are also causes. Beryl is seen to have coffee with full cream milk that is affecting her immensely. She is also not having enough chances of exercising and eating healthy foods as she has to buy take in food due to lack of time of cooking healthy food (Bozkurt et al., 2016). All these act as important causes for the patient developing hyperlipidemia. Here large number of low-density lipoprotein is developed in the body that results in deposition of cholesterol in body cells and in walls of arteries. It is also resulting in development of low quantity of good cholesterol or high density lipoprotein which helps in cleaning up excess of the ‘bad cholesterol; from the body and brings them to the liver away from the arteries. This pathophysiology clearly states how her low HDL and her high LDL are responsible for occurrence of hyperlipidemia in BERYL.

Researchers are of the opinion that there might not be any specific cause of occurrence of hypertension in patients as the condition develops over years. The main causes like sleep apnea, kidney issues, adrenal gland tumors and others were not found to be true in case of the concerned patient called Beryl. However, a number of risk factors can be noted in the discussion that might help to shed more light on the reason of the occurrence of the symptoms of hypertension in the client. The risk factors of hypertensions include being overweight or obese which is true in case of Beryl. In addition, when human beings are not physically active and drink too much alcohol, it also results in development of hypertension (Falaschetti et al., 2014). Therefore, Beryl was exposed to these risk factors developed hypertension in the course of time. Beryl was also exposed to high levels of stress in her daily schedules as she had to perform huge number of responsibilities. Researchers opine that blood pressure is the product of the cardiac output as well as the total peripheral vascular resistance where different factors are informed. The factors include short term as well as long-term regulation of the blood pressure for successful tissue perfusion (Patel et al., 2017). The main factors are cardiac output as well as the circulatory blood volume. Other factors are vascular caliber, reactivity as well as elasticity. Humoral mediators and neural stimulation are also important for maintaining blood pressure. The main pathophysiology of the disorder is intricately associated with increased systemic vascular resistance, increased vascular responsiveness as well as increased vascular stiffness that cause hypertension. Therefore, the risk factors that are resulting in occurrence of hypertension need to be handled with care by the nursing professionals ensuring that the patient can develop high quality life (Maron & Ryan et al., 2016).  Management Cardiovascular Disease Morbidity Discussion Paper

Causes Of Hyperlipidemia

The main intervention that should be taken by the nurse in case of the patient is the use of statin therapy for hyperlipidemia. However, before the use of the statin therapy, it becomes extremely important for the nurse to educate properly to the patient so that she can understand the importance of the medication and the way by which this medication would help her from any further life threatening disorders (Barkas & Elisaf, 2018). Once, the nurse ensures that the patient has understood the issues properly, she should counsel the client in way by which she can align herself with the medication schedules and take her medication on the right time. The nurse can advice her to set alarms or consult a colleague to remind her of the medication timing, so that she cannot forget to take them. The nurse should be have proper knowledge about the function of the statin so that she can ensure that the medication helps the patient to overcome the issue and at the same time maintain safety of the patient. Researchers suggest this drug to be of the first choice for patients who suffer from hyperlipidemia (Rehman et al., 2017). These drugs mainly act by effectively inhibiting the different rate limiting steps of cholesterol synthesis. They mainly help in creation of a transient decrease in the different intracellular cholesterol that helps in increasing the synthesis of the cell surface LDL receptor.  They are also seen for accelerating the removal of the LDL-C as well as triglyceride rich lipoprotein. Triglyceride rich lipoprotein is seen to be effectively casing reduction of the triglyceride levels. Researchers have also stated that more potent statins have the capability of the inhibition of the synthesis of the VLDL. These drugs are also responsible for the increase of the high-density lipoproteins. Researchers have therefore stated that this class of drug is not only the most potent, bets tolerated and most effective drug in reducing LDL-C but also reduces the chances of cardiovascular disorders ensuring decreasing life threats (Safford et al., 2015). Although the statins are seen to vary in their physicochemical characteristics, potency as well as in their routes of metabolism, they are yet said to be one of the safest drug administered. Most of the patients are seen to tolerate them with absence of side effects. Muscle pain as well as damage may be one of the side effects that include soreness, tiredness and even weakness in the muscles. Occasionally liver damage may also take place in some individuals along with increased blood sugar level or type 2diabetes. Neurological side effects may also result like loss of memory and confusion. It has been also seen that those individuals who drink high amount of alcohol every day are prone to develop side effects. Therefore, the nurse while prescribing the medication to the patient and educating her about the dosage and route of administration, she should also evaluate the risks and provide preventing medications along with it (Shrank et al., 2015). Beryl has been seen to use wine that is actually grapefruit juice that can chemically combine with that of enzymes that have the capacity to break down the statins in the digestive system. Therefore, it should be eliminated from the diet of beryl.

Hypertension: Risk Factors And Pathophysiology

In order to provide effective intervention for the patient for her hypertension issues, a combined plan of the proper use of angiotensinogen converting enzyme called the  ACE inhibitors and proper lifestyle modification would be extremely helpful for the patients. The medications mainly work by helping in the relaxation of the blood vessel and blocking the formation of the natural chemical called the angiotensinogen 2 . This chemical is mainly responsible for the narrowing of the blood vessels that thereby causes increase in the pressure of the blood. However, the most common side effects include cough, low blood pressures, and elevated blood potassium, headaches, weakness, drowsiness, abdominal taste, chest pain, rash, sun sensitivity, increased uric acid levels, increased BUN and creatinine levels (Kumar et al., 2015). However, this should be associated with lifestyle modifications otherwise which, the disorders cannot be brought under control. The patient should be taught the importance of eating healthier diet that consists of less salt. The DASH diet should be proposed to her which means the he Dietary Approaches to Stop Hypertension which has been planned keeping in mind, solely the diet procedures to reduce blood glucose levels. Moreover she should find out one hour everyday during which she would be conducting exercises at a regular basis (Risso et al., 2015). Moreover limiting the amount of drink is also essential for controlling the blood pressure level. Researchers are of the opinion that if the patients are able to maintain a healthy diet and even lose weight if they are overweight or obese, can help in three-fold decrease of the risk of occurrence of any life threatening situations due to hypertensions.

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The nurse should then try to evaluate the results of the interventions that she had prepared for the patient. The nurse should make appointments with the patients following a week in order to evaluate how well the patient is complying with the different advises given with her (Cherry & Jacob et al., 2016). By an open-ended discussion, the nurse will be able to understand how the patient is taking self-care and how well she is adhering with the different interventions and medications. Following this, the nurse would then decide whether she would consider the patient to follow, the same interventions or whether she should propose methods for helping her to comply with the interventions (Piscotty et al., 2015). A single meeting every month would follow this meeting. This would help her to overcome the syndromes of the disorders. Following this, the nurse should then reflect on her practices and jot down the important aspects so that she can develop knowledge from her experiences and improve her skills accordingly (Burky et al., 2015)

Statin Therapy For Hyperlipidemia

From the entire discussion above, it is shown that with the proper use of the clinical reasoning skill, a nurse can develop effective care interventions for the patient. The steps of the cycle had helped to understand the risk factors and causes of occurrence of the disorders of hyperlipidemia and hypertension. Accordingly, the nurse had also provided pharmacologic intervention for hyperventilation and mixed intervention for hypertension. The side effects had also been taken into consideration ensuring safe care for the patient.

References:

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Barkas, F., & Elisaf, M. (2018). National hyperlipidemia management policies improve lipid target attainment in clinical practice.

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Bozkurt, B., Aguilar, D., Deswal, A., Dunbar, S. B., Francis, G. S., Horwich, T., … & Rosendorff, C. (2016). Contributory risk and management of comorbidities of hypertension, obesity, diabetes mellitus, hyperlipidemia, and metabolic syndrome in chronic heart failure: a scientific statement from the American Heart Association. Circulation, 134(23), e535-e578.

Burke, K. M., Mohn-Brown, E., & Eby, L. (2015). Medical-surgical nursing care. Prentice Hall.

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Falaschetti, E., Mindell, J., Knott, C., & Poulter, N. (2014). Hypertension management in England: a serial cross-sectional study from 1994 to 2011. The Lancet, 383(9932), 1912-1919.

Jafar, T. H., Allen, J. C., Jehan, I., Hameed, A., Saffari, S. E., Ebrahim, S., … & Chaturvedi, N. (2016). Health education and general practitioner training in hypertension management: long-term effects on kidney function. Clinical journal of the American Society of Nephrology, CJN-05300515.

Kumar, N., Khunger, M., Gupta, A., & Garg, N. (2015). A content analysis of smartphone–based applications for hypertension management. Journal of the American Society of Hypertension, 9(2), 130-136.

Maron, B. A., & Ryan, J. J. (2016). Treatment differences in pulmonary arterial hypertension management. Pulmonary circulation, 6(4), 619-619.

Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). Critical care nursing: a holistic approach (p. 1056). Lippincott Williams & Wilkins. Management Cardiovascular Disease Morbidity Discussion Paper