Mr. Cowen’s employer sponsored a free blood pressure (BP) screening program for its employees. Mr. Cowen’s blood pressure is 160/90mm Hg when measuring with a large BP cuff.
Client Profile:
Mr. Cowen’s employer sponsored a free blood pressure (BP) screening program for its employees. Mr. Cowen’s blood pressure is 160/90mm Hg when measuring with a large BP cuff. The nurse observes that the client is overweight. The nurse assesses the client for risk factors for hypertension and learns that Mr. Cowen sits all day at a desk answering telephone calls from customers with questions about the use of the company’s computer . He does not exercise regularly and admits that he does not following a special diet saying, “My wife is a great cook. I eat anything that she puts in front of me. At night, I like to have a snack and watch television.’ The client denies tobacco use and recreational drug use and reports drinking “socially.” Mr. Cowen does not take any prescription drugs or herbal supplements but report taking “Tylenol on occasion when I have a headache.” The nurse record Mr. Cowen’s BP and gives the client the reading materials with instructions to make an appointment with his primary health care provider (HCP) as soon as possible for a more thorough assessment and discuss treatment options.
Case Study:
Mr. Cowen calls his HCP to schedule an appointment. Prior to the appointment, he goes to the laboratory and has a series of blood tests drawn as prescribed by the HCP.
At his appointment with the HCP, the nurse weighs Mr. Cowen. He is 5 feet 9 inches and weighs 225 pounds. Mr. Cowen’s BP is 162/92 mm Hg with a large BP cuff in the right arm and 166/92mm Hg in the left arm. His heart rate is 84 beats per minute with a regular rhythm., respiratory rate is 18, and he is afebrile. His cholesterol is 260 mg/dL. During the health history and assessment, and HCP learns that Mr. Cowen drinks at least four six-ounce regular cups of regular coffee per day, and his father has coronary artery disease and hypertension. Mr. Cowen denies feeling stress because of his job, relationship with his wife and family, or other factors. “I am a pretty laid-back guy. “I am not worked or excited about much. I leave the worrying to my wife.” The HCP notes that Mr. Cowen carries the majority of his weight in his upper body. He has an increased amount of subcutaneous fat in his waist and in his abdomen.
The HCP prescribes hydrochlorothiazide daily for the client and asks the nurse to provide Mr. and Mrs. Cowen with instructions regarding medication and lifestyle modifications. A follow-up appointment is scheduled for one month.
Questions:
- Briefly explain what the systolic and diastolic BP reading indicate? Which stage of HTN is Mr. Cowen currently in?
- Identify Mr. Cowen’s risk factors for HTN. Indicate which of the client’s risk factors are modifiable or nonmodifiable.
- The nurse is providing Mr. Cowen with instructions regarding his newly prescribed hydrochlorothiazide. What are the most common adverse side effects of hydrochlorothiazide that Mr. Cowen should monitor and what should Mr. Cowen do if he forgets to take his daily dose of the medication as prescribed?
- The nurse is providing Mr. and Mr. Cowen with instructions regarding lifestyle modifications to help reduce the client’s HTN. Identify at least two points of discussion that the nurse will reinforce in the teaching plan.
- One month later, Mr. Cowen returns for a follow-up appointment with his HCP. His BP is 138/82. The nurse congratulates Mr. Cowen on his success and asks him about his compliance with the DASH diet. He states, “I don’t like it, but I am following it like you said. My wife has been keeping a close eye on me, and everything that I eat. She walks with me every night to give me the push I need to exercise.” To confirm his compliance with the DASH diet, the nurse asks him to recall his last three meals and any snacks. Which meal or snack is least compliant with the DASH diet, and what alternative can the nurse suggest?
Breakfast- a bowl or whole grain cereal with low-fat milk, a banana, and a glass of orange juice
Lunch- roast beef sandwich on white bread with mayonnaise and a soft drink
Dinner- fish, cooked vegetable, brown rice, and a glass of low-fat milk
Snack- a toasted slice of bread with grape jelly