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
-WBC 14000/mm3
-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
Introduction:
In this scenario, we will be discussing three different cases involving patients with various medical conditions. We will explore their symptoms, medical history, and laboratory results to address the questions related to lifestyle modifications for maintaining blood pressure, pharmacological treatments for hypertension, vital sign assessment, and preoperative laboratory values. Let’s dive into each question and provide appropriate answers based on the given information.
Answer to Question A:
In order to maintain blood pressure under control, it is important for Ms. C to make certain lifestyle modifications. Here are some appropriate teaching points for her:
1. Diet: Encourage Ms. C to follow a healthy and well-balanced diet with reduced sodium intake. Emphasize the importance of consuming fresh fruits, vegetables, whole grains, lean proteins, and low-fat dairy products. Educate her on portion control and the DASH (Dietary Approaches to Stop Hypertension) diet.
2. Regular Exercise: Encourage Ms. C to engage in regular physical activity, such as brisk walking, swimming, or cycling, for at least 30 minutes most days of the week. Explain the benefits of exercise in regulating blood pressure, managing weight, and improving overall cardiovascular health.
3. Weight Management: Since Ms. C is moderately obese, she should be motivated to achieve and maintain a healthy weight. Discuss the advantages of weight loss in reducing blood pressure and lowering the risk of cardiovascular diseases. Collaborate with a nutritionist to develop a personalized weight loss plan.
4. Smoking Cessation: Educate Ms. C on the detrimental effects of smoking on blood vessels and overall health. Provide resources and support to help her quit smoking. Recommend nicotine replacement therapy or other appropriate smoking cessation methods.
5. Stress Management: Emphasize the importance of stress reduction techniques such as deep breathing exercises, meditation, yoga, and engaging in hobbies or activities that promote relaxation and well-being. Educate Ms. C about the direct impact of stress on blood pressure.
6. Medication Adherence: Stress the significance of taking prescribed antihypertensive medications regularly and as directed by the healthcare provider. Discuss strategies to remember medication schedules, such as using pill containers, setting reminders, or linking medication administration to daily routines.
By implementing these lifestyle modifications, Ms. C can have better control over her blood pressure and decrease her risk of developing cardiovascular complications.
Answer to Question B:
To treat hypertension, there are various pharmacological treatment options available. Here are two recommended medications for hypertension:
1. Angiotensin-Converting Enzyme (ACE) Inhibitors: ACE inhibitors, such as Lisinopril and Enalapril, work by blocking the conversion of angiotensin I to angiotensin II. By doing so, they help relax blood vessels, reduce fluid retention, and lower blood pressure. ACE inhibitors are commonly prescribed as first-line therapy for hypertension, especially in patients with comorbid conditions like diabetes or heart failure.
2. Calcium Channel Blockers (CCBs): CCBs like Amlodipine and Nifedipine inhibit the entry of calcium into smooth muscle cells of the arteries, resulting in vasodilation and decreased peripheral resistance. This leads to a decrease in blood pressure. CCBs are often used as alternative or adjunct therapy for patients who cannot tolerate ACE inhibitors or angiotensin receptor blockers (ARBs).
It is important to note that the choice of medication depends on various patient-specific factors, including comorbidities, concurrent medications, and individual response to treatments. The eventual decision on which medication to prescribe should be made by the healthcare provider based on a comprehensive evaluation of the patient.
Answer to Question 1:
Among the vital signs, the blood pressure reading of 160/88 mm Hg requires follow-up by the LPN/LVN. Hypertension is defined as a blood pressure reading of 130/80 mm Hg or higher. Ms. Burke’s blood pressure reading of 160/88 mm Hg indicates that her systolic and diastolic blood pressures are elevated, which may require further assessment and intervention.
Answer to Question 2:
Among the given serum lab values, the WBC count of 14,000/mm3 requires follow-up action by the LPN/LVN. A WBC count above the normal range (4,500 to 11,000/mm3) may indicate the presence of an infection or other underlying pathology. Further evaluation and consultation with the healthcare provider are necessary to investigate the cause and determine the appropriate management.
Answer to Question 3:
The best action for the LPN/LVN to implement first is to demonstrate the deep breathing and coughing technique again. It is important to ensure that Ms. Burke understands and performs the deep breathing exercises correctly before the surgery. Reinforcement and re-demonstration of the technique can help address any confusion or misunderstanding, thereby maximizing the effectiveness of the exercises in preventing postoperative complications such as atelectasis and pneumonia.
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