4-2 Case Study: Hypertension – NUR-315-X6745 Pathophysiology for Nurses 19EW6
NUR 315 Case Study: Hypertension
You are caring for a 59-year-old African American male who is a non-smoker and a non-drinker. The individual has a healthy weight for his height. On weekends, he coaches a youth baseball team in his community and enjoys eating hot dogs and nachos with the children after games. He has been monitoring his blood pressure at the community center and noted that the highest reading was 168/92 mm Hg. He is pleased with this number, as the results were “lower than previous readings.” However, his healthcare provider is still concerned. She informed him about the dietary choices he was making and reminded him to limit his sodium intake. She also renewed the individual’s prescription for a thiazide diuretic and added an ACE inhibitor to his treatment regime.
Please answer the following prompts in your analysis of the case:
Speculate how the individual’s ethnicity contributes to his hypertension. Discuss other determinants of health that contribute to the prevalence of hypertensive disease in this population.
Discuss the significance of an elevated systolic pressure, even in the absence of diastolic hypertension, detailing the pathophysiology behind elevation in blood pressure and the ultimate development of hypertension.
Identify if this individual is at risk for developing heart failure. If so, what type of heart failure would he be most at risk of developing?
Briefly discuss the mechanism of action of the two classes of drugs this individual was prescribed for the management of his hypertension.
For additional details, please refer to the Case Study Guidelines and Rubric document.
NUR 315 Case Study: Hypertension
NUR 315 Case Study Guidelines and Rubric
Critical thinking is a habit of mind characterized by the comprehensive exploration of issues, ideas, artifacts, and events before accepting or formulating an opinion or conclusion. Case studies are meant to connect real-world scenarios with theoretical teachings. You are expected to test assumptions and find creative ways to consider all the facets contributing to analysis of the case.
For each case study, be sure to:
• Introduce main elements and concerns and identify the pathology.
• Use the associated questions to guide your paper and explain the pathology in the development of a plan of care.
• Explain the role patient-care technologies (i.e., point of care testing, computer provider order entry, bar-coding medication administration, EMR/EHR) in caring for the individual(s).
• Apply critical thinking in analyzing and interpreting the data.
• Include evidence to support your analysis of the case.
• Write clearly and concisely, following standard rules of grammar.
Guidelines for Submission: Your paper must be submitted as at least a 2-page Microsoft Word document with double spacing, 12-point Times New Roman font, one-inch margins, and at least two peer-reviewed sources cited in APA format.
Critical Elements Exemplary (100%) Proficient (85%) Needs Improvement (55%) Not Evident (0%) Value
Pathology: Introduction and Identification Meets “Proficient” criteria and uses industry-specific language and is exceptionally clear and well-informed Introduces the reader to specific themes and main elements of the assigned case study without any gaps and precisely identifies specific
pathology Introduces the reader to specific themes and main elements of the assigned case study and identifies the pathology, but with gaps in
information presented Does not accurately introduce the reader to specific themes and main elements of the assigned case study and does not identify the pathology 15
Pathology: Explanation and Plan of Care Meets “Proficient” criteria and uses industry-specific language to establish expertise Comprehensively explains the pathological condition in the development of plan of care for the individual in the assigned
case study without any gaps Explains the pathological condition in the development of plan of care for the individual in the assigned case study, but
with gaps Does not explain the pathological condition in the development of plan of care for the individual in the assigned
case study 20
Response to Questions Meets “Proficient” criteria and seamlessly incorporates these responses into the submission Thoroughly addresses all prompts from the case study and comprehensively explores
issues, ideas, and concerns Adequately addresses most prompts included in the case study, but does not explore
issues, ideas, or concerns Addresses less than half of the prompts from the case study 25
Patient-Care Technologies Meets “Proficient” criteria, and explanation is exceptionally clear and well-informed Accurately explains the role of patient-care technologies (as appropriate) in caring for individuals identified in the assigned case study without any
gaps Accurately explains the role of patient-care technologies (as appropriate) in caring for individuals identified in the assigned case study, but with
gaps in information given Does not accurately explain the role of patient-care technologies (as appropriate) in caring for individuals identified in the assigned case study 15
Incorporation of Resources Incorporates more than two discipline-specific, peer- reviewed journal articles and one source from an interdisciplinary, peer-reviewed journal. Viewpoints of experts
are analyzed and well-informed Incorporates sources of evidence from at least two discipline-specific, peer- reviewed journal articles Incorporates at least two sources of evidence from peer- reviewed journals, but fails to make connection to case study clear Does not incorporate at least two sources of evidence from a peer-reviewed journal 15
Articulation of Response (APA/Mechanics) Submission is free of errors related to citations, grammar, spelling, syntax, and organization and is presented in a professional and easy-to-read
format Submission has no major errors related to citations, grammar, spelling, syntax, or organization Submission has major errors related to citations, grammar, spelling, syntax, or organization that negatively impact readability and articulation of
main ideas Submission has critical errors related to citations, grammar, spelling, syntax, or organization that obstruct understanding 10
Earned Total 100%. NUR 315 Case Study: Hypertension
Terms in this set (99)
The nurse is completing a health history with a client in a clinic. What assessment finding best correlates with a diagnosis of osteoarthritis?
joint stiffness that decreases with activity
A characteristic feature of osteoarthritis (degenerative joint disease) is joint stiffness that decreases with activity and movement. Erythema and edema over the affected joint, anorexia, weight loss, and fever and malaise are associated with rheumatoid arthritis, a more severe and destructive form of arthritis.
Which newer pharmacological therapy, used to treat osteoarthritis, is thought to prevent the loss of cartilage and repair chondral defects, as well as have some anti-inflammatory effects?
Viscosupplementation, the intra-articular injection of hyaluronates, is thought to prevent the loss of cartilage and repair chondral defects. It may also have some anti-inflammatory effects. Glucosamine and chondroitin are thought to improve tissue function and retard breakdown of cartilage. Capsaicin is a topical analgesic.
The presence of crystals in synovial fluid obtained from arthrocentesis is indicative of
The presence of crystals is indicative of gout, whereas the presence of bacteria is indicative of infective arthritis.
Which joint is most commonly affected in gout?
The metatarsophalangeal joint of the big toe is the most commonly affected joint (90% of clients); this is referred to as podagra. The wrists, fingers, and elbows are less commonly affected. The tarsal area, ankle, and knee are not the most commonly affected in gout.
The nurse is reviewing the medication administration record of the client. Which medication would lead the nurse to suspect that the client is suffering from an acute attack of gout?
Colchicine is prescribed for the treatment of an acute attack of gout.
A client with gout has been advised to lose weight. The client informs the nurse of plans to go on a “guaranteed rapid weight loss” plan that involves fasting and heavy exercise. Which response would be most appropriate?
“There might be some difficulties with your plan and fasting.”
Clients should avoid fasting, low-carbohydrate diets, and rapid weight loss because these measures increase the likelihood of ketone formation, which inhibits uric acid excretion. Gradual weight loss helps reduce serum uric acid levels in clients with gout.
Which of the following disorders is characterized by an increased autoantibody production?
Systemic lupus erythematosus (SLE)
SLE is an immunoregulatory disturbance that results in increased autoantibody production. Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death. Rheumatoid arthritis results from an autoimmune response in the synovial tissue, with damage taking place in body joints. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.
The nurse intervenes to assist the client with fibromyalgia to cope with which symptoms?
Chronic fatigue, generalized muscle aching, and stiffness
Fibromyalgia is a common condition that involves chronic fatigue, generalized muscle aching, and stiffness. The cause is unknown, and no pathologic characteristics specific for the condition have been identified. Treatment consists of attention to the specific symptoms reported by the client. NSAIDs may be used to treat the diffuse muscle aching and stiffness. Tricyclic antidepressants are used to improve or restore normal sleep patterns, and individualized programs of exercise are used to decrease muscle weakness and discomfort and to improve the general deconditioning that occurs in these individuals.
A client with rheumatoid arthritis reports joint pain. What intervention is a priority to assist the client?
Nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs are the mainstay of treatment for rheumatoid arthritis pain. They help to decrease inflammation in the joints. Heat, rather than ice packs, is used to relieve pain. Paraffin baths may also help. Surgery is reserved for joint replacement when the joint is no longer functional; it is not an intervention specific to relieving pain.
The nurse is caring for a client