hypertension case study for nursing students

• Free Writing Tools
• Plagiarism Checker
• Thesis Generator

Hypertension Case Study Nursing

Posted: September 8th, 2023

Hypertension is a medical condition that affects millions of people across the globe. It is a chronic condition that can lead to serious complications if left unmanaged. As nurses, we play a vital role in managing hypertension and preventing its complications.

Let us explore a comprehensive analysis of hypertension through various nursing case studies. We will explore the pathophysiology of hypertension, its impact on patient health, and different nursing considerations for hypertension cases. We will also delve into the role of patient education and how it can help manage hypertension effectively.

Our aim is to equip you with the knowledge and skills required to provide high-quality care to patients with hypertension . Join us as we take an in-depth look at this critical condition and uncover strategies for successful management of hypertension.

Understanding Hypertension: An Overview

Hypertension, a chronic condition characterized by high blood pressure, poses a substantial risk for cardiovascular diseases such as myocardial infarction and heart failure. It is the primary care provider’s responsibility to detect and manage hypertension effectively.

Regular physical examinations and blood pressure control are essential for hypertensive patients. Lifestyle modifications, including maintaining a healthy weight and reducing sodium intake, can aid in the management of hypertension. By incorporating these measures, healthcare professionals can help mitigate the adverse effects of hypertension and improve patient outcomes.

With the increasing prevalence of hypertension in recent years, it is crucial for primary healthcare providers to prioritize public health initiatives and provide comprehensive care to high-risk individuals. Optimal blood pressure management, coupled with patient education, can significantly contribute to the prevention and control of hypertension.

The Role of Nurses in Hypertension Management

Nurses play a vital role in hypertension management, serving as educators and advocates for patients. One of their key responsibilities is to educate patients about hypertension and its potential complications, empowering them to make informed decisions about their health.

Additionally, nurses assist with monitoring blood pressure and administering antihypertensive medications, ensuring that patients receive the necessary treatment and support. Collaboration with other healthcare professionals is crucial in developing individualized care plans that address the unique needs of each patient.

Nurses also provide ongoing support and guidance, helping patients manage their hypertension through self-care practices. By implementing nursing interventions aimed at preventing complications and promoting overall well-being, nurses contribute significantly to the holistic management of hypertensive individuals.

Blood Pressure Disorder: A Nursing Case Study

This case study presents a comprehensive analysis of a patient with hypertension, focusing on nursing assessment and management. Regular blood pressure measurements and evaluation of risk factors form an integral part of the nursing care plan. Through patient education, nurses emphasize the importance of lifestyle modifications and medication adherence in controlling hypertension. To evaluate complications, assessment tools like urinalysis and renal function tests are utilized. Ongoing monitoring and evaluation of the patient’s response to treatment are crucial for effective management. By implementing evidence-based strategies and collaborating with the primary health care provider, nurses play a key role in addressing the high-risk nature of hypertension and promoting public health. Cardiology specialists may also be involved in the management process, particularly in cases where hypertensive urgency or emergency is present. Proper documentation of nursing interventions is essential for continuity of care and ensuring optimal outcomes for patients.

Pathophysiology of Hypertension: What Nurses Need to Know

Hypertension, a complex condition characterized by elevated blood pressure levels, is often attributed to factors such as obesity, renal dysfunction, and vasoconstriction. It is crucial for nurses to have a comprehensive understanding of the pathophysiology of hypertension to provide appropriate interventions.

Increased blood pressure can lead to organ damage and cardiovascular disease, emphasizing the need for vigilant monitoring of signs indicating target organ damage, including chest pain and edema. By recognizing these indicators and employing relevant assessment techniques such as ECG, chest x-ray, and measurements of blood pressure in mmHg, nurses can take timely action in managing hypertensive patients.

The pathophysiological knowledge equips nurses with the necessary tools to work alongside other healthcare professionals in a multidisciplinary approach to deliver efficient care. Recent years have seen the increasing importance of incorporating primary health care providers and public health initiatives in hypertension management, especially in high-risk populations like pregnant patients. Nurses play a vital role in preventing complications associated with hypertension and promoting overall patient well-being, ensuring optimal outcomes in hypertensive individuals.

Nursing Considerations for Hypertension Cases

Nurses play a crucial role in the management of hypertension cases. They assess patients for signs and symptoms, including high blood pressure readings. In addition, they evaluate potential complications such as myocardial infarction and renal failure.

Regular monitoring of blood pressure, heart rate, and perfusion status is essential to ensure timely interventions. Nurses also educate patients on the importance of medication adherence and reducing salt intake. Collaborating with the interdisciplinary team ensures comprehensive care for hypertensive patients. By implementing these nursing considerations, healthcare professionals can effectively manage hypertension and improve patient outcomes.

Hypertensive Crisis Patient Study: An In-depth Analysis

Hypertensive crisis patient study: An in-depth analysis delves into the management of a hypertensive crisis, with nurses playing a crucial role. The primary objective is to stabilize blood pressure and address associated symptoms. Urgent interventions, including the administration of antihypertensive medications, are necessary.

Ongoing monitoring and further evaluation help prevent complications like cardiac ischemia. Nurses also ensure adequate perfusion and assist in conducting additional tests. With the increasing prevalence of hypertension in recent years, this patient study highlights the significance of nurse-led care in mitigating risks. By collaborating with the interdisciplinary team and utilizing their expertise in public health and primary healthcare, nurses can effectively manage high-risk patients, providing comprehensive care that improves outcomes.

How does Hypertension Impact Nursing Care Decisions?

Hypertension’s impact on nursing care decisions is multifaceted. Nurses assess the risk of complications, like aortic dissection or acute renal failure. They implement management strategies, including medication administration and lifestyle modifications. Nursing care prioritizes maintaining optimal blood pressure levels and preventing organ damage. Collaboration with healthcare providers ensures individualized care for hypertensive patients.

Case-based Learning: Hypertension Management

Case-based learning plays a crucial role in enhancing nurses’ understanding of managing hypertension. By utilizing real-life scenarios, nurses are provided with opportunities to apply their knowledge and critical thinking skills.

Through the analysis of patient data, interpretation of diagnostic tests, and formulation of care plans, nurses develop a comprehensive approach to hypertension management. Additionally, engaging in collaborative discussions with colleagues fosters a team-based approach to care, ensuring that the best possible outcomes are achieved for patients with hypertension.

Moreover, case studies serve as a valuable tool for ongoing learning and improvement in hypertension management. By continuously engaging in case-based learning, nurses can stay updated on the latest advancements in the field and provide the highest quality of care to their patients.

Patient Education in High Blood Pressure Cases: A Nursing Perspective

Patient education plays a crucial role in high blood pressure cases from a nursing perspective. Nurses provide vital information to patients about lifestyle modifications and medication adherence as part of their educational role.

The focus of patient education is to enhance understanding of risk factors and potential complications associated with hypertension. By empowering patients, nurses encourage them to take an active role in managing their condition. Ongoing support and reinforcement of education significantly contribute to successful outcomes in hypertension management.

Through their expertise, nurses ensure that patients are equipped with the necessary knowledge to make informed decisions about their health. This comprehensive patient education approach is a key aspect of nursing care in high blood pressure cases.

Hypertension Medication: A Study of Nursing Case Studies

Nursing management in hypertension medication involves assessing its effectiveness and monitoring for adverse effects. Collaboration with the healthcare team ensures safe administration and dosage adjustments. Patient education plays a crucial role, covering medication purpose, potential interactions, and side effects. Ongoing support and monitoring by nurses are essential to promote medication adherence. This comprehensive study delves into various nursing case studies that highlight the importance of proper medication management in hypertension. By using their expertise in evaluating medication effectiveness and monitoring for adverse effects, nurses contribute significantly to patient care and improved outcomes. The integration of such studies into nursing practice enhances knowledge and critical thinking skills, enabling nurses to provide optimal care for patients with hypertension.

Chronic Hypertension Cases: A Nursing Approach

Chronic hypertension cases require a comprehensive nursing approach to ensure effective management. Nurses play a crucial role in assessing risk factors and symptoms in hypertensive patients, such as elevated blood pressure (BP) levels measured in mmHg. Monitoring BP levels and evaluating the effectiveness of medications are essential tasks in managing chronic hypertension. Educating patients on lifestyle modifications, such as maintaining a healthy body mass index (BMI) and implementing a calcium channel blocker, can help control hypertension. Collaborating with primary health care providers allows for a more holistic approach to patient care. By implementing evidence-based nursing interventions and using NLP terms like aldosterone and potassium, nurses can contribute towards successful hypertension management while prioritizing patient safety and well-being.

Hypertension-related Complications: A Case Analysis

Hypertension can lead to various complications that pose significant risks to patient health. By analyzing the patient’s medical history and risk factors, healthcare providers can better understand the underlying causes of hypertension. Signs and symptoms, along with diagnostic testing results like blood pressure measurements and chest X-rays, help in assessing the severity of the condition. Complications such as stroke, heart failure, and kidney disease are potential outcomes of uncontrolled hypertension. Developing a comprehensive treatment plan based on individual needs is crucial for effective management. Patient education and lifestyle modifications play a pivotal role in preventing adverse outcomes. With the guidance of healthcare professionals, patients can make informed decisions about their health and take proactive steps to manage hypertension successfully.

Importance and Impact of Nursing Documentation in Hypertension Case Studies

Accurate and complete nursing documentation plays a crucial role in hypertension case studies. It has a significant impact on patient outcomes and overall care quality. By documenting key information such as blood pressure (BP) measurements, signs of hypertension-related complications, and patient responses to medication, nurses can track progress and make informed decisions.

Regular chart audits and staff training are effective strategies for ensuring that nursing documentation remains up-to-date and comprehensive. Moreover, technology can streamline communication between healthcare providers, enhancing the accuracy and efficiency of nursing documentation in hypertension cases. Emphasizing the importance of meticulous nursing documentation in hypertension case studies is essential for delivering high-quality care and improving patient outcomes.

Hypertension and Its Effects on Patient Care Decisions

Hypertension, also known as high blood pressure, is a chronic medical condition that affects millions of individuals worldwide. It is characterized by elevated blood pressure levels, typically measured in millimeters of mercury (mmHg). Hypertension can have significant implications for patient health and daily activities, leading to an increased risk of cardiovascular events such as strokes and heart attacks.

Accurate monitoring and management of blood pressure are crucial in hypertension care. Healthcare providers rely on techniques like manual or automated blood pressure measurement, including the use of devices such as sphygmomanometers or digital monitors. These measurements help determine the severity of hypertension and guide treatment decisions.

In addition to medications that help control blood pressure, lifestyle modifications play a vital role in hypertension management. For instance, patients are often advised to follow a low-sodium diet, engage in regular exercise, manage stress levels, and limit alcohol consumption. By making these changes, patients can effectively lower blood pressure levels and reduce the risk of complications associated with hypertension.

Nurses play a crucial role in educating patients about hypertension and providing ongoing support. They provide information on medication adherence, lifestyle modifications, and regular blood pressure monitoring. Additionally, nurses offer emotional support and help patients navigate the challenges of hypertension management. By empowering patients with knowledge and resources, nurses contribute to better outcomes and improved quality of life for individuals living with hypertension.

How does Hypertension Influence Nursing Care Plans?

Hypertension impacts nursing care plans through frequent blood pressure monitoring and incorporating lifestyle modifications like diet and exercise. Medication management and patient education on hypertension management and complications are crucial components of nursing care plans.

Managing Hypertensive Crisis: A Nursing Case Study

In this nursing case study, we delve into the management of a hypertensive crisis, focusing on the patient’s medical history and risk factors for hypertension. We analyze the patient’s symptoms and physical exam findings, providing crucial insights into their condition. As nurses play a crucial role in managing hypertensive crises, we discuss their responsibilities, including medication administration and monitoring vital signs. It is imperative to outline the potential complications of uncontrolled hypertension and stress the importance of ongoing management. Furthermore, we highlight strategies for patient education, emphasizing lifestyle changes that can prevent hypertension and reduce the risk of complications. This comprehensive analysis aims to equip nurses with the knowledge and tools needed to effectively manage hypertensive crises.

Navigating Challenges in Chronic Hypertension Cases: A Nursing Perspective

Understanding the risk factors and causes of chronic hypertension is vital for nurses in order to effectively navigate the challenges presented by this condition. By identifying and managing hypertension in a clinical setting, nurses can play a crucial role in improving patient outcomes. Patient education and lifestyle changes are key components of hypertension management, emphasizing the importance of empowering patients to take control of their health. Collaboration with healthcare professionals allows for the development of a comprehensive treatment plan tailored to each patient’s unique needs. Additionally, recognizing potential complications and providing ongoing monitoring and support are essential in ensuring optimal care for patients with chronic hypertension. By addressing these challenges head-on, nurses can make a significant impact on the well-being of individuals affected by this condition.

Understanding the Effect of Hypertension on Patient Health: A Case Study

In this case study, we delve into the profound impact hypertension has on a patient’s health. Hypertension, commonly known as high blood pressure (BP), poses serious risks to individuals’ well-being. By analyzing a specific patient’s medical history and symptoms, we gain insights into the challenges faced in managing this condition. Moreover, nursing interventions play a crucial role in mitigating the adverse effects of hypertension. From promoting lifestyle changes to implementing medication management strategies, nurses strive to ensure comprehensive care. Patient education and diligent monitoring are paramount for long-term management. Collaboration among healthcare professionals, including doctors and pharmacists, is vital for a multidisciplinary approach to hypertension care. By prioritizing these considerations, we can navigate the complexities of hypertension and improve patient outcomes.

What are the Key Considerations for Nurses in Hypertension Cases?

When managing hypertension cases, nurses play a crucial role. They should regularly monitor the patient’s blood pressure and medication adherence. Patient education on lifestyle modifications is essential, and nurses should be aware of potential medication side effects. Collaboration with other healthcare professionals can also improve patient outcomes.

Evaluating the Effectiveness of Hypertension Medications: A Nursing Case Study

Evaluating the effectiveness of hypertension medications is a crucial aspect of nursing case studies. It involves analyzing the impact of various medications on controlling blood pressure (BP) and reducing the risk of complications. The evaluation includes assessing the response of patients to different medications, such as calcium channel blockers and beta-blockers, and monitoring their BP levels using mmHg measurements. Additionally, healthcare professionals need to consider potential side effects, such as electrolyte imbalances and potassium elevation, while evaluating medication effectiveness. By conducting comprehensive evaluations, nurses can make informed decisions regarding the best course of treatment for hypertensive patients, improving their overall health outcomes.

The Role of Patient Education in Managing Hypertension: Nurse’s Perspective

Patient education plays a crucial role in effective hypertension management. Understanding the causes and risk factors of hypertension empowers patients to make lifestyle modifications that can help manage their condition. By educating patients about the importance of regular blood pressure monitoring and follow-up appointments, nurses can ensure they stay on top of their condition. Additionally, educating patients about medication adherence and monitoring for side effects enhances their understanding and promotes better medication management. Collaborating with the healthcare team, including dietitians and pharmacists, allows for well-rounded care and optimal hypertension management. Patient education is a vital aspect of nursing care, as it equips patients with the knowledge and tools they need to actively participate in their own health management.

Understanding Complications Related to Hypertension: A Comprehensive Study

Complications related to hypertension can have serious implications for patients. Hypertension, commonly known as high blood pressure, is defined as a persistent elevation of blood pressure above 140/90 mmHg. It is caused by various factors including genetics, lifestyle choices, and certain medical conditions. This condition affects a wide range of demographics, including pregnant patients, the elderly, and individuals with certain risk factors such as obesity and a sedentary lifestyle.

One of the most significant complications of hypertension is heart disease, which can lead to serious cardiovascular events such as heart attacks and strokes. Another complication is kidney damage, which can result in renal failure if left untreated. Additionally, hypertension can cause damage to the arteries, leading to an increased risk of aneurysms and other cardiovascular issues.

Nursing interventions and treatment options for hypertension focus on both lifestyle changes and medications. Patients are educated on the importance of maintaining a healthy weight, following a balanced diet, engaging in regular physical activity, and managing stress effectively. Medications such as calcium channel blockers and beta-blockers may also be prescribed to help lower blood pressure.

Patient education and follow-up care are crucial in managing hypertension and preventing complications. Nurses play a vital role in providing information on self-care measures, medication adherence, and the importance of monitoring blood pressure regularly. Collaborating with the primary healthcare provider and other members of the healthcare team ensures optimal management and reduces the risk of complications.

Strategies for Successful Management of Hypertension: A Nursing Case Study

Successful management of hypertension in nursing involves a collaborative approach between primary care providers and nurses. They work together to develop individualized treatment plans that address the specific needs of hypertensive patients. Regular physical examinations, including laboratory tests like urinalysis and creatinine levels, are crucial for monitoring renal function and ensuring optimal patient care. Treatment strategies may include lifestyle modifications, medication management, and consultation with specialists to effectively control blood pressure levels. Nurses play a critical role in closely monitoring blood pressure levels and assessing for complications such as edema and perfusion deficits. By employing a multidisciplinary approach, healthcare teams can ensure patient safety and achieve optimal outcomes in managing hypertension.

In conclusion, hypertension is a complex condition that requires comprehensive nursing care and management. Nurses play a crucial role in educating patients about the importance of managing their blood pressure and providing support throughout their healthcare journey. By understanding the pathophysiology of hypertension, considering nursing considerations, and implementing effective care plans, nurses can make a significant impact on patient outcomes. Documentation and communication are essential for ensuring continuity of care and facilitating collaborative decision-making. Through case studies and in-depth analysis, nurses can enhance their knowledge and skills in managing hypertension and its related complications. By staying informed and continually seeking opportunities for professional development, nurses can provide optimal care and support to patients with hypertension.

Expert paper writers are just a few clicks away

Place an order in 3 easy steps. Takes less than 5 mins.

Calculate the price of your order

• High School
• You don't have any recent items yet.
• You don't have any courses yet.
• You don't have any books yet.
• You don't have any Studylists yet.
• Information

Case Study Hypertension

Medical surgical nursing i (nurs211), bryant & stratton college, recommended for you, students also viewed.

• Med Surg 1 - respiratory, cardiac, hematology systems
• Essay on Hypertension
• Med Surg Miller Ch44 - ATI questions
• ATIlabvaluesstudyguide PDF
• Clinical paperwork 2021
• Med surg chapter 1 practice questions

Related documents

• Mental Health Notes ATI
• 2. Pancreatic Cancer for med surg
• Med Surg TLS breakdown - A summary of tumor lysis syndrome
• Med Surg GI - A presentation on the GI system
• Nursing School Semester 5

Related Studylists

Preview text, hypertension, mike kelly, 51 years old, primary concept, interrelated concepts (in order of emphasis).

• Glucose Regulation
• Clinical Judgment
• Patient Education
• Communication
• Collaboration

UNFOLDING Reasoning Case Study: STUDENT

History of present problem:.

Mike Kelly is a 51-year-old Caucasian male who is 6 feet tall and weighs 275 pounds (BMI 37) with an abnormal distribution of weight around his abdomen. He does not regularly exercise, does not like to cook, and eats fast food three to five times during the week. He has smoked one pack per day since the age of 20 (31 pack years). He has a history of hyperlipidemia, but is unable to afford his medication (atorvastatin), and has not taken since he was diagnosed 5 years ago. He has no current diagnosed medical problems. He became concerned and came to the emergency department because he is more easily fatigued and has had a headache the past three days that has not improved.

Personal/Social History:

Mike is self-employed and owns his own auto mechanic business. He has no health insurance. His father had hypertension and died of a myocardial infarction (MI) at the age of 50. Angelina, his wife, came with him to urgent care. She shares that he is usually stoic about health problems, so this must really bother him or he is afraid. He took Excedrin and Motrin for pain and it didn’t help.

What data from the histories is RELEVANT and has clinical significance for the nurse? RELEVANT Data from Present Problem: Clinical Significance:

RELEVANT Data from Social History: Clinical Significance:

Patient Care Begins:

What VS data is RELEVANT and must be recognized as clinically significant by the nurse? RELEVANT VS Data: Clinical Significance:

Current VS: P-Q-R-S-T Pain Assessment (5th VS):

T: 98 f/37 c (oral) p rovoking/palliative: nothing/nothing, p: 88 ( regular) q uality: ache, r: 20 r egion/radiation: global head ache (ha), bp: 220/118 s everity: 8/, o2 sat: 95% room air t iming: continuous.

1 37. 2 around abdomen 3. No regular exercise 4. Eats fast food 3-5 days a week 5. Smokes 1 pack a day 6. Hyperlipidemia 7. Cant afford medication 8. Easily fatigued 9. Headache for 3 days

• This BMI is considered obese, this increases risk of diabetes and hypertention as well as heart disease.
• At risk for insulin resistance
• Possible reason Mike is obese
• This can cause weight gain and other health problems
• This can cause cancer, heart disease, diabetes, and high BP
• Increases risk of heart disease
• Can cause heart disease and stroke
• Could be caused by another health problem
• Could be coming from health problem, or being fatigued.

1. Self-employed

2. no health insurance, 3. family history of high bp and mi, 4. took excedrin and motrin for pain,, with no relief, 1. finances are affected with his unability to work., 2. find resources to help pay for medications, 3. puts him at greater risk due to it being in the family, 4. these two meds should not be taken together., 1. blood pressure, 2. headache 8/, this bp is very high and could cause a hypertensive crisis or stroke., sign of intercranial pressure from high blood pressure., radiology reports: chest x-ray, what diagnostic results are relevant that must be recognized as clinically significant to the nurse, relevant results: clinical significance:.

The cardiac size is enlarged. There are no focal infiltrates or consolidations or pleural effusions. IMPRESSION:

• No acute disease in the chest.
• Moderate to severe cardiomegaly

Lab Results:

What lab results are relevant and must be recognized as clinically significant by the nurse, relevant lab(s): clinical significance:.

Complete Blood Count (CBC:) Current: High/Low/WNL? WBC (4–11 mm 3) 10. Hgb (12–16 g/dL) 15. Platelets(150–450x 103/μl) 422 Neutrophil % (42–72) 68

Basic Metabolic Panel (BMP:) Current: High/Low/WNL? Sodium (135–145 mEq/L) 136 Potassium (3–5 mEq/L) 4. Glucose (70–110 mg/dL) 188 BUN (7–25 mg/dl) 32 Creatinine (0–1 mg/dL) 1.

Cardiac Labs: Current: High/Low/WNL? BNP (B-natriuretic Peptide) (<100 ng/L) 758

His heart is larger than normal and could increase his risk for heart failure.

WNL WNL WNL WNL

All labs are normal Overall health is good

WNL WNL High High High

1. Glucose 188

3. creatine 1., 1. sign of infection, or diabletes, 2. likely from poor diet, 3. could be caused by heart failure or kidney failure, bnp 758 very high bnp in blood. sign of heart failure, lab planning: creating a plan of care with a priority lab:.

Lab: Normal Value: Why Relevant? Nursing Assessments/Interventions Required:

(B-natriuretic Peptide)

Critical Value:

Lipid Panel: Current: High/Low/WNL? Low density lipoprotein–LDL (<130 mg/dL) 260 High density lipoprotein–HDL (>40 mg/dL) 28 Total cholesterol (<200 mg/dL) 290 Triglycerides (30–149 mg/dL) 484

Urine Analysis (UA:) Current: High/Low/WNL? Color (yellow) Yellow Clarity (clear) Clear Specific Gravity (1–1) 1. Protein (neg) Moderate Glucose (neg) Moderate Ketones (neg) Negative Bilirubin (neg) Negative Blood (neg) Positive Nitrite (neg) Negative LET (Leukocyte Esterase) (neg) Negative MICRO: RBC’s (<5) 3 WBC’s (<5) 2 Bacteria (neg) Negative Epithelial (neg) Negative

High Low High High

1. Low density

Lipoprotein 260, 2. high denesity, lipoprotein 28, 3. total cholesteol 290, 4. triglycerides 484, 1. could lead to coronary heart disease., 2. higher risk of heart disease, 3. possible blockage in arteries, 4. indication of other conditions that could increase risk of heart disease and.

WNL WNL WNL High High WNL WNL High WNL WNL

1. major sign of kidney disease

2. diabetes mellitus, 3. kidney disease, indicates heart failure ekg monitoring, 5. what body system(s) will you most thoroughly assess based on the primary/priority concern.

6. What is the worst possible/most likely complication to anticipate?

7. What nursing assessments will identify this complication EARLY if it develops?

8. What nursing interventions will you initiate if this complication develops?

9. What psychosocial needs will this patient and/or family likely have that will need to be addressed?

10. How can the nurse address these psychosocial needs?

Medication Dosage Calculation:

Medication/Dose: Mechanism of Action: Volume/time frame to Safely Administer:

Nursing Assessment/Considerations:

20 mg IV push 5 mg/mL vial

Volume every 15

Evaluation:.

Evaluate your patient’s response to nursing and medical interventions during your shift. All physician orders listed under medical management have been implemented..

Two hours later...

Mike has received a third dose of labetalol 20 mg iv push and you obtain the following clinical, data when he is re-assessed:, current vs: most recent: current pqrst: previous:, t: 98 (oral) t: 98 (oral) p rovoking/palliative: nothing/nothing nothing/nothing, p: 82 ( regular) p: 78 ( regular) q uality: ache ache, r: 16 r: 20 r egion/radiation: global ha global ha, bp: 176/104 bp: 188/102 s everity: 3/10 8/, o2 sat: 96% ra o2 sat: 95% (ra) t iming: continuous continuous, blocks stimulation of beta, and beta2. contains, alpha1-adrenergic blocking, activity, which may result, in orthostatic hypotension, monitor bp (orthostatic), i & o, daily weight, listen to heart and lungs, cardiac arrest, call code, and start cpr, he has no health insurance, and not working. maybe a social worker could help, social worker to help find finacial support..

1. What clinical data is RELEVANT that must be recognized as clinically significant? RELEVANT VS Data: Clinical Significance:

RELEVANT Assessment Data: Clinical Significance:

2. Has the status improved or not as expected to this point?

3. Does your nursing priority or plan of care need to be modified in any way after this evaluation assessment?

4. Based on your current evaluation, what are your nursing priorities and plan of care?

Assessment:

####### GENERAL

####### APPEARANCE:

Resting comfortably, appears relaxed and in no acute distress

RESP: Breath sounds clear with equal aeration bilaterally ant/post, nonlabored respiratory effort CARDIAC: Pink, warm and dry, no edema, heart sounds regular with no abnormal beats, pulses strong, equal with palpation at radial/pedal/post-tibial landmarks NEURO: Alert and oriented to person, place, time, and situation (x4) GI: Abdomen soft/non-tender, bowel sounds audible per auscultation in all 4 quadrants GU: Voiding without difficulty, urine clear/yellow SKIN: Skin integrity intact

Blood pressure had decreased

From 220/118 to 176/, indication that medication is working, cardiac bp is lowering, pulse is regular, has not met goal of bp being 160/100, but should get there., no, just continuous monitoring of heart, lungs, blood pressure and ekg to monitor his, must continue to monitor heart, lungs and blood pressure, effective and concise handoffs are essential to excellent care and if not done well can adversely impact the care, of this patient. you have done an excellent job to this point, now finish strong and give the following sbar, report to the nurse who will be caring for this patient who is being admitted on the telemetry floor:, s ituation:.

BRIEF summary of primary problem:

Day of admission/post-op #:

B ackground:

Primary problem/diagnosis:

RELEVANT past medical history:

A ssessment:

Most recent vital signs:

RELEVANT body system nursing assessment data:

RELEVANT lab values:

TREND of any abnormal clinical data (stable-increasing/decreasing):

How have you advanced the plan of care?

Patient response:

INTERPRETATION of current clinical status (stable/unstable/worsening):

R ecommendation:

Suggestions to advance plan of care:

Mike Kelly, 51 yrs old

Patient came in to ed due to fatigue and severe headache for, three days with no relief, admission: september 21, 2020, diagnosed with hyperlipidemia five years ago. father had, hypertension and died at age 50 from mi.

Temp: 98 oral Pulse: 82 regular Resp: 16 BP: 176/ O2 sat: 96% RA

body shows no signs of abnormalities, within normal limit

Lipd panel: LDL 260, HDL 28, Cholesterol 290, Triglycerides 484 BNP: Glucose 188, BUN 32, Creatine 1.

Care: Give medications ordered, monitor vitals, lab, and diagnostic results

Patient: resting comfortably, relaxed in no distress.

Blood pressure and pain is decreasing from the medications given.

Monitor Blood Pressure, another EKG, Check A1c, and adress lipid

Test results, education priorities/discharge planning.

1. What will be the most important discharge/education priorities you will reinforce with Mike’s medical condition to prevent future readmission with the same problem?

2. What are some practical ways you as the nurse can assess the effectiveness of your teaching with this patient?

Caring and the <Art= of Nursing

1. What is the patient likely experiencing/feeling right now in this situation?

2. What can you do to engage yourself with this patient’s experience and show that he matters to you as a person?

Use Reflection to THINK Like a Nurse

Reflection-IN-action (Tanner, 2006) is the nurse’s ability to accurately interpret the patient’s response to an intervention in the moment as the events are unfolding to make a correct clinical judgment.

1. What did I learn from this scenario?

2. How can I use what has been learned from this scenario to improve patient care in the future?

1. Changes in lifestyle to lower BP

2. education about what causes high bp and what it does to the body., anxiety and fear, have patient repeat instuctions on how to take their bp, have them explain to you what they know of their condition, show empathy and support. find resources he may need to make lifestyle changes, poor diet and lack of exercise, along with diabetes and high blood pressure can have a, serious effect on the heart and overall health of the patient., being overweight, smoking, eating fast foods, no exercise, and family history are all risk, factors for htn. educate the patient on ways they can improve their lifestyle and health..

• Multiple Choice

Course : Medical Surgical Nursing I (NURS211)

University : bryant & stratton college.

• Discover more from: Medical Surgical Nursing I NURS211 Bryant & Stratton College 34   Documents Go to course
• More from: Medical Surgical Nursing I NURS211 Bryant & Stratton College 34   Documents Go to course
• More from: Print by Cleopatra Jones 415 415 documents Go to Studylist

This website is intended for healthcare professionals

• { $refs.search.focus(); })" aria-controls="searchpanel" :aria-expanded="open" class="hidden lg:inline-flex justify-end text-gray-800 hover:text-primary py-2 px-4 lg:px-0 items-center text-base font-medium"> Search

Search menu

Abegaz TM, Shehab A, Gebreyohannes EA, Bhagavathula AS, Elnour AA. Nonadherence to antihypertensive drugs. Medicine (Baltimore). 2017; 96:(4) https://doi.org/10.1097/MD.0000000000005641

Armitage LC, Davidson S, Mahdi A Diagnosing hypertension in primary care: a retrospective cohort study to investigate the importance of night-time blood pressure assessment. Br J Gen Pract. 2023; 73:(726)e16-e23 https://doi.org/10.3399/BJGP.2022.0160

Barratt J. Developing clinical reasoning and effective communication skills in advanced practice. Nurs Stand. 2018; 34:(2)48-53 https://doi.org/10.7748/ns.2018.e11109

Bostock-Cox B. Nurse prescribing for the management of hypertension. British Journal of Cardiac Nursing. 2013; 8:(11)531-536

Bostock-Cox B. Hypertension – the present and the future for diagnosis. Independent Nurse. 2019; 2019:(1)20-24 https://doi.org/10.12968/indn.2019.1.20

Chakrabarti S. What's in a name? Compliance, adherence and concordance in chronic psychiatric disorders. World J Psychiatry. 2014; 4:(2)30-36 https://doi.org/10.5498/wjp.v4.i2.30

De Mauri A, Carrera D, Vidali M Compliance, adherence and concordance differently predict the improvement of uremic and microbial toxins in chronic kidney disease on low protein diet. Nutrients. 2022; 14:(3) https://doi.org/10.3390/nu14030487

Demosthenous N. Consultation skills: a personal reflection on history-taking and assessment in aesthetics. Journal of Aesthetic Nursing. 2017; 6:(9)460-464 https://doi.org/10.12968/joan.2017.6.9.460

Diamond-Fox S. Undertaking consultations and clinical assessments at advanced level. Br J Nurs. 2021; 30:(4)238-243 https://doi.org/10.12968/bjon.2021.30.4.238

Diamond-Fox S, Bone H. Advanced practice: critical thinking and clinical reasoning. Br J Nurs. 2021; 30:(9)526-532 https://doi.org/10.12968/bjon.2021.30.9.526

Donnelly M, Martin D. History taking and physical assessment in holistic palliative care. Br J Nurs. 2016; 25:(22)1250-1255 https://doi.org/10.12968/bjon.2016.25.22.1250

Fawcett J. Thoughts about meanings of compliance, adherence, and concordance. Nurs Sci Q. 2020; 33:(4)358-360 https://doi.org/10.1177/0894318420943136

Fisher NDL, Curfman G. Hypertension—a public health challenge of global proportions. JAMA. 2018; 320:(17)1757-1759 https://doi.org/10.1001/jama.2018.16760

Green S. Assessment and management of acute sore throat. Pract Nurs. 2015; 26:(10)480-486 https://doi.org/10.12968/pnur.2015.26.10.480

Harper C, Ajao A. Pendleton's consultation model: assessing a patient. Br J Community Nurs. 2010; 15:(1)38-43 https://doi.org/10.12968/bjcn.2010.15.1.45784

Hitchings A, Lonsdale D, Burrage D, Baker E. The Top 100 Drugs; Clinical Pharmacology and Practical Prescribing, 2nd edn. Scotland: Elsevier; 2019

Hobden A. Strategies to promote concordance within consultations. Br J Community Nurs. 2006; 11:(7)286-289 https://doi.org/10.12968/bjcn.2006.11.7.21443

Ingram S. Taking a comprehensive health history: learning through practice and reflection. Br J Nurs. 2017; 26:(18)1033-1037 https://doi.org/10.12968/bjon.2017.26.18.1033

James A, Holloway S. Application of concepts of concordance and health beliefs to individuals with pressure ulcers. British Journal of Healthcare Management. 2020; 26:(11)281-288 https://doi.org/10.12968/bjhc.2019.0104

Jamison J. Differential diagnosis for primary care. A handbook for health care practitioners, 2nd edn. China: Churchill Livingstone Elsevier; 2006

History and Physical Examination. 2021. https://patient.info/doctor/history-and-physical-examination (accessed 26 January 2023)

Kumar P, Clark M. Clinical Medicine, 9th edn. The Netherlands: Elsevier; 2017

Matthys J, Elwyn G, Van Nuland M Patients' ideas, concerns, and expectations (ICE) in general practice: impact on prescribing. Br J Gen Pract. 2009; 59:(558)29-36 https://doi.org/10.3399/bjgp09X394833

McKinnon J. The case for concordance: value and application in nursing practice. Br J Nurs. 2013; 22:(13)766-771 https://doi.org/10.12968/bjon.2013.22.13.766

McPhillips H, Wood AF, Harper-McDonald B. Conducting a consultation and clinical assessment of the skin for advanced clinical practitioners. Br J Nurs. 2021; 30:(21)1232-1236 https://doi.org/10.12968/bjon.2021.30.21.1232

Moulton L. The naked consultation; a practical guide to primary care consultation skills.Abingdon: Radcliffe Publishing; 2007

Medicine adherence; involving patients in decisions about prescribed medications and supporting adherence.England: NICE; 2009

National Institute for Health and Care Excellence. How do I control my blood pressure? Lifestyle options and choice of medicines patient decision aid. 2019. https://www.nice.org.uk/guidance/ng136/resources/patient-decision-aid-pdf-6899918221 (accessed 25 January 2023)

National Institute for Health and Care Excellence. Hypertension in adults: diagnosis and management. NICE guideline NG136. 2022. https://www.nice.org.uk/guidance/ng136 (accessed 15 June 2023)

Nazarko L. Healthwise, Part 4. Hypertension: how to treat it and how to reduce its risks. Br J Healthc Assist. 2021; 15:(10)484-490 https://doi.org/10.12968/bjha.2021.15.10.484

Neighbour R. The inner consultation.London: Radcliffe Publishing Ltd; 1987

The Code. professional standards of practice and behaviour for nurses, midwives and nursing associates.London: NMC; 2018

Nuttall D, Rutt-Howard J. The textbook of non-medical prescribing, 2nd edn. Chichester: Wiley-Blackwell; 2016

O'Donovan K. The role of ACE inhibitors in cardiovascular disease. British Journal of Cardiac Nursing. 2018; 13:(12)600-608 https://doi.org/10.12968/bjca.2018.13.12.600

O'Donovan K. Angiotensin receptor blockers as an alternative to angiotensin converting enzyme inhibitors. British Journal of Cardiac Nursing. 2019; 14:(6)1-12 https://doi.org/10.12968/bjca.2019.0009

Porth CM. Essentials of Pathophysiology, 4th edn. Philadelphia: Wolters Kluwer; 2015

Rae B. Obedience to collaboration: compliance, adherence and concordance. Journal of Prescribing Practice. 2021; 3:(6)235-240 https://doi.org/10.12968/jprp.2021.3.6.235

Rostoft S, van den Bos F, Pedersen R, Hamaker ME. Shared decision-making in older patients with cancer - What does the patient want?. J Geriatr Oncol. 2021; 12:(3)339-342 https://doi.org/10.1016/j.jgo.2020.08.001

Schroeder K. The 10-minute clinical assessment, 2nd edn. Oxford: Wiley Blackwell; 2017

Thomas J, Monaghan T. The Oxford handbook of clinical examination and practical skills, 2nd edn. Oxford: Oxford University Press; 2014

Vincer K, Kaufman G. Balancing shared decision-making with ethical principles in optimising medicines. Nurse Prescribing. 2017; 15:(12)594-599 https://doi.org/10.12968/npre.2017.15.12.594

Waterfield J. ACE inhibitors: use, actions and prescribing rationale. Nurse Prescribing. 2008; 6:(3)110-114 https://doi.org/10.12968/npre.2008.6.3.28858

Weiss M. Concordance, 6th edn. In: Watson J, Cogan LS Poland: Elsevier; 2019

Williams H. An update on hypertension for nurse prescribers. Nurse Prescribing. 2013; 11:(2)70-75 https://doi.org/10.12968/npre.2013.11.2.70

Adherence to long-term therapies, evidence for action.Geneva: WHO; 2003

Young K, Franklin P, Franklin P. Effective consulting and historytaking skills for prescribing practice. Br J Nurs. 2009; 18:(17)1056-1061 https://doi.org/10.12968/bjon.2009.18.17.44160

Newly diagnosed hypertension: case study

Angela Brown

Trainee Advanced Nurse Practitioner, East Belfast GP Federation, Northern Ireland

View articles · Email Angela

The role of an advanced nurse practitioner encompasses the assessment, diagnosis and treatment of a range of conditions. This case study presents a patient with newly diagnosed hypertension. It demonstrates effective history taking, physical examination, differential diagnoses and the shared decision making which occurred between the patient and the professional. It is widely acknowledged that adherence to medications is poor in long-term conditions, such as hypertension, but using a concordant approach in practice can optimise patient outcomes. This case study outlines a concordant approach to consultations in clinical practice which can enhance adherence in long-term conditions.

Hypertension is a worldwide problem with substantial consequences ( Fisher and Curfman, 2018 ). It is a progressive condition ( Jamison, 2006 ) requiring lifelong management with pharmacological treatments and lifestyle adjustments. However, adopting these lifestyle changes can be notoriously difficult to implement and sustain ( Fisher and Curfman, 2018 ) and non-adherence to chronic medication regimens is extremely common ( Abegaz et al, 2017 ). This is also recognised by the National Institute for Health and Care Excellence (NICE) (2009) which estimates that between 33.3% and 50% of medications are not taken as recommended. Abegaz et al (2017) furthered this by claiming 83.7% of people with uncontrolled hypertension do not take medications as prescribed. However, leaving hypertension untreated or uncontrolled is the single largest cause of cardiovascular disease ( Fisher and Curfman, 2018 ). Therefore, better adherence to medications is associated with better outcomes ( World Health Organization, 2003 ) in terms of reducing the financial burden associated with the disease process on the health service, improving outcomes for patients ( Chakrabarti, 2014 ) and increasing job satisfaction for professionals ( McKinnon, 2013 ). Therefore, at a time when growing numbers of patients are presenting with hypertension, health professionals must adopt a concordant approach from the initial consultation to optimise adherence.

Great emphasis is placed on optimising adherence to medications ( NICE, 2009 ), but the meaning of the term ‘adherence’ is not clear and it is sometimes used interchangeably with compliance and concordance ( De Mauri et al, 2022 ), although they are not synonyms. Compliance is an outdated term alluding to paternalism, obedience and passivity from the patient ( Rae, 2021 ), whereby the patient's behaviour must conform to the health professional's recommendations. Adherence is defined as ‘the extent to which a person's behaviour, taking medication, following a diet and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider’ ( Chakrabarti, 2014 ). This term is preferred over compliance as it is less paternalistic ( Rae, 2021 ), as the patient is included in the decision-making process and has agreed to the treatment plan. While it is not yet widely embraced or used in practice ( Fawcett, 2020 ), concordance is recognised, not as a behaviour ( Rae, 2021 ) but more an approach or method which focuses on the equal partnership between patient and professional ( McKinnon, 2013 ) and enables effective and agreed treatment plans.

NICE last reviewed its guidance on medication adherence in 2019 and did not replace adherence with concordance within this. This supports the theory that adherence is an outcome of good concordance and the two are not synonyms. NICE (2009) guidelines, which are still valid, show evidence of concordant principles to maximise adherence. Integrating the theoretical principles of concordance into this case study demonstrates how the trainee advanced nurse practitioner aimed to individualise patient-centred care and improve health outcomes through optimising adherence.

Patient introduction and assessment

Jane (a pseudonym has been used to protect the patient's anonymity; Nursing and Midwifery Council (NMC) 2018 ), is a 45-year-old woman who had been referred to the surgery following an attendance at an emergency department. Jane had been role-playing as a patient as part of a teaching session for health professionals when it was noted that her blood pressure was significantly elevated at 170/88 mmHg. She had no other symptoms. Following an initial assessment at the emergency department, Jane was advised to contact her GP surgery for review and follow up. Nazarko (2021) recognised that it is common for individuals with high blood pressure to be asymptomatic, contributing to this being referred to as the ‘silent killer’. Hypertension is generally only detected through opportunistic checking of blood pressure, as seen in Jane's case, which is why adults over the age of 40 years are offered a blood pressure check every 5 years ( Bostock-Cox, 2013 ).

Consultation

Jane presented for a consultation at the surgery. Green (2015) advocates using a model to provide a structured approach to consultations which ensures quality and safety, and improves time management. Young et al (2009) claimed that no single consultation model is perfect, and Diamond-Fox (2021) suggested that, with experience, professionals can combine models to optimise consultation outcomes. Therefore, to effectively consult with Jane and to adapt to her individual personality, different models were intertwined to provide better person-centred care.

The Calgary–Cambridge model is the only consultation model that places emphasis on initiating the session, despite it being recognised that if a consultation gets off to a bad start this can interfere throughout ( Young et al, 2009 ). Being prepared for the consultation is key. Before Jane's consultation, the environment was checked to minimise interruptions, ensuring privacy and dignity ( Green, 2015 ; NMC, 2018 ), the seating arrangements optimised to aid good body language and communication ( Diamond-Fox, 2021 ) and her records were viewed to give some background information to help set the scene and develop a rapport ( Young et al, 2009 ). Being adequately prepared builds the patient's trust and confidence in the professional ( Donnelly and Martin, 2016 ) but equally viewing patient information can lead to the professional forming preconceived ideas ( Donnelly and Martin, 2016 ). Therefore, care was taken by the trainee advanced nurse practitioner to remain open-minded.

During Jane's consultation, a thorough clinical history was taken ( Table 1 ). History taking is common to all consultation models and involves gathering important information ( Diamond-Fox, 2021 ). History-taking needs to be an effective ( Bostock-Cox, 2019 ), holistic process ( Harper and Ajao, 2010 ) in order to be thorough, safe ( Diamond-Fox, 2021 ) and aid in an accurate diagnosis. The key skill for taking history is listening and observing the patient ( Harper and Ajao, 2010 ). Sir William Osler said:‘listen to the patient as they are telling you the diagnosis’, but Knott and Tidy (2021) suggested that patients are barely given 20 seconds before being interrupted, after which they withdraw and do not offer any new information ( Demosthenous, 2017 ). Using this guidance, Jane was given the ‘golden minute’ allowing her to tell her ‘story’ without being interrupted ( Green, 2015 ). This not only showed respect ( Ingram, 2017 ) but interest in the patient and their concerns.

Once Jane shared her story, it was important for the trainee advanced nurse practitioner to guide the questioning ( Green 2015 ). This was achieved using a structured approach to take Jane's history, which optimised efficiency and effectiveness, and ensured that pertinent information was not omitted ( Young et al, 2009 ). Thomas and Monaghan (2014) set out clear headings for this purpose. These included:

• The presenting complaint
• Past medical history
• Drug history
• Social history
• Family history.

McPhillips et al (2021) also emphasised a need for a systemic enquiry of the other body systems to ensure nothing is missed. From taking this history it was discovered that Jane had been feeling well with no associated symptoms or red flags. A blood pressure reading showed that her blood pressure was elevated. Jane had no past medical history or allergies. She was not taking any medications, including prescribed, over the counter, herbal or recreational. Jane confirmed that she did not drink alcohol or smoke. There was no family history to note, which is important to clarify as a genetic link to hypertension could account for 30–50% of cases ( Nazarko, 2021 ). The information gathered was summarised back to Jane, showing good practice ( McPhillips et al, 2021 ), and Jane was able to clarify salient or missing points. Green (2015) suggested that optimising the patient's involvement in this way in the consultation makes her feel listened to which enhances patient satisfaction, develops a therapeutic relationship and demonstrates concordance.

During history taking it is important to explore the patient's ideas, concerns and expectations. Moulton (2007) refers to these as the ‘holy trinity’ and central to upholding person-centredness ( Matthys et al, 2009 ). Giving Jane time to discuss her ideas, concerns and expectations allowed the trainee advanced nurse practitioner to understand that she was concerned about her risk of a stroke and heart attack, and worried about the implications of hypertension on her already stressful job. Using ideas, concerns and expectations helped to understand Jane's experience, attitudes and perceptions, which ultimately will impact on her health behaviours and whether engagement in treatment options is likely ( James and Holloway, 2020 ). Establishing Jane's views demonstrated that she was eager to engage and manage her blood pressure more effectively.

Vincer and Kaufman (2017) demonstrated, through their case study, that a failure to ask their patient's viewpoint at the initial consultation meant a delay in engagement with treatment. They recognised that this delay could have been avoided with the use of additional strategies had ideas, concerns and expectations been implemented. Failure to implement ideas, concerns and expectations is also associated with reattendance or the patient seeking second opinions ( Green, 2015 ) but more positively, when ideas, concerns and expectations is implemented, it can reduce the number of prescriptions while sustaining patient satisfaction ( Matthys et al, 2009 ).

Physical examination

Once a comprehensive history was taken, a physical examination was undertaken to supplement this information ( Nuttall and Rutt-Howard, 2016 ). A physical examination of all the body systems is not required ( Diamond-Fox, 2021 ) as this would be extremely time consuming, but the trainee advanced nurse practitioner needed to carefully select which systems to examine and use good examination technique to yield a correct diagnosis ( Knott and Tidy, 2021 ). With informed consent, clinical observations were recorded along with a full cardiovascular examination. The only abnormality discovered was Jane's blood pressure which was 164/90 mmHg, which could suggest stage 2 hypertension ( NICE, 2019 ; 2022 ). However, it is the trainee advanced nurse practitioner's role to use a hypothetico-deductive approach to arrive at a diagnosis. This requires synthesising all the information from the history taking and physical examination to formulate differential diagnoses ( Green, 2015 ) from which to confirm or refute before arriving at a final diagnosis ( Barratt, 2018 ).

Differential diagnosis

Hypertension can be triggered by secondary causes such as certain drugs (non-steroidal anti-inflammatory drugs, steroids, decongestants, sodium-containing medications or combined oral contraception), foods (liquorice, alcohol or caffeine; Jamison, 2006 ), physiological response (pain, anxiety or stress) or pre-eclampsia ( Jamison, 2006 ; Schroeder, 2017 ). However, Jane had clarified that these were not contributing factors. Other potential differentials which could not be ruled out were the white-coat syndrome, renal disease or hyperthyroidism ( Schroeder, 2017 ). Further tests were required, which included bloods, urine albumin creatinine ratio, electrocardiogram and home blood pressure monitoring, to ensure a correct diagnosis and identify any target organ damage.

Joint decision making

At this point, the trainee advanced nurse practitioner needed to share their knowledge in a meaningful way to enable the patient to participate with and be involved in making decisions about their care ( Rostoft et al, 2021 ). Not all patients wish to be involved in decision making ( Hobden, 2006 ) and this must be respected ( NMC, 2018 ). However, engaging patients in partnership working improves health outcomes ( McKinnon, 2013 ). Explaining the options available requires skill so as not to make the professional seem incompetent and to ensure the patient continues to feel safe ( Rostoft et al, 2021 ).

Information supported by the NICE guidelines was shared with Jane. These guidelines advocated that in order to confirm a diagnosis of hypertension, a clinic blood pressure reading of 140/90 mmHg or higher was required, with either an ambulatory or home blood pressure monitoring result of 135/85 mmHg or higher ( NICE, 2019 ; 2022 ). However, the results from a new retrospective study suggested that the use of home blood pressure monitoring is failing to detect ‘non-dippers’ or ‘reverse dippers’ ( Armitage et al, 2023 ). These are patients whose blood pressure fails to fall during their nighttime sleep. This places them at greater risk of cardiovascular disease and misdiagnosis if home blood pressure monitors are used, but ambulatory blood pressure monitors are less frequently used in primary care and therefore home blood pressure monitors appear to be the new norm ( Armitage et al, 2023 ).

Having discussed this with Jane she was keen to engage with home blood pressure monitoring in order to confirm the potential diagnosis, as starting a medication without a true diagnosis of hypertension could potentially cause harm ( Jamison, 2006 ). An accurate blood pressure measurement is needed to prevent misdiagnosis and unnecessary therapy ( Jamison, 2006 ) and this is dependent on reliable and calibrated equipment and competency in performing the task ( Bostock-Cox, 2013 ). Therefore, Jane was given education and training to ensure the validity and reliability of her blood pressure readings.

For Jane, this consultation was the ideal time to offer health promotion advice ( Green, 2015 ) as she was particularly worried about her elevated blood pressure. Offering health promotion advice is a way of caring, showing support and empowerment ( Ingram, 2017 ). Therefore, Jane was provided with information on a healthy diet, the reduction of salt intake, weight loss, exercise and continuing to abstain from smoking and alcohol ( Williams, 2013 ). These were all modifiable factors which Jane could implement straight away to reduce her blood pressure.

Safety netting

The final stage and bringing this consultation to a close was based on the fourth stage of Neighbour's (1987) model, which is safety netting. Safety netting identifies appropriate follow up and gives details to the patient on what to do if their condition changes ( Weiss, 2019 ). It is important that the patient knows who to contact and when ( Young et al, 2009 ). Therefore, Jane was advised that, should she develop chest pains, shortness of breath, peripheral oedema, reduced urinary output, headaches, visual disturbances or retinal haemorrhages ( Schroeder, 2017 ), she should present immediately to the emergency department, otherwise she would be reviewed in the surgery in 1 week.

Jane was followed up in a second consultation 1 week later with her home blood pressure readings. The average reading from the previous 6 days was calculated ( Bostock-Cox, 2013 ) and Jane's home blood pressure reading was 158/82 mmHg. This reading ruled out white-coat syndrome as Jane's blood pressure remained elevated outside clinic conditions (white-coat syndrome is defined as a difference of more than 20/10 mmHg between clinic blood pressure readings and the average home blood pressure reading; NICE, 2019 ; 2022 ). Subsequently, Jane was diagnosed with stage 2 essential (or primary) hypertension. Stage 2 is defined as a clinic blood pressure of 160/100 mmHg or higher or a home blood pressure of 150/95 mmHg or higher ( NICE, 2019 ; 2022 ).

A diagnosis of hypertension can be difficult for patients as they obtain a ‘sick label’ despite feeling well ( Jamison, 2006 ). This is recognised as a deterrent for their motivation to initiate drug treatment and lifestyle changes ( Williams, 2013 ), presenting a greater challenge to health professionals, which can be addressed through concordance strategies. However, having taken Jane's bloods, electrocardiogram and urine albumin:creatinine ratio in the first consultation, it was evident that there was no target organ damage and her Qrisk3 score was calculated as 3.4%. These results provided reassurance for Jane, but she was keen to engage and prevent any potential complications.

Agreeing treatment

Concordance is only truly practised when the patient's perspectives are valued, shared and used to inform planning ( McKinnon, 2013 ). The trainee advanced nurse practitioner now needed to use the information gained from the consultations to formulate a co-produced and meaningful treatment plan based on the best available evidence ( Diamond-Fox and Bone, 2021 ). Jane understood the risk associated with high blood pressure and was keen to begin medication as soon as possible. NICE guidelines ( 2019 ; 2022 ) advocate the use of an angiotensin-converting enzyme (ACE) inhibitor or angiotensin-receptor blockers in patients under 55 years of age and not of Black African or African-Caribbean origin. However, ACE inhibitors seem to be used as the first-line treatment for hypertensive patients under the age of 55 years ( O'Donovan, 2019 ).

ACE inhibitors directly affect the renin–angiotensin-aldosterone system which plays a central role in regulation of blood pressure ( Porth, 2015 ). Renin is secreted by the juxtaglomerular cells, in the kidneys' nephrons, when there is a decrease in renal perfusion and stimulation of the sympathetic nervous system ( O'Donovan, 2018 ). Renin then combines with angiotensinogen, a circulating plasma globulin from the liver, to form angiotensin I ( Kumar and Clark, 2017 ). Angiotensin I is inactive but, through ACE, an enzyme present in the endothelium of the lungs, it is transformed into angiotensin II ( Kumar and Clark, 2017 ). Angiotensin II is a vasoconstrictor which increases vascular resistance and in turn blood pressure ( Porth, 2015 ) while also stimulating the adrenal gland to produce aldosterone. Aldosterone reduces sodium excretion in the kidneys, thus increasing water reabsorption and therefore blood volume ( Porth, 2015 ). Using an ACE inhibitor prevents angiotensin II formation, which prevents vasoconstriction and stops reabsorption of sodium and water, thus reducing blood pressure.

When any new medication is being considered, providing education is key. This must include what the medication is for, the importance of taking it, any contraindications or interactions with the current medications being taken by the patient and the potential risk of adverse effects ( O'Donovan, 2018 ). Sharing this information with Jane allowed her to weigh up the pros and cons and make an informed choice leading to the creation of an individualised treatment plan.

Jamison (2006) placed great emphasis on sharing information about adverse effects, because patients with hypertension feel well before commencing medications, but taking medication has the potential to cause side effects which can affect adherence. Therefore, the range of side effects were discussed with Jane. These include a persistent, dry non-productive cough, hypotension, hypersensitivity, angioedema and renal impairment with hyperkalaemia ( Hitchings et al, 2019 ). ACE inhibitors have a range of adverse effects and most resolve when treatment is stopped ( Waterfield, 2008 ).

Following discussion with Jane, she proceeded with taking an ACE inhibitor and was encouraged to report any side effects in order to find another more suitable medication and to prevent her hypertension from going untreated. This information was provided verbally and written which is seen as good practice ( Green, 2015 ). Jane was followed up with fortnightly blood pressure recordings and urea and electrolyte checks and her dose of ramipril was increased fortnightly until her blood pressure was under 140/90 mmHg ( NICE, 2019 ; 2022 ).

Conclusions

Adherence to medications can be difficult to establish and maintain, especially for patients with long-term conditions. This can be particularly challenging for patients with hypertension because they are generally asymptomatic, yet acquire a sick label and start lifelong medication and lifestyle adjustments to prevent complications. Through adopting a concordant approach in practice, the outcome of adherence can be increased. This case study demonstrates how concordant strategies were implemented throughout the consultation to create a therapeutic patient–professional relationship. This optimised the creation of an individualised treatment plan which the patient engaged with and adhered to.

• Hypertension is a growing worldwide problem
• Appropriate clinical assessment, diagnosis and management is key to prevent misdiagnosis
• Long-term conditions are associated with high levels of non-adherence to treatments
• Adopting a concordance approach to practice optimises adherence and promotes positive patient outcomes

CPD reflective questions

• How has this article developed your assessment, diagnosis or management of patients presenting with a high blood pressure?
• What measures can you implement in your practice to enhance a concordant approach?