Cardiac: Hypertension

Case Study Patient: Mr. John Smith, a 65-year-old male Chief Complaint: Shortness of breath History of Present Illness: Mr. Smith presents to the emergency department with shortness of breath that has been getting worse over the past few weeks. He also reports fatigue, chest pain, and swelling in his ankles. He has a history of hypertension, which he has been taking medication for for the past 10 years. Past Medical History: Hypertension, hyperlipidemia, diabetes mellitus type 2 Social History: Mr. Smith is a retired construction worker. He smokes 1 pack of cigarettes per day and drinks alcohol occasionally. He is married and has two adult children. Physical Examination:

• Vital signs: BP 170/100 mmHg, HR 100 bpm, RR 22 bpm, SpO2 92% on room air
• General: Well-developed, well-nourished male in no acute distress
• HEENT: Pupils equal, round, and reactive to light; Sclerae anicteric
• Neck: No jugular venous distension
• Lungs: Decreased breath sounds at the bases
• Heart: Regular rate and rhythm, no murmurs, rubs, or gallops
• Abdomen: Soft, non-tender, non-distended
• Extremities: 2+ pitting edema in bilateral lower extremities

Laboratory Studies:

• Complete blood count: Within normal limits
• Blood chemistry: Sodium 135 mEq/L, potassium 4.0 mEq/L, chloride 100 mEq/L, bicarbonate 24 mEq/L, glucose 120 mg/dL, creatinine 1.2 mg/dL, BUN 15 mg/dL
• Creatinine clearance: 60 mL/min
• Urinalysis: Negative for protein, glucose, and blood
• Electrocardiogram: Left ventricular hypertrophy, sinus rhythm
• Chest X-ray: Cardiomegaly, pulmonary edema

Diagnosis: Hypertensive heart disease Treatment Plan:

• Medications:
  • ACE inhibitor
  • Beta-blocker
  • Diuretic
• Lifestyle modifications:
  • Smoking cessation
  • Weight loss
  • Increased physical activity
• Education:
  • Patient education about hypertension and its complications
  • Importance of taking medications as prescribed
  • Lifestyle modifications to reduce risk of further complications

Nursing Interventions:

• Monitor vital signs and fluid status
• Administer medications as prescribed
• Provide patient education about hypertension and its complications
• Encourage lifestyle modifications to reduce risk of further complications

Discussion Questions:

1. What are the risk factors for hypertension?
2. What are the laboratory and diagnostic findings that are consistent with hypertensive heart disease?
3. What are the medications that are commonly used to treat hypertension?
4. What are the lifestyle modifications that can help to reduce the risk of complications from hypertension?
5. What are the nursing interventions that are important for the care of a patient with hypertensive heart disease?

Conclusion: Mr. Smith is a 65-year-old male with a history of hypertension who presents with shortness of breath, chest pain, and swelling in his ankles. His physical examination and laboratory studies are consistent with hypertensive heart disease. He has been started on medications and has been given education about hypertension and its complications. He will be monitored closely for further complications.  

Sample Solution

History of Present Illness: Mr. Smith presents to the emergency department with shortness of breath that has been getting worse over the past few weeks.