Nursing 22

  Client Profile Mr. Cowen's employer-sponsored a loose rank hurry (BP) screening program for its employers. Mr. Cowen's BP is 160/90 mm Hg when measured delay a comprehensive BP cuff. The comfort observes that the client is overweight. The comfort assesses the client for lavish factors for Hypertension and learns that Mr. Cowen sits at a desk all day covet answering telephone calls from customers delay questions encircling the use of the company's computer tenderware. He does not exertion recurrently and admits that he does not ensue a appropriate nourishment stating, "My consort is a majestic mistake. I'll eat anything she puts in face of me. At ignorance I love to bear a snack suitableness I wake television." The client denies tobacco and recreational refuse use and reports drinking "socially". " I bear indecent of five beers on the weekend wakeing the football sport." Mr. Cowen does not catch any recipe medications or herbal supplements but reports prelude "Tylenol on form when I bear a debauchery." The comfort chronicles Mr. COwen's BP and imparts the client the lection materials delay instructions to form an enactment delay his elementary bloom foresight producer (HCP) as early as potential for a further perfect impost and to debate bargainment options. Case study Mr. Cowen calls his elementary HCP to schedule an enactment.  Before the enactment, Mr. Cowen goes to a persomal laboratory and has a rotation of rank tests drawn as prescribed by the HCP.   At his enactment delay the HCP, the comfort weighs Mr. Cowen. He is 5 feet 9 inches towering and weighs 225 pounds. Mr. Cowen's BP is 166/92 mm Hg delay a comprehensive cuff in the exact arm and 168/96 mm Hg in the left arm. His character trounce is 84 beats per searching delay a recurrent rhythm, respiratory trounce is 18, and he is afebrile. His entirety cholesterol is 260 mg/dL. During the bloom truth impost, the HCP learns that Mr. Cowen drinks at smallest indecent to six ounces of recurrent coffee per day and that his senior has coronary artery disappoint and Hypertension. Mr. Cowen denies sensitiveness pressure consequently of his job, homogeneity delay his consort and extraction, or other factors. "I am a tolerably laid tail guy. I am not worked up or wandering encircling plenteous. I liberty that worrying to my consort." The HCP notes that Mr. Cowen carries the preponderance of his importance in his preferable substance. He has an increased total of subcutaneous fat about his waist and his abdomen. The HCP prescribes Hydrochlorothiazide (HCTZ) daily for the client and askes the comfort to produce Mr. and Mrs. Cowen delay instructions respecting the advice and lifestyle modifications. A ensue-up enactment is scheduled for one month. Questions 1. Briefly expound what the systolic and diastolic BP lections evidence? 2. According to the Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Rank Hurry (JNC 8), what is the restriction of prehypertension, range 1 HTN, and range 2 HTN? Describe elementary and minor HTN. Based on Mr. Cowen's clinical manifestations and truth, how would you collocate his HTN, and does he bear elementary or minor HTN? 3. Genetrounce at smallest 5 questions the comfort should ask the client to assess for the potential symptoms of HTN. 4. Fix Mr. Cowen's lavish factors for HTN. Evidence which of the client's lavish factors are nonmodifiable and which are modifiable. 5. Mr. Cowen asks the comfort, "Is my cholesterol that bad? What should my aggregate be?" How should the comfort meet? 6. The HCP prescribes Hydrochlorothiazide for Mr. Cowen. Debate the benefits of monotherapy delay Hydrochlorothiazide to bargain the client's HTN. 7. The comfort is providing Mr. Cowen delay instructions respecting his newly prescribed HCTZ. What are the most vulgar impertinent proceeds of HCTZ that Mr. Cowen should mentor and what should Mr. Cowen do if he forgets to catch his daily dose of medication as prescribed? 8. The comfort warns Mr. Cowen not to break the medication abruptly.  Briefly expound why the comfort offers this providence? 9. The comfort is providing Mr. and Mrs. Cowen delay instructions respecting lifestyle modifications to acceleration curtail the client's HTN. Fix at smallest 2 points of debateion the comfort achieve conceive in the instruction intent? 10. In guidance appoint, fix 5 nursing diagnoses the comfort achieve conceive in the instruction intent? 11. One month subjoined, Mr. Cowen receipts for a ensue-up enactment delay his HCP. His BP is 138/82. The comfort congratulates Mr. Cowen on his good-fortune and asks him encircling his acquiescence delay the DASH nourishment. He states, "I don't love it but I am ensueing it as you said. My consort has been guardianship a bar eye on me and anything that I eat. She walks delay me perfect ignorance to impart me the expedite I scarcity to exertion." To fix his acquiescence delay the DASH nourishment, the comfort asks him to foreclosure his last 3 moderations and any snacks. Which moderation or snack is smallest disposed delay the DASH nourishment and what opinion(s) can the comfort allude-to? Breakfast: a bowl of whole-grain cereal delay low-fat calm, a banana, and a glass of orange-flame-flame juice Lunch: roast beef sandwich on colorless meat delay mayonnaise and a tender drink Dinner: fish, mistakeed vegetables, brown rice, and a glass of low-fat calm Snack: a toasted mass of meat delay grape jelly