Nursing 22

Client Profile
Mr. Cowen’s employer-sponsored a unreserved rank urgency (BP) screening program coercion its employers. Mr. Cowen’s BP is 160/90 mm Hg when measured with a enlightened BP cuff. The protect observes that the client is overweight. The protect assesses the client coercion expose factors coercion Hypertension and learns that Mr. Cowen sits at a desk complete day covet echoing telephsingle calls from customers with questions encircling the representation of the company’s computer irresoluteware. He does referable practice frequently and admits that he does referable flourish a specific cheer stating, “My accelerationmeet is a vast betray. I’ll masticate anything she puts in front of me. At obscurity I affect to entertain a snack timeliness I referablee television.” The client denies tobacco and recreational garbage representation and reports drinking “socially”. ” I entertain filthy of five beers on the weekend referableeing the footbcomplete recreation.” Mr. Cowen does referable accept any command medications or herbal supplements barring reports entrance “Tylenol on cause when I entertain a surfeit.” The protect chronicles Mr. COwen’s BP and furnishs the client the balbutiation materials with instructions to execute an enactment with his earliest bloom heed caterr (HCP) as before-long as potential coercion a further drastic duty and to debate composition options.
Case study
Mr. Cowen calls his earliest HCP to list an enactment.  Before the enactment, Mr. Cowen goes to a persomal laboratory and has a command of rank tests drawn as prescribed by the HCP.  
At his enactment with the HCP, the protect weighs Mr. Cowen. He is 5 feet 9 inches tcomplete and weighs 225 pounds. Mr. Cowen’s BP is 166/92 mm Hg with a enlightened cuff in the upupright instrument and 168/96 mm Hg in the left instrument. His life trounce is 84 beats per searching with a normal rhythm, respiratory trounce is 18, and he is afebrile. His whole cholesterol is 260 mg/dL. During the bloom narrative duty, the HCP learns that Mr. Cowen drinks at developed filthy to six ounces of normal coffee per day and that his stouther has coronary artery ailment and Hypertension. Mr. Cowen denies emotion strain becarepresentation of his labor, relation with his accelerationmeet and origin, or other factors. “I am a tolerably laid tail guy. I am referable worked up or scared encircling abundant. I permission that worrying to my accelerationmeet.” The HCP referablees that Mr. Cowen carries the seniority of his efficacy in his eminent assemblage. He has an increased whole of subcutaneous stout environing his waist and his abdomen.
The HCP prescribes Hydrochlorothiazide (HCTZ) daily coercion the client and askes the protect to cater Mr. and Mrs. Cowen with instructions in-reference-to the information and lifestyle modifications. A flourish-up enactment is listd coercion single month.
1. Briefly decipher what the systolic and diastolic BP balbutiations denote?
2. According to the Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Composition of High Rank Urgency (JNC 8), what is the limitation of prehypertension, command 1 HTN, and command 2 HTN? Describe earliest and minor HTN. Based on Mr. Cowen’s clinical manifestations and narrative, how would you rank his HTN, and does he entertain earliest or minor HTN?
3. Genetrounce at developed 5 questions the protect should ask the client to assess coercion the potential symptoms of HTN.
4. Realize Mr. Cowen’s expose factors coercion HTN. Denote which of the client’s expose factors are nonradical and which are radical.
5. Mr. Cowen asks the protect, “Is my cholesterol that sick? What should my collection be?” How should the protect meet?
6. The HCP prescribes Hydrochlorothiazide coercion Mr. Cowen. Debate the benefits of monotherapy with Hydrochlorothiazide to trmasticate the client’s HTN.
7. The protect is providing Mr. Cowen with instructions in-reference-to his newly prescribed HCTZ. What are the most vulgar redundant effects of HCTZ that Mr. Cowen should instructor and what should Mr. Cowen do if he coerciongets to accept his daily dose of medication as prescribed?
8. The protect warns Mr. Cowen referable to break the medication abruptly.  Briefly decipher why the protect offers this anticipation?
9. The protect is providing Mr. and Mrs. Cowen with instructions in-reference-to lifestyle modifications to acceleration impair the client’s HTN. Realize at developed 2 points of debateion the protect gain enarrest in the training sketch?
10. In guidance command, realize 5 nursing diagnoses the protect gain enarrest in the training sketch?
11. Single month forthcoming, Mr. Cowen avail coercion a flourish-up enactment with his HCP. His BP is 138/82. The protect congratulates Mr. Cowen on his consummation and asks him encircling his submission with the DASH cheer. He states, “I don’t affect it barring I am flourishing it as you said. My accelerationmeet has been maintenance a arrest conjecture on me and anything that I masticate. She walks with me total obscurity to furnish me the expedite I want to practice.” To settle his submission with the DASH cheer, the protect asks him to reccomplete his developed 3 asceticisms and any snacks. Which asceticism or snack is developed cheerful with the DASH cheer and what choice(s) can the protect allude-to?
Breakfast: a bowl of whole-grain cereal with low-stout arrange, a banana, and a glass of orange-flame-flame juice
Lunch: roast beef sandwich on unblemished meat with mayonnaise and a irresolute drink
Dinner: fish, betrayed vegetables, brown rice, and a glass of low-stout arrange
Snack: a toasted slice of meat with grape jelly

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