Case Study Primary Hypertension
Patient Profile Frank Windsong is a 45-year-old man who has no previous history of hypertension. At a screening clinic, his BP was found to be 180/120 mm Hg.
Subjective Data
• Father died of stroke at age 60
• Mother is alive but has type 2 diabetes
• States that he feels fine and is not a “hyper” person
• Smokes one pack of cigarees daily
• Drinks a six-pack of beer on Friday and Saturday nights
• Does not enjoy physical activity
• Has had type 2 diabetes for 5 years and is nonadherent to his diabetic treatment plan
• Has been told that some medications interfere with sexual relationships
Objective Data
Physical Examination
• Moderately obese male
• Sustained apical impulse palpable in the fourth intercostal space, just
lateral to the midclavicular line
Diagnostic Studies
• ECG: left ventricular hypertrophy
• Urinalysis: protein 0.3 g/L
• Serum creatinine level: 141 mmol/L
Collaborative Care
• Low-sodium diet
• Hydrochlorothiazide (HCTZ) 12.5 mg daily PO
• Enalapril sodium (Vasotec) 5 mg daily PO
Discussion Questions
1. What risk factors for hypertension does Mr. Windsong have?
2. What evidence of target-organ damage is present?
3. What misconceptions about hypertension should be corrected?
4. What are the nursing priorities for Mr. Windsong? What resources are available to assist in promoting health for Mr. Windsong?
5. Priority decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems? How will they affect Mr. Windsong's treatment?
6. Evidence-informed practice: Mr. Windsong wants to know the most effective nonpharmacological strategies to lower his BP. What should the nurse tell him?