Hypertension Case Study

Case Study 4- Hypertension Finished
Hsiaoling Alice Ko
Patient Name: Cookie, Sander
Age: 54 years old
Weight: 160lbs 73kg
Height: 5'6ft 168cm 66 inches
UBW: 170lb. 77.1kg
CW: 160lb. 72.6kg
% Weight Change:
Current weight-usual weight/usual weight x 100
((160-170)/170)x100
= 5.8% intentional weight lost
BMI:
(160lb/(66in)^2) x 703
= 25.8 Overweight
RMR:
Female (10xkg) + (6.25xcm) - (5xage) – 161
(10 x 73kg) + (6.25 x 168cm) – (5 x 54yo) – 161
= 1349kcal
TEE
with activity factor of 1.4 because of walking 30 minutes 4-5 times a week.
= 1349 x 1.4
= 1888.8kcal
EPR:
73kg
.8 unstressed gm/kg/day
73kg x .8
=58.4gm protein
Interpretation of Diet hx:
High levels of sodium, saturated fat, total fat intake. Low levels of all essential vitamins and mineral intake. High levels of calorie intake.

Drug Interpretation:
None

Lab Interpretations:
High Bun level 20
High Glucose at 115
High bilirubin at 1.1
High cholesterol at 270
High LDL at 210
High Apo B at 140
Low HDL at 30
Low Apo A at 75
High Triglyceride at 150


Med/Social hx/Physical Assessment:
Hx: HTN, fx of mother HTN, drinks alcohol, use to smoke 2-packs a day. Ruled out metabolic syndrome, BMI of 25.8 overweight. Consumes excess sodium and saturated fat, began a walking program which resulted in 10 pounds weight loss.
ADIME
A.
54y.o female hx. Stage 2 HTN; ht 5ft 6in; wt 160lb; BMI 25.8 overweight. Patient lost 10lbs due to a walking program, use to be a 2 pack a day smoker, currently drinks 2-4 years a week. Patient is on a high salt and fat diet. No c/o of symptoms related to HTN. TEE: 1888.8kcal; EPR: 58.4gm/day
Lab Interpretation
High Bun level 20
High Glucose at 115
High bilirubin at 1.1
High cholesterol at 270
High LDL at 210
High Apo B at 140
Low HDL at 30
Low Apo A at 75
High Triglyceride at 150

D.
PES#1
Excessive sodium intake related to higher risk of HTN evidenced by systolic of 160 mmHg and diastolic 100mmHg

PES#2
Food nutrition knowledge deficient related to hypertension evidenced by constant intake of alcohol and poor food choices.
I.
A goal for the PES statement is reduce salt intake to lower the risk of hypertension in the patient. Introduce patient to the DASH diet and encourage patient to follow the diet as mush as possible to enforce healthy eating related to hypertension. Provide sample meal plans of the DASH diet. A goal for the PES statement is to provide nutrition education on hypertension. Educate patient on health consequences of excessive alcohol intake related to hypertension.

M/E.
Evaluate weight and BMI regularly I would also re-evaluate her whole lipid profile to see if there are decreases. I would also re-educate her on the DASH diet and provide more sample meals, as well as communicate about possible barriers and complications on following the diet plan.




Case Questions I. Understanding the Disease and Pathophysology
Define blood pressure and explain how it is measured.
Blood pressure is the forces that the blood flow is exerted on the walls of the blood vessels during contraction of the ventricles. There are two of blood pressure, the systolic blood pressure, which is exerted during contraction of the ventricles and the diastolic blood pressure, which is the force exerted during relaxation of the ventricles. An instrument that measures blood pressure is the Sphygmomanometer. Blood pressure is measured by the stroke volume, which is the volume of blood ejected with each contraction of the left ventricle. The stroke volume is regulated by the end diastolic volume (EDV), mean aortic blood pressure (MAP), and strength of ventricular contractions. EDV refers to the amount of blood in the ventricle at the end of diastole. A measurement of blood pressure is expressed using the reading for systolic pressure as the first number, and the diastolic pressure as the second number.
How is blood pressure normally regulated in the body?
Blood pressure is regulated by the combination of cardiac output and total peripheral resistance. MAP needs to be regulated so it is high enough to force blood through the systemic circulation, but it can't be so high that it'll cause vascular damage. The regulation of MAP involves pathetic nervous system, the renin-angiotensin-aldosterone system, and renal functions. All three of these can affect the cardiac output, therefore they can affect the blood pressure. The cardiac output is the heart rate multiplied by the stroke volume. The heart rate is dependent on the balance between parasympathetic activity and the sympathetic activity. The resistance is dependent on the radius of all arterioles, length of the vessel, and the blood viscosity.
What causes essential hypertension?
Hypertension is the chronic elevation in blood pressure. Essential hypertension, also known as primary hypertension is idiopathic, which means there is no known cause. However, essential hypertension is the most common as it accounts for 90% of all cases of high blood pressure. Even though it is unkown, essential hypertension may be the result of a variety of factors including lifestyle factors such as diet (excessive sodium intake, low potassium intake, excessive alcohol intake), lack of exercise, smoking, stress, and obesity.


What are the symptoms of hypertension?
There are no symptoms of hypertension, the only way to find out if you have high blood pressure is to get the blood pressure checked on a regular basis. Hypertension affects so many Americans mostly because it is often not diagnosed in the early stages due to lack of symptoms. This causes hypertension to be known as the "silent killer".
How is hypertension diagnosed?
In order to be diagnosed with hypertension, a detailed history and physical examination of the patient to identify risk factors. Blood pressure is measured. The doctor will look at both the systolic blood pressure and the diastolic blood pressure. A reading greater than or equal to 140/90 mmHg is considered hypertensive.
List the risk factors for developing hypertension.
Some risk factors for developing hypertension could be age, ethnicity, family history, being overweight or obese, not being physically active, smoking, excessive salt intake, low potassium intake, excessive alcohol intake, stress, chronic conditions such as high cholesterol, diabetes, and kidney disease.
What risk factors does Mrs. Sanders currently have?
Some risk factors that Mrs. Sanders have include family history (mother died of MI related to uncontrolled HTN), history of smoking 2 packs a day, excessive alcohol intake of 2-4 beers a week, African American female, overweight of BMI 25.8, high cholesterol level of 270, and excessive salt intake.
Hypertension is classified in stages based on the risk of developing CVD. Complete the following table of hypertension classifications.
Case 4 Hypertension and Cardiovascular Disease 41

Blood Pressure mmHg
Category
Systolic BP

Diastolic BP
Normal