Nursing Priorities for Hypertension and Osteoarthritis Patient

This case study assignment discusses nursing priorities for a patient with hypertension and osteoarthritis. It suggests medication therapy and lifestyle changes for hypertension and physiotherapy for osteoarthritis.

Running head: CASE STUDY ASSIGNMENT
CASE STUDY PART B
Name of the student:
Name of the university:
Author note:

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CASE STUDY ASSIGNMENT
Part B:
One of the most important nursing priorities identified for the patient is hypertension. It
was very important for the nursing professional to tackle the condition of hypertension as it acts
as the risk factor for serious health disorders like strokes and cardiovascular disorders. The first
nursing intervention is application of medication therapy to help the patient manage his blood
pressure successfully within the limits. The nurses can prescribe Leonard to have Angiotensin-
converting enzyme (ACE) inhibitors like that of lisinopril (Zestril), benazepril (Lotensin),
captopril (Capoten) or others. Studies are of the opinion that these medications help in relaxing
the blood vessels by blocking the formation of the natural chemical called angiotensin II that
causes narrowing of the blood vessels (Wang et al. 2017). The nurses can also prescribe the
medications of the group Angiotensin II receptor blockers (ARBs) like that of the candesartan
(Atacand), losartan (Cozaar). These medications are slightly different from the previous set of
medications where they help in relaxing the blood vessels not by blocking the formation but by
blocking the action of angiotensin II (Pai et al. 2016). The nurse might also suggest another
group of medications like the calcium channel blockers that include amlodipine (Norvasc),
diltiazem (Cardizem) and similar others. The medications help in relaxing the muscles of the
blood vessels and also contribute in slowing down the heart rates. However, the nurse should
educate Leonard about the side effects of the medication and warn him about different
contraindications. The nurse can prevent the patient from having grape juice. Studies suggest that
grape juice might interact with calcium channel blockers and this would increase blood levels of
the medication and put the life of the patient at risk. Hence, prescribing proper medication and
educating Leonard about the correct doses of the medication, its side effects and
contraindications would help him to manage his high blood pressure. Another very important

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CASE STUDY ASSIGNMENT
intervention that nurse need to take for managing hypertension in the patient is to educate him
about the importance of maintaining proper lifestyle and healthy behaviors. Leonard has been
seen to stop cooking and resides on fast foods and take-away foods. Such foods are high on
calories that increase chances of developing high blood pressure (Jiang et al. 2016). Sedentary
lifestyle and heavy body weight often contributes to development of hypertension (Susic and
Varagic 2017). Leonard’s body weight has increased by 5-6 kgs and he is also living sedentary
lifestyle within his house only. The nurse in such situation should educate him about the
importance of eating a healthy diet with more greens and fibers, less fatty foods and meat and
foods with less salt. He should be also educated about importance of physical activities,
marinating a healthy body weight and living an active life to reduce chances of hypertension.
Another important nursing priority would be management of his condition of
osteoarthritis, regain back his mobility and prevent any chances of fall. The nurse should be
allocating a physiotherapist for Leonard. The physiotherapy would be working collaboratively
with the nurse and apply physical therapy. This therapy would mainly help in reduction of the
pain, swelling as well as stiffness of the knee osteoarthritis helping in improving the knee joint
function. This makes it easier for the patient in walking bending. Kneeling and sitting ad
squatting. Walsh et al. (2017) has found that combination of manual physical therapy as well as
supervised exercises can result in delaying or preventing the requirement of surgery (Gwynne-
Jones et al. 2018). This approach would help Leonard overcome his pain in the joints and regain
back his mobility. The physical therapy can be passive where the physiotherapists would do most
of the work like cold therapy, heat therapy and hydrotherapy. Cold therapy reduces circulation
thereby reducing swelling whereby heat therapy increases blood flow for decreasing muscle
stiffness. The other aspect is the active treatments which need to be done by Leonard by himself.

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CASE STUDY ASSIGNMENT
These are the strengthening exercises which would be shown by the expert and would be done by
the patient at home for strengthening the muscles. The other component of active therapy would
be flexibility therapy and this helps in increasing the range of motion (Hoffman et al. 2015). This
would make Leonard’s knees more flexible and help in restoration of the normal knee joint
function. When Leonard would be able to regain his mobility the chances of fall would
automatically cease. However, the nurse would need to conduct an environmental assessment of
Leonard’s house and manage changes to it in ways by which chances of his fall can be reduced.
Light furniture should be removed as it increases chances of vulnerable patients getting toppled
over. The house of Leonard should only possess heavy furniture that would reduce chances of
fall. Attaching bed rails, bathroom rails, reducing the height of the bed are some of the changes
that need to be made. Clutters should be removed from the pathway and patients should be
provided with no-skid shoes and slippers to prevent chances of falls (Schnock et al. 2019). This
would reduce his chances of fall as well.

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CASE STUDY ASSIGNMENT
References:
Gwynne-Jones, D.P., Hutton, L.R., Stout, K.M. and Abbott, J.H., 2018. The joint clinic:
managing excess demand for hip and knee osteoarthritis referrals using a new physiotherapy-led
outpatient service. The Journal of arthroplasty, 33(4), pp.983-987.
Hoffmann, V.S., Neumann, L., Golgert, S. and von Renteln-Kruse, W., 2015. Pro-active fall-risk
management is mandatory to sustain in hospital-fall prevention in older patients-validation of the
lucas fall-risk screening in 2,337 patients. The journal of nutrition, health & aging, 19(10),
pp.1012-1018.
Jiang, S.Z., Lu, W., Zong, X.F., Ruan, H.Y. and Liu, Y., 2016. Obesity and
hypertension. Experimental and therapeutic medicine, 12(4), pp.2395-2399.
Pai, P.Y., Muo, C.H., Sung, F.C., Ho, H.C. and Lee, Y.T., 2016. Angiotensin receptor blockers (ARB) outperform
angiotensin-converting enzyme (ACE) inhibitors on ischemic stroke prevention in patients with hypertension and
diabetes—a real-world population study in Taiwan. International journal of cardiology, 215, pp.114-119.
Schnock, K.O., Howard, E.P. and Dykes, P.C., 2019. Fall prevention self-management among
older adults: a systematic review. American journal of preventive medicine.
Susic, D. and Varagic, J., 2017. Obesity: a perspective from hypertension. Medical Clinics, 101(1),
pp.139-157.
Walsh, N.E., Pearson, J. and Healey, E.L., 2017. Physiotherapy management of lower limb osteoarthritis. British
medical bulletin, 122(1), pp.151-161.

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CASE STUDY ASSIGNMENT
Wang, G.M., Li, L.J., Chen, Y.J., Wright, J.M. and Tang, W.L., 2017. Renin inhibitors versus
angiotensin converting enzyme (ACE) inhibitors for primary hypertension. The Cochrane
database of systematic reviews, 2017(2).