Case Study Analysis: Hypertension, Hyperlipidemia and Patient Care

This case study examines a patient, Beryl, diagnosed with hypertension and hyperlipidemia. It applies the clinical reasoning cycle to plan and assess appropriate patient care, focusing on the priority problems of high blood pressure and elevated cholesterol. The study details nursing interventions, including blood pressure assessment, stress reduction techniques, nutrition education, and increased physical activity. It emphasizes the importance of lifestyle modifications and patient education in managing these conditions, highlighting the role of nurses in monitoring, educating, and supporting patients to improve their health outcomes. The analysis underscores the need for comprehensive care plans tailored to individual patient needs, promoting cardiovascular health and preventing complications. The assignment provides a comprehensive overview of the conditions, their management, and the crucial role of nursing interventions.

Running head: CASE STUDY 1
Case study
Name
Institution

CASE STUDY 2
Hypertension and Hyperlipidemia
Introduction
Hypertension, also known as high blood pressure is a medical condition that causes a rise
in the blood pressure within the arterial walls of an individual. According to Harrison et al.
(2011), some people may have this condition for long periods without showing any symptoms
until it gets so severe to the point that it becomes life-threatening (p. 134). Hyperlipidemia, on
the other, is a condition that leads to an increase in the amount of cholesterol or fat proteins the
in an individual’s bloodstream. These two conditions are more prevalent among the elderly as
shoe by the presented scenario of Beryl. This essay aims at applying the clinical reasoning cycle
in planning and assessing the most appropriate patient care. Additionally, the essay talks about
the patient’s priority problems and the necessary nursing interventions to address each of these
problems. We will pay particular attention to hypertension and hyperlipidemia as the two main
priority problems.
Hypertension
Hypertension is a condition of a high blood pressure that causes several health
complications. It can even cause heart attack, stroke, and even death in the worst case scenarios.
Medical guidelines describe hypertension as any blood pressure that is higher than 130/80
mmHg. The amount of blood that the heart can pump and the magnitude of resistance offered by
the arterial walls to blood flow is what defines blood pressure. As Harrison et al. ascertain
(2011), blood pressure rises when the heart pumps more blood but the walls of the arteries are
narrow (138). There are two types of hypertension that include primary and secondary
hypertension. Primary hypertension tends to gradually develop in someone over a long period of

CASE STUDY 3
time. Secondary hypertension, on the other hand, develops as a result of some underlying
conditions such as sleep apnea, thyroid problems, and kidney problems (Pedrosa et al., 2011, p.
813).
As previously stated, the symptoms of hypertension may fail to reveal themselves in
some instance.an inflatable arm cuff can, however, be placed around a patient’s arm to measure
their blood pressure. Several studies reveal that the normal blood pressure should be 130/80
mmHg (Mitchel, 2014, p. 15). Beryl’s blood pressure conversely is 160/95 mmHg as revealed by
the nursing assessment. This value is extremely high which could indicate that Beryl has stage 2
hypertension.
Nursing Interventions
The main aim of these nursing interventions is to lower the patient’s blood pressure and
ensure that it is maintained at a normal range. Like in Beryl’s case, her blood pressure should be
lowered to below 140/90 mmHg. According to Hacihasanoğlu & Gözüm (2011), these
interventions always focus on modifying the lifestyle of all the patients with conditions of
prehypertension and hypertension (p. 695). In the following paragraphs, we will discuss some of
the nursing interventions for hypertension.
Blood Pressure Assessment
The most important thing to identify before you start treating a patient with hypertension
is their blood pressure. Assessing and monitoring a patient’s blood pressure, are very significant
as they aid in obtaining a baseline, scrutinizing the variations in the blood pressure, diagnosing
the condition, and to administer medication among others (Li et al., 2012, p. 780). The two main

CASE STUDY 4
ways of performing assessment and monitoring of blood pressure are invasive and non-invasive
measurements (Weber et al., 2014, p. 17).
The nurse is required to explain to the patient what they intend to do before they can
embark on this procedure. As Li et al. (2012), confirms, this explanation helps the patient to
become comfortable and relaxed to avoid any form of distress (p. 782). The attending doctor or
the registered nurse must also note whether the patient might have been using any form of
medication that could raise their blood pressure.
The significance of this intervention lies in the fact that it helps in lowering the blood
pressure thus preventing hypertension and other heart-related complications. This intervention is
additionally fundamental in monitoring cardiovascular hemostasis. It is worth noting that
assessment and monitoring of the blood pressure, gives both the nurse and the patient to assess,
discuss and decide the probable treatment outcomes (Mirhosseini, Baradaran & Rafieian-Kopaei,
2014, p. 758). Through this intervention, the nurse can effectively establish the most appropriate
treatment plan and even adjust drugs and medication if the need arises. Furthermore, assessment
of the blood pressure gives the nurse the opportunity of observing any complications and
recommending emergency treatment.
Beryl’s blood pressure, as documented in the nursing assessment form is 160/95 mmHg
which is extremely high. This blood pressure, therefore, needs close observation to avoid any
other complications like stroke or death at worse. The registered nurse tasked with caring for
Beryl should, therefore, assess this blood pressure and develop an appropriate treatment plan.
Decrease Stress

CASE STUDY 5
It is important to always avoid a stressful life in order to reduce chances of hypertension
and any other heart-related conditions. Several medical studies have revealed that stress may
cause temporary spikes in an individual’s blood pressure (Lin et al., 2012, p. 8). As revealed by
Grenard et al. (2011), stress may cause long-term hypertension (p. 1177). From the presented
scenario of Beryl, we notice that depression may force a patient to engage in some self-
destructive activities like non-adherence to medication. Beryl has medication that she uses to
control her blood pressure but she sometimes fails to take them due to depression. The control
and management of stress are thus important to help in preventing spikes in the blood pressure.
Nonetheless, it is important to note that decreasing stress may not directly reduce blood
pressure (Persell, 2011, p. 1078). Applying some strategies aimed at reducing stress can
massively improve health. These strategies can influence some behavioral changes in a patient,
which may help in managing hypertension and lower blood pressure.
There are several ways that can be used to lower stress and control blood pressure under
the advisement of the registered nurse. One of the ways is through the simplification of one’s
schedule (Parekh, J., Corley, D. A., & Feng, 2012, p. 2181). The revelations from Beryl’s
assessment form indicate that her schedule is very tight and it involves working with 8am-5pm
on a daily basis. She, therefore, does not have some time to relax and spend some quality time
with her family. She, therefore, needs the nurse to tell convince her that her life should be her
main priority. She could be further advised on some of the ways she could use to simplify her
schedule. Exercise is another very crucial aspect of stress management and thus Beryl should
spend some time exercising to get her mind off a lot of things. Additionally, if by any chance
she is sleep deprived, then it would be necessary to get enough hours of sleep every day.

CASE STUDY 6
Hyperlipidemia
Hyperlipidemia is a condition that leads to high cholesterol or fat protein levels in an
individual’s bloodstream. According to Eliopoulos (2013), elevated levels of lipids in one’s
bloodstream increases the risks associated with coronary heart diseases. As Mirhosseini,
Baradaran & Rafieian-Kopaei (2014), confirm, there are two main abnormalities of lipids that
are linked to hyperlipidemia. These abnormalities are hypercholesterolemia and
hypertriglyceridemia. Hypercholesterolemia is characterized by elevated levels of cholesterols
while hypertriglyceridemia can be defined as having increased levels of triglycerides in the blood
(p. 758). Having increased levels of blood cholesterol can lead to some heart-related conditions
like cardiovascular diseases (Nelson, 2013, p. 198). This happens because the cholesterol gets
deposited on the arterial walls making the arteries narrow.
This condition is detected when a doctor performs a blood test referred to as lipid profile
on the patient. Just like hypertension, hyperlipidemia may also lack obvious symptoms until the
condition gets severe. The lipid profile test, therefore, is aimed at determining the levels of blood
cholesterol. A normal amount of blood cholesterol is considered to be 0.05mmol/L. it is
additionally important to note that the normal amount of high-density lipoprotein is considered to
be 3.3mmol/L (Eliopoulos, 2013). It is preferable to have a higher quantity of high-density
lipoprotein because it is described as good cholesterol. Low-density lipoprotein which is
considered to be bad cholesterol should, on the other hand, be lower than 5.5mmol/L. From
Beryl’s pathology results, we realize that she has a cholesterol level of 6mmol/L which is
exceedingly high. Additionally, her high-density lipoprotein value is lower than the normal value
at 0.8mml/L. we can further notice that her low-density lipoprotein is however within the normal

CASE STUDY 7
range at around 3.2mm /L. These assessment results could be a clear indication of a condition of
hyperlipidemia.
Nursing Intervention
Nursing interventions can be classified as independent or collaborative, direct and
indirect. Independent nursing interventions are those interventions that are endorsed by the
professional nurse practice acts and may, therefore not require directions from other healthcare
professionals. In the paragraphs below, we will discuss two nursing interventions that include
nutrition education and increased physical activity.
Nutrition Education
There are numerous dietary factors that affect the level of an individual’s blood
cholesterol. However, Last, Ference & Falleroni (2011), confirm that a reduction in the
consumption of saturated fats is the most important strategy for ensuring reduced levels of lipids
in the blood. The nurses need to be educated on several aspects that include nutrition education,
patient counseling, and skills of dietary assessment (Tietge, 2014, p. 95). This ensures that the
nurses can efficiently implement the strategies that are necessary for the treatment of
hyperlipidemia. It is then the responsibility of the nurses to enlighten the public on healthy diets
that are low in saturated fats to lower hyperlipidemia-associated risks. As revealed by Baljani,
Rahimi, Amanpour, Salimi & Parkhashjoo (2011), nutrition education can inspire the patients
and their families to consume more fruits and vegetables in place of already processed food.
This, therefore, helps them to develop a clear perspective of health and wellness.
From the case study provided in Beryl’s scenario, it is clear that she never has time to
prepare her food and instead buys take away food for her dinners. We are further informed that

CASE STUDY 8
during lunch hours, she often consumes a large muffin and full cream milk coffee. This diet is
clearly unhealthy and it has led to elevated levels of blood cholesterol. The importance of this
intervention can, therefore not be understated because it helps to lower the number of lipids and
maintain the level of blood cholesterol within the normal range (Baljani et al, 2011).
Increased Physical Activity
Physical activities are important in an individual’s daily routine because it is one of the
crucial risk factors for coronary heart disease. Gao et al. (2012), ascertain that engaging in
regular aerobic exercises is important as it helps in managing the levels of blood cholesterol (p.
55). The effectiveness of exercises, however, depends on a healthy diet. Exercising for around
120-150 minutes on a weekly basis is recommended for a start. For better results, every
exercising session should last around 40 minutes. As Tucker et al. (2013) confirm, physical
activities help to boost lipoprotein profiles as it helps to reduce the levels of triglycerides and
increase the levels of high-density lipoprotein (p. 540). It is further important to note that
physical exercises help to reduce the LDL-to-HDL ratio.
There are numerous methods an individual, with the help of a nurse, can use to integrate
physical activities into their daily routine. Some of these methods include running up and down
the stairs, cycling, dancing, and preferring to walk over taking a car or bus for short distances
among others (Navar-Boggan et al., 2014, p. 455). These physical activities should be aimed at
maximizing the benefits with much-reduced risks if worsening a patient’s physical or health
conditions. The nurse must, therefore, advise the patient on any possible concerns related to a
specific physical activity to ensure patient safety and quality care (Wong et al., 2012, p. 567).

CASE STUDY 9
From the presented scenario, we are told that Beryl rarely engages in any form of
exercise but occasionally taking a walk to the local restaurant. The lack of routine physical
activity in addition to her poor eating habits has put her at a risk of developing hyperlipidemia.
We are additionally informed that she drives to work and packs just next to her office, an
indication that she does not walk for long distances. It would, therefore, be important if she
engaged in more physical activities to help reduce the level of blood cholesterol and maintain it
at a normal range (Wong et al., 2012, p. 570). Using other forms of medication to reduce the
levels of lipids can, however, cause discomfort with this intervention thus making it a challenge
in some cases.
Conclusion
Hypertension is a condition that leads to increased levels of blood pressure within an
individual’s arterial walls. Hyperlipidemia, on the other hand, leads to elevated levels of blood
cholesterol in the body. These two conditions could be life-threatening and they, therefore,
require care and seriousness when managing them to avoid other critical conditions like stroke
and cardiovascular disease. They, in most cases, arise as a result of lifestyle choices such as poor
eating habits and lack of exercise. Other factors like stress and depression can also cause
hypertension and hyperlipidemia. There are however some nursing interventions that can be
appropriately applied to help in controlling and managing these conditions to improve the quality
of care and enhance patient safety. The nursing interventions include physical activities,
nutritional education, and stress reduction among others. They help in improving health and
educating the patients on the ways of handling the diseases.

CASE STUDY 10
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CASE STUDY 11
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