Clinical Reasoning Cycle: Hypertension and Hyperlipidemia Care

This essay presents a comprehensive nursing care plan for a patient with hypertension and hyperlipidemia, applying the clinical reasoning cycle for assessment, planning, implementation, and evaluation of care. It identifies hyperlipidemia and hypertension as the two priority problems, detailing nursing interventions for each. For hyperlipidemia, the interventions include nutrition education focusing on reducing saturated fats and encouraging increased physical activity to manage cholesterol levels. For hypertension, the interventions involve assessing and monitoring blood pressure regularly and decreasing stress through lifestyle modifications such as simplifying schedules and promoting exercise. The essay emphasizes the importance of lifestyle changes and continuous monitoring to manage these conditions effectively and prevent complications.

Running head: HYPERTENSION 1
Hypertension
Name
Institution

HYPERTENSION 2
Hypertension
Introduction
Hypertension is a medical condition also referred to as high blood pressure in which the
blood pressure within the arteries of an individual is elevated. It is possible to have this condition
for years without any symptoms until it gets severe and starts attacking target organs (Harrison et
al., 2011, p. 134). It is more prevalent among the elderly as is evident with Beryl’s case. In this
essay, we will apply clinical reasoning cycle to plan and assess the patient care required.
Additionally, we will talk about two priority problems for the patient and highlight nursing
interventions for each of the priority problems. We will particularly talk about the
hyperlipidemia and hypertension as the two priority problems.
Hyperlipidemia
Hyperlipidemia can be described as a high level of cholesterol or fat proteins in the
bloodstream of an individual. The presence of high level of lipids in the bloodstream increases
the risks of coronary heart disease (Eliopoulos, 2013). The two common abnormalities of lipids
that are associated with hyperlipidemia are hypercholesterolemia which refers to high levels of
blood cholesterols and hypertriglyceridemia which can be described as high levels of blood
triglycerides. If the levels of cholesterol in the bloodstream get elevated, they can get deposited
in the arterial walls and cause some heart-related conditions such as cardiovascular diseases
(Nelson, 2013, p. 198).
This condition rarely has symptoms and it is normally diagnosed when a doctor performs
a blood test known as lipid profile on the patient. The test is aimed at determining the levels of
cholesterol in the blood. Normally, 0.05mmol/L for cholesterol is considered normal in the lipid

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profile test. Additionally, a high-density lipoprotein of 3.3mmol/L is okay under normal
circumstances (Eliopoulos, 2013). High-density lipoprotein is considered as good cholesterol and
therefore its quantity should be high. Furthermore, low-density lipoprotein should be in the
region less than 5.5mmol/L. However, from the pathology results of Beryl, we notice that her
cholesterol level is 6mmol/L which is extremely high. Her high-density lipoprotein level is
0.8mmol/L which is lower than the normal value. The range of her low-density lipoprotein, on
the other hand, is 3.1mmol/L which can be considered as normal. These results indicate the
presence of hyperlipidemia.
Nursing Intervention
Classification of nursing interventions includes independent or collaborative, direct, and
indirect. Independent nursing interventions are the interventions that are sanctioned by the acts of
professional nurse practice and thus do not require directions from another healthcare
professional. The following two are some of the nursing interventions for hyperlipidemia;
nutrition education and encouraging the patient on increased physical activity.
Nutrition Education
There are several dietary factors that influence the level of blood cholesterol. It is,
however, important to note that reducing the consumption of saturated fats is the most beneficial
strategy for lowering the levels of lipids in the blood (Last, Ference & Falleroni, 2011). It is
crucial that nurses are educated on patient counseling, nutritional education, and techniques of
dietary assessment so that they can effectively implement the strategies required to treat
hyperlipidemia. The nurses are then required to educate the public on appropriate diets that are
low in saturated fats to reduce the risks associated with hyperlipidemia (Tietge, 2014, p. 95). It is

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also important to note that nutrition education can inspire the patients and their families to reach
for fruits and vegetables instead of already processed food. As a result, they are able to shape
their perspectives of wellness and health (Baljani, Rahimi, Amanpour, Salimi & Parkhashjoo,
2011).
From the evidence-based literature provide, it is clear that Beryl never gets time to
prepare healthy foods. She instead bus take away food for dinner and mostly takes a large muffin
and full cream milk coffee for lunch. This kind of diet has led to elevated levels of cholesterol in
her blood. The application of this intervention is therefore justified because will help to reduce
the number of lipids in the body and maintain the cholesterol level at a normal range (Baljani et
al, 2011).
Increased Physical Activity
Physical inactivity is a crucial risk factor for coronary heart disease there for consistent
physical activity is essential in an individual’s daily routine. It is important to engage in regular
aerobic exercises to help manage the levels of cholesterol (Gao et al., 2012, p. 55). Exercises are
however effective if they are accompanied by a healthy diet. The recommended time for exercise
is around 120-150 minutes every week. It is even more effective if every exercise session lasts
around 40 minutes. It is important to note that physical activities help to enhance lipoprotein
profiles (Tucker et al., 2013, p. 540). This is done through the reduction of triglyceride and the
increase of high-density lipoprotein. It also helps to lower the LDL-to-HDL ratio.
There are several techniques an individual can use to incorporate physical activity into
their routine. Some of these ways include cycling, running up and down the stairs, choosing to
walk instead of taking a car or bus for short distances and dancing among others (Navar-Boggan

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et al., 2014, p. 455). The program of the physical activity should be designed in such a way that
they will maximize the benefits with very minimal risks of aggravating the health or physical
condition of a patient. It is therefore imperative that the nurse advises the patient on any specific
concerns they might have regarding a particular physical activity (Wong et al., 2012, p. 567).
We are informed that Beryl rarely engages in any form of exercise apart from
occasionally walking to the local restaurant. This lack of exercise combined with her poor eating
habit has put her at a risk of hyperlipidemia. Additionally, she drives to work and parks just next
to her office and thus she rarely walks for longer distances. Increased physical activity is,
therefore, necessary to help in reducing and maintaining the levels of blood cholesterol and a
normal range. One challenge however to this intervention is that if an individual is using other
medications to lower the lipid level then they might experience some muscle discomfort.
Hypertension
Hypertension is also known as high blood pressure and it can cause numerous health
complications and even lead to heart attack, strong, and sometimes death. Hypertension,
according to medical guidelines is defined as blood pressure that exceeds 130/80 mmHg. Blood
pressure is defined by the amount of blood pumped by the heart and the amount of resistance
offered by the walls of the arteries to the flow of blood. Blood pressure increases when the heart
pumps more blood but the arterial walls are narrow (Harrison et al., 2011, p. 138). It is possible
to have hypertension for many years without discovering any symptoms. It is, however,
important to note that even in the absence of the symptoms, the damage to the vessels and the
heart continues and can be detected in some instance. There are two types of hypertension that
include primary hypertension that tends to develop gradually in an individual over the years. The

HYPERTENSION 6
other type is secondary hypertension that results from some underlying conditions that include
kidney problems, thyroid problems and sleep apnea among others (Pedrosa et al., 2011, p. 813).
As mentioned above, the symptoms of this condition may not reveal themselves during
the early stages. Blood pressure can, however, be measured using an inflatable arm cuff that is
placed around the arm of a patient. Normally, the blood pressure should be 130/80 mmHg
(Mitchel, 2014, p. 15). From the nursing assessment, Beryl’s blood pressure is revealed to be
160/95 mmHg. This value is extremely which is an indication of stage 2 hypertension.
Nursing Interventions
The goals of the nursing interventions should be aimed at lowering the blood pressure of
an individual and maintaining it at a normal range. The blood pressure should be reduced to
below 140/90 mmHg. The interventions normally focus around lifestyle modification for all the
patients suffering from prehypertension and hypertension (Hacihasanoğlu & Gözüm, 2011, p.
695). Below we will discuss some nursing interventions for patients with hypertension.
Assess and Monitor the Blood Pressure
It is important to know the level of a patient’s blood pressure before you start treating the
condition (Weber et al., 2014, p. 17). The assessment and monitoring of the blood pressure are
important to aid in acquiring a baseline, analyzing the fluctuations in the blood pressure,
diagnosing the disease, and to monitor medication among others (Li et al., 2012, p. 780). This
assessment and monitoring of the blood pressure can be done in two ways that include invasive
and non-invasive measurement.

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Before commencing on this procedure, it is important that the nurse explains to the
patient what they are about to do. This helps to ensure that the patient is relaxed and comfortable
so that they are not distressed(Li et al., 2012, p. 782). It is also important to note if the patient
takes any forms of medication that could raise their blood pressure.
This intervention is important because it helps in the treatment and prevention of blood
pressure and any related diseases. Additionally, it helps in monitoring the cardiovascular
hemostasis. It is also important to note that monitoring the blood pressure enables both the nurse
and the patient to assess the possible treatment outcomes (Mirhosseini, Baradaran & Rafieian-
Kopaei, 2014, p. 758). The nurse will effectively develop a treatment program that is appropriate
for the patient and adjusts drugs and medication if necessary. Furthermore, assessing and
monitoring the blood pressure enables a nurse to observe any complications and recommend
emergency treatment.
From the nursing assessment form, it is indicated that Beryl’s blood pressure is 160/95
mmHg. This value is extremely elevated and if not monitored appropriately may cause a stroke
or even worse, death. It is therefore important to assess this blood pressure and design a
treatment plan that suits Beryl.
Decrease Stress
Lowering stress is very fundamental in reducing hypertension and preventing any blood
pressure-related diseases (Lin et al., 2012, p. 8). Medical reports indicate that stressful situations
are responsible for temporary spikes in blood pressure. It is also worth noting that stress may
cause long-term hypertension (Grenard et al., 2011, p. 1177). Being depressed may lead to some
self-destructive behaviors like failing to take your medications to control blood pressure like is

HYPERTENSION 8
the case with Beryl. It is therefore important to control and reduce stress to prevent blood
pressure spikes and manage hypertension.
Decreasing stress may not necessarily reduce blood pressure directly but it is important to
note that applying some stress reduction strategies can tremendously improve health (Persell,
2011, p. 1078). These stress management strategies can help a patient have some behavioral
changes, some of which may help to manage hypertension and lower blood pressure.
There are several ways that a nurse can propose to a patient to help in lowering stress and
controlling blood pressure. The first strategy is simplifying one’s schedule (Parekh, J., Corley, D.
A., & Feng, 2012, p. 2181). From Beryl’s assessment form, we realize that she has a very busy
schedule that involves working daily from 8am-5pm. This is an indication that she rarely has
time to relax and spend maybe some time with her three kids. She, therefore, needs to be advised
on how she could simplify her schedule because her health should be her priority. Secondly, it is
important to exercise because exercising helps in stress reduction. Additionally, she needs to
have enough sleep if in any case, she is sleep deprived.
Conclusion
Hypertension and hyperlipidemia are life-threatening diseases that should be addressed
with care and seriousness to prevent other conditions like stroke and cardiovascular disease.
They are mostly caused by lifestyle choices like unhealthy eating habits. These conditions can,
however, be controlled and managed by applying the appropriate nursing interventions. These
nursing interventions help to improve health and educate the patients on how to handle these
diseases.

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