RNSG 1261 Clinical Absence Assignment: Hypertensive Crisis Case Study

This case study analyzes the case of Mildred James, a 64-year-old patient presenting with a hypertensive crisis. The paper addresses the patient's symptoms, including a severe headache and visual problems, and discusses relevant diagnostic tests, such as blood pressure and glucose level assessments. It explores the potential causes of James' condition, including depression and high blood sugar, and examines factors that may lead to inaccurate blood pressure readings. The paper details clinical guidelines for preventing hypertension, various blood pressure levels, and the connection between high blood pressure and seizures. It further outlines nursing diagnoses, interventions, dietary recommendations, and foods to avoid for patients with hypertension, supported by APA-formatted references. The assignment fulfills the requirements of RNSG 1261, focusing on the analysis and management of hypertensive crises within a nursing context.

RNSG 1261 HTN C/S Plus 2 Hesi C/S – Clinical Absence Assignment. Summer 2018
Student Name: ________________________________ Date: ____________
RNSG 1261 Grading Rubric: Case Study Assignment Grading Criteria Sheet
Focus Clarification
Possible
Points
Points
Earned
Cover
sheet
Cover sheet to include name of student, name of case
study topic, Course #, name of College, Date, Name
of Instructor and credentials
5
Answers to
questions
of case
study
Answers all eight questions in a comprehensive
manner utilizing APA format, internal citation and
complete sentences without typographical errors
80
Reference
page
APA formatted with at least 3-4 references current
(within 5 years)
5
APA
format:
body of
paper and
reference
page
Paper should follow all APA formatting guidelines
(e.g. white paper, typed, 12-pt font, Times New
Roman, 1” margin, double spacing, first line of each
paragraph indented, header, internal citations,
spelling, grammar, and reference page formatted
correctly) with at least 3-4 current (within 5 years)
references. 3 to 4 pages in length, not including the
cover page and reference page. (Total = 6)
10
Total Possible Points 100
Attach and turn in this page with your paper!!

RNSG 1261 HTN C/S Plus 2 Hesi C/S – Clinical Absence Assignment. Summer 2018
Student Name
HYPERTENSIVE CRISIS
San Jacinto College Central School of Nursing
Date
Clinical Professor Name and Credentials

RNSG 1261 HTN C/S Plus 2 Hesi C/S – Clinical Absence Assignment. Summer 2018
Abstract
This paper is based on the case study of Mildred James who have been going through depression,
high blood pressure and high blood sugar. All these factors added up to her headache. She visited
the hospital with severe headache and nurse is diagnosing the cause of her for severe headache.
The paper also discussed few questions related to hypertension and the causes for it.
Objectives
This paper discusses about different objectives for hypertension and the ways to deal with it.
Signs and symptoms of the diseases. It focusses on the causes of the disease
Mildred James has been going through high blood pressure; this creates pressure in the cranium
resulting in the sudden increase in the blood pressure. The blood pressure rises to a critical level
causing headache or migraine.
The most common cause of headache for James might be vision problem. She might have
over used her eye muscle, which is giving her vision problem this further develops pain in the
eye as well in the head (Elfarra, Bean & Martin, 2016).
Diagnostic test that were significant
Significant values observed in case of James are excessive high glucose and blood pressure.
It has been noticed that James is going through anxiety that cause increase in blood
pressure. In case of James both of her systolic and diastolic blood pressure are significantly high.
Recent researches have shown that person-undergoing depression also undergoes high blood
sugar level. The brain neurotransmitter gets affected for an individual with high blood sugar

RNSG 1261 HTN C/S Plus 2 Hesi C/S – Clinical Absence Assignment. Summer 2018
therefore cause anxiety and depression (Nadruz, 2015). The blood glucose level for James is 151
mg/dl, which is very high from the normal range of 90-125 mg/dl. It is also seen that with the
increase in high blood sugar the brain neuropathy gets affect as well as block in blood vessel
occurs causing depression in the people.
James have been taking medication for high blood pressure and glucose however, the
level is still very high. It might be that the blood pressure reading was not taken properly for
James.
Diagnostic error that might cause the reading of blood pressure to be wrong
Factors that can hinder the correct assessment of blood pressure
Unsupported back/feet – The patient need to sit comfortably, the back of the patient
must be well supported and the feet must be flat on the floor else the blood pressure would show
an increase by 6 to 10 points (Stocchetti & Maas, 2015).
Wrong wrapping of cuff – Sometimes the cuff is wrapped wrong, that also gives wrong
pressure reading. The cuff must be wrapped in the bare arm.
Talking – The patient must be sitting quietly while recording the blood pressure. It has
been seen that a talking person pressure increases by 10 points as compared to the normal
pressure reading.

RNSG 1261 HTN C/S Plus 2 Hesi C/S – Clinical Absence Assignment. Summer 2018
Clinical guidelines to be followed for preventing hypertension
The clinical guidelines established for hypertension are-Steps that are required for prevention
and treatment of high blood pressure are eat healthy, requirement of proper exercise, reduction in
the weight and quit smoking.
Various blood pressure levels starting from normal to the hypertensive blood pressure
The normal reading shows less than 120/ 80 mmHg (systolic/ diastolic)The elevated blood
pressure reading would be systolic in the range of 120-129 whereas diastolic would be 80
mmHg.
The stage 1 hypertension reading would show systolic between 130-130 and diastolic to
be 80-90 mmHg. Stage 2 hypertension for an individual would be systolic ranging to 140
however; the diastolic would be at least 90mmHg
When an individual is undergoing hypertension crisis then the systolic would be over
180mmHg and the diastolic would be over 120 mmHg. At this stage, the patient requires
immediate attention, change of medicine or hospitalization (Wright, Musini & Gill, 2018).
The way high blood pressure can cause seizure
The hypertension of James is well connected with seizure in two ways. As James blood pressure
is very high, which means she is undergoing chances of vascular disease. Hence there is
predisposition of subclinical cerebrovascular disease. This disease is a strong cause of this
disease or epilepsy (Abalos et al., 2018). In an elderly individual the chances of seizure or
epilepsy increases with age.

RNSG 1261 HTN C/S Plus 2 Hesi C/S – Clinical Absence Assignment. Summer 2018
Nursing plan, diagnosis and intervention needed for preventing the disease hypertension
Nursing diagnosis for hypertensive crises is of the risk prone behavior, which is related to less
knowledge about the disease.
Nursing intervention for the disease would be assisting the patient in predicting the risk
factors related to diabetes or blood pressure such as high sodium diet, cholesterol and saturated
fats. The nurses must explain the effect of hypertension on the heart, kidney, brain and blood
vessel of individuals (Nadruz, 2015). Nurses must explain the patient about regular leg exercise
and other therapies that keep blood pressure under control.
The diet plan a patient must follow while undergoing this disease
Food that are recommended for hypertension patient are-vegetable, fruits, fat free dairy
products, nuts, seeds, grains and sweets. All these foods are anti-hypertensive it helps in keeping
the pressure level in control thereby reducing stroke and heart attack (Simonneau et al., 2019).
Foods that are to be avoided are alcohol as it enhances the blood pressure level; sodium
diet as all the canned and frozen food contains lots of sodium as preservative hence it should not
be taken by the patient with high blood pressure. Fatty foods need to be avoided as it increases
the weight of an individual thereby enhancing the pressure.

RNSG 1261 HTN C/S Plus 2 Hesi C/S – Clinical Absence Assignment. Summer 2018
References
Abalos, E., Duley, L., Steyn, D. W., & Gialdini, C. (2018). Antihypertensive drug therapy for
mild to moderate hypertension during pregnancy. Cochrane Database of Systematic
Reviews, (10).
ElFarra, J., Bean, C., & Martin, J. N. (2016). Management of hypertensive crisis for the
obstetrician/gynecologist. Obstetrics and Gynecology Clinics, 43(4), 623-637.
Nadruz, W. (2015). Myocardial remodeling in hypertension. Journal of human
hypertension, 29(1), 1-6.
Simonneau, G., Montani, D., Celermajer, D. S., Denton, C. P., Gatzoulis, M. A., Krowka, M., ...
& Souza, R. (2019). Haemodynamic definitions and updated clinical classification of
pulmonary hypertension. European Respiratory Journal, 53(1), 1801913.
Stocchetti, N., & Maas, A. I. (2015). Traumatic intracranial hypertension. New England Journal
of Medicine, 370(22), 2121-2130.
Wright, J. M., Musini, V. M., & Gill, R. (2018). First‐line drugs for hypertension. Cochrane
Database of systematic reviews, (4).