Integrated Nursing Practices: Case Study on Hypertension Management

This case study focuses on the integrated nursing practices involved in managing a 50-year-old patient, Beryl Simmons, suffering from hypertension and hyperlipidemia, complicated by a busy lifestyle and poor medication adherence. The study identifies two primary problems: Beryl's prioritization of work over health and her forgetfulness regarding medication. Nursing interventions discussed include motivating Beryl to prioritize her health through lifestyle changes such as smoking cessation, reduced alcohol consumption, regular exercise, and a healthier diet. The importance of regular blood pressure monitoring and cholesterol level checks is emphasized, along with strategies to improve medication adherence, such as statin therapy and patient education. The interventions aim to address both hypertension and hyperlipidemia, considering Beryl's medical history and lifestyle factors to promote better health outcomes. This document is available on Desklib, a platform offering a range of study tools and solved assignments for students.

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Integrated Nursing Practices 2 (on campus) Case Study
Nursing is not a new concept for society. Nursing professionals have been
helping patients with injuries, infections and other life threatening diseases for many
years. Nurses provide the treatment and services for the patients to help them to achieve
the health goal and to achieve this target they faced lots of problems. In this essay the
adult case study will be discussed and reviewed where 50 years old patient Beryl
Simmons suffered from hypertension and mismanagement towards exercise and
medication. The priority problems occurred during nursing interventions like busy life
style and hypertension. The busy schedule of patient does not allow them to give
sufficient time for health and for their loved ones. Because of this patient was not able
to take medicines on time. Hypertension is another priority problem occurred during
treatment. In this essay nursing interventions will be discussed to understand the
problems occurred in treatment.
There were two priority problems identified by assessing patients profile and
data. One was her priority for work more than health and another was that she
frequently forgets to take medicines. Her habits of smoking and drinking were also the
reason of hypertension. Some of the sign and symptoms indicate relation with problems
identified. Beryl was identified with high level of total cholesterol which was 6 mmol/L,
LDL (low density lipoprotein) 3.1 mmol/L and HDL (high level lipoprotein) 0.8
mmol/L which was abnormal (Fletcher, 2017) and could be results of unfavourable diet
and led to Hypertension. Patient’s data showed that she was suffering from hypertension
and hyperlipidaemia. Hypertension is the pressure exerted by blood on the walls of
arteries. When cholesterol reach to the blood vessels it get stuck to the inner walls of
arteries and results in increased pressure on the walls (Winters, 2018). When the

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pressure produced on walls, it causes hypertension. When the systolic blood pressure is
more than 140 mm Hg and diastolic pressure is equal or more than 90 mm Hg, these
results in Hypertension (Messerli, 2011). According to a report published by world
health organisation nearly 17 million people died every year in all over the world
because of cardiovascular diseases and among these all deaths 9.4 million died because
of hypertension annually (World Health Organisation, 2013). Beryl was a working
woman with responsibility of three children’s. She had no time for her health issues not
even for her kids. Her stats lack of time for exercise and cooking which was directly
impacting her wellness. The data sheet of the patient showed that her BMI was irregular
(weight 105 kg and height 150 cm.).
Nursing interventions is all about providing health care services to the patents to
achieve a wellness goal. It plays major role in patient’s recovery from various diseases
(Arkansas state university, 2016) and to achieve a positive outcome after completion of
treatment. According to a study conducted by Farnandez, Dona, Raya and Gallardo
(2013) it was revealed that nursing interventions helped patients to recover more
accurately ,they conducted a survey among 2250 patients and it was found that by
providing nursing services 95 % positive treatment were achieved. Nursing
interventions are very important for patients recovery (Hage, 2015) provided to the
receiver are changed according to the disease. According to an study published by
Goudreau, Boyer and Letourneau (2014) there are some steps for providing
interventions to the patients: first is assess, second is plan and third one is implement.
To deliver a favourable and health goal achieving interventions has to pass through
these three steps to reach to the target. First is he or she needs to assess the data
provided in assessment sheet of patient: the data should we checked carefully. The

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knowledge should be recalled regarding physiology, pathophysiology, pharmacology,
epidemiology etc. Information that is already given in patient sheet should be evaluated
by nurses. Some questions can be asked to the health services receiver to get more
information to understand the health issue more and allergies or complications will be
gathered to implement nursing interventions more accurately. It should be checked that
all the old and new information has been written in data sheet. Second step is planning:
in this step nurses needs to identify the main problem and priority problem of the
patient. What is urgent and what can be provided to them later. It should be cleared
what is the problem and what type of health services will be given to them. Nurses
should list all the allergies and other health problems that can be occurred in future after
discussing with physician. Third step is implementation on interventions: it should be
cleared before implementing the services that what type of intervention will be provided
and what should be not be done before any action. The services being provided by other
members should be noticed. All the supportive research for future interventions needs to
be considered.
The first priority problem identified in Beryl’s case was she had no time for her
health or wellness because her work and family was more important to her. In these type
of problems patients totally failed to recover from the stress and develop psychological
and physiological diseases like hypertension, anxiety, depression, obesity etc. Some of
them used cigarettes alcohol to reduce the stress and these all associated with high blood
pressure (Nordqvist, 2017). Nurses must be there with the patient to motivate him or her
towards health. Nurse’s care has been a proven method for early recovery of diseased
person. By implementing some nursing interventions the priority problem can be
resolved. By observing Beryl’s report and her pathophysiology data it is found that she

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was less considering her health. Patient had imbalanced cholesterol level, cigarettes
smoking and high alcohol consumption. The consumption of rich fat food led to
increased blood pressure (Fukushima, 2014). It was also found that she had medical
history of Cholecystitis, left ovarian cystectomy, menorrhagia, Epicondylitis bilaterally,
and left knee reconstruction.
Nurses intervention can be provided in this case are: motivating patient to be
conscious towards her health and time to time BP check-up. As Mrs Beryl stated that
she had no time to eat health food so it is essential to encourage the patient to follow
healthy life style for better recovery. Nursing interventions also include some
counselling for the patient like the patient should be advised to stop or reduce
consumption of cigarettes and alcohol, to do regular aerobic exercises, and stress
releasing workouts. However it quite difficult for the patient to stop smoking cigarettes
and drinking alcohol suddenly, because they are addicted to those habits and it can be
reduced with time only. Nurses should be well known to the types of cigarettes contain
less nicotine so that it is not very harmful for the patient (Worth, 2016). To maintain the
healthy diet, fruits, and green leafy vegetable should be include in the diet to reduce
cholesterol level. According to an article published in Healthline by Ellis and Nall
(2017) blood pressure can be reduced by eating bananas and green vegetables regularly.
The weight management is also associated with blood pressure or hypertension so
weight should also measure accordingly. Another intervention that is more important
for nurse is to check blood pressure to evaluate whether the treatment is on right track or
not. Sphygmomanometer should be used to evaluate the blood pressure after discussing
with the assigned physician (Freshe, Fick & Sadowsky, 2011). Some positive aspects of
these interventions includes lowering blood pressure increase health quality, stress will

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be reduced and decreasing the risk of developing other deadly diseases. Some negative
aspects can be occurred that she might be panic because she will not be able to provide
enough time to her work and kids.
The second priority problems observed in Mrs Beryl’s case that she forgets to
take medicines and hyperlipidaemia. Medicine prescribed by the dr. was Atorvastatin
20mg and Perindopril 4mg. As discussed above patient had a very busy life and she
revealed that she used to work for whole day. She also had three school age children’s
so she is not able to give time for her. It was found that because stress she had, patient
forgot to take medicines. It was diagnosed that she was suffering from hyperlipidaemia.
Hyperlipidaemia, as the name suggests it is increase in normal value lipids and fats in
body which may be caused by unhealthy eating habits drinking, smoking (Memorial
Sloan Kettering cancer centre, 2015). Beryl said that she had lack of time for cooking
healthy food and the symptoms can be directly seen in her medical data. Smoking and
eating food that rich in trans-fat and saturated fat increases the risk of developing high
cholesterol (Cruickshank, 2018). According to an article published by Costa and Park
(2017) hyperlipidaemia is associated with hypercholesterolemia, hypertriglyceridemia
and mixed hyperlipidaemia. It is the abnormal elevation of serum cholesterol,
triglycerides or both. Davis (2017) stated that people with hyperlipidaemia have high
risk of developing cardiovascular diseases; it was revealed in that study that recovery
one in three American is affected by this disease. The assessment sheet of patient
showed that the total cholesterol level was abnormal and the symptoms observed that
linked with the diagnosed disease was short of breathing, agitation, obesity. In this case
nursing assistance is necessary and steps discussed above will be followed to provide
services to the patient. The two nursing services can be provided to the patient is remind

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them for medicine on time and regular check-up for cholesterol level in body. Statin
therapy can also be provided to treat patients with this disease. According to an article
published in Pharmacy Times by Zanni (2014) statin therapy is being carried out by
most of the physicians these days to decrease cholesterol level in obese patients.to assist
patient with health services all the queries regarding previous medical history that are
not listed in data should be asked, enlist all the allergies and complications that can be
occurred during the treatment. Patient and their family should be provided all the
knowledge about the disease and all the precautions that need to be considered during
the treatment. It is essential to deliver all the information regarding medication to the
person. After discussing with prior knowledge about pre-treatment requirements the
next step will be followed. During the treatment process, the adverse reaction of
medicine should also be noticed and if there is any side effects occurred, physician
should be informed. By providing these interventions are this case it will be ensured that
recovery will be done on time.it is important to do regular check-ups of cholesterol level
should be delivered to the diseased person on different time intervals (Bel Marra Health,
2017). This pathophysiology behind this intervention is that by conducting regular
check-ups the lipid control could be possible and by reducing the cholesterol level
hyperlipidaemia reduced Atorvastatin was prescribed by the doctor to control
hyperlipidaemia but patient were unable to take medicine because of her tight schedule.
As identified in assessment data it was observed that patient was taking unhealthy
outside food like full cream milk, muffin & coffee which could be a reason of
Hyperlipidaemia (Schaefer & McDermott, 2016). By motivating patient for medicine
intake, the health result could be achieved on time. Investigations for hyperlipidaemia
are: total serum cholesterol test, LDL level tests (Costa & Park, 2017). By motivating

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patient to do exercise every day the recovery can be achieved more significantly. An
article published in Drugs.com (2018) about hyperlipidaemia suggested that to maintain
a healthy weigh and to lower cholesterol down daily workouts is essential. It was also
stated that fibre rich diet is also helps in recovering from this disease .nursing
intervention played a major role by giving health instruction to the patient and their
family. As Mrs Beryl revealed that she had no adult member in her family all the care
should be done by nurses only. In these conditions where patients are not having any
member with them all the responsibilities has to be done by health service providers.
During the whole treatment nurses should be there with the patient to help them for
medicine reminders, food exercise reminders and other investigations. When providing
interventions, feedback from patient should be taken to understand that the services
being provided to the patients are doing well. The positive aspects of these interventions
are: the risk of developing cholesterol level will be reduced, smoking habit that increase
the risk of heart diseases will be stopped, and by reminders of medicines patient will be
recovered positively. There are some negative aspects also like anxiety could be
occurred due to not smoking cigarettes and alcohol.
After analysing the case study and reviewing the articles it is found that Mrs
Simmons Beryl was an old single mother suffering from hypertension and
hyperlipidaemias. She had obesity problem and imbalance cholesterol level which was
occurred due to unhealthy diet and high consumption of alcohol and cigarettes. She
occasionally forgot to take medicine. Both the conditions are associated with her extra
fat level it is possible to develop cardiovascular diseases. By providing nursing
intervention regularly the two priority problems could be solved. The high blood
pressure will be maintained by regular check-ups and motivating her for health will be

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beneficial to reduce mental stress .statin therapy is also recommended to treat
hyperlipidaemia patients by reviewing all related article and reports it is found that
nursing intervention are necessary to achieve a health goal which is set for the patient.
Nursing interventions can also cause some complications to the patient but these are not
very major.

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