Nursing Health Assessment: A Case Study of Mr. A's Health Conditions

This report presents a detailed nursing health assessment of Mr. A, a 50-year-old patient with obesity and hypertension. It outlines the essential history and physical examination data required, including diagnostic procedures for both conditions, such as BMI calculation, waist circumference measurement, blood tests (glucose, cholesterol, thyroid, etc.), and blood pressure monitoring. The report further discusses the psychosocial factors, including stress, hostility, depression, and hopelessness, that can affect Mr. A's adherence to pharmacologic and non-pharmacologic interventions. It then provides a comprehensive overview of both types of interventions, including lifestyle modifications, anti-obesity drugs, and antihypertensive medications. Finally, the report emphasizes the importance of patient education, offering strategies to increase Mr. A's awareness of his condition and enhance his adherence to the care plan, including balanced diet, physical exercise, and medication adherence, to manage his health conditions effectively.

Nursing Health Assessment

Table of Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Describe the detail history and physical examination data that should be obtained from Mr. A
.....................................................................................................................................................1
Discuss the psychosocial factors that may affect his adherence to pharmacologic and non
pharmacologic interventions.......................................................................................................3
Exemplify an appropriate patient education to increase his awareness and enhance adherence
to his care plan............................................................................................................................6
CONCLUSION................................................................................................................................8
REFERENCES................................................................................................................................9

INTRODUCTION
Nursing health assessment refers to conduct required clinical procedures to gather patient
information to understand physiological, psychological sociological and spiritual condition. It
includes the criterion of conducting diagnosing activities including physical examination and
several lab tests to evaluate actual heath problems of an individual with its cause (Andrea and
Kotowski, 2017). However, it is essential to conduct appropriate diagnosing procedures and
clinical examination as it facilitate to provide accurate treatment for patient well-being. The
present report is based on the case study of patient named Mr. A having age of 50 years with
obese condition and persistent elevated blood pressure. This assignment will focus on detailed
history and physical examination data that should be obtained form the given patient. It will also
includes psychosocial factors that may affect their adherence to pharmacologic and non
pharmacologic interventions. The exemplification of patient education to increase his awareness
and enhance adherence to care plan is given below.
MAIN BODY
Describe the detail history and physical examination data that should be obtained from Mr. A
Nursing health assessment can be described various kinds of diagnosing procedures
which helps to identify the about specific health problem and its relevant causes. It is necessary
to understand about symptoms observed in patients along with their causes which helps care
practitioners to make appropriate decision of treatment. Basically, nursing assessment is
favourable to make an effective as well as efficient care plan in order deliver better quality of
treatment for wellness of patient (Bartlett, Taylor and Nelson, 2016). However, it consist
physical examination of patient suitable to to gather information about visible and non visible
symptoms to understand the medical condition of patient to provide initial treatment for making
an individual feel relieved.
According to the case of Mr. A, he is suffering from a condition of being obese with
elevated high blood pressure. His age is 50 years and having problem of hypertension from last 7
months for which he consult with a physician and use the lifestyle management technique to
overcome with his health problems. However, lifestyle management did not work with patient
and his blood pressure continued to rise which is not a good sign regarding health. It has been
analysed that he was began on a regimen of antihypertensive medication since one month. Now
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he has returned to the clinic for follow up visit and his blood pressure as identified higher as
compared to the initial one at previous clinical visit of patient.
Considering the case of Mr. A, it is very important to carry out possible and suitable
pathological tests and physical examination to asses regarding obese condition and hypertension.
It includes the criterion to evaluate cause of rising in blood pressure after providing medication
and using lifestyle management technique. In context of given case, there are certain diagnosing
activities and tests which should be carry out in which some of them are explained below.
Diagnosis of obese condition of Mr. A
Excess fat on body means obesity. Mr. A has greater weight than what is considered
normal and healthy according to his height, thus he is an obese. High calories intake than usual
make an individual to suffer from obesity. Each person has a different metabolism to balance
between calories in and out in body (Durham, 2017). Genetic build, eating junk foods,
overeating, and inactiveness are some factors which may affect weight. If not treated timely
obesity may increase the risk of heart diseases, cancers, strokes, diabetes and arthritis. For
diagnosing obesity few tests and exams are conducted:
 Knowing health history of includes eating patterns, stress level, physical activity, weight
history, appetite control, and other medical health issues about his as well as his
ancestors for making a pedigree to check the possibility of getting obesity.
 Calculating body mass index (BMI) and if it comes 30 or higher then a person is suffering
from obesity. Risk increases as the BMI number increases.
 Checking waist circumference can conclude whether the individual is obese or not.
Visceral and abdominal fat is called as the fat around the waist. Men with 40 inches and
women with 35 inches are more prone to get diabetes and heart related diseases (Sink and
et. al., 2016).
 A general physical examination consider measuring weight and height, examining vital
signs such as body temperature, blood pressure, breathing rate per second and analysing
abdomen.
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 Blood tests including blood glucose level, cholesterol test, thyroid test, liver function
tests, ECG and so on for getting an idea whether an individual need to loosen his/her
weight and what possible medical and health help that individual can seek.
Diagnosis of hypertension condition of Mr. A
Hypertension also called as high blood pressure is a condition where the pressure and force of
blood in arteries is relentlessly elevated. Typically it doesn't cause any symptoms but if the
condition is long term the risk of heart failure, vision loss, strokes, arterial disease, dementia and
chronic kidney disease (Décary and et. al., 2018). Factors like lifestyle, diet with excess salt,
smoking, high body weight, use of alcohol, old age, genetics, stress may be the cause of high
blood pressure. Hypertension can be best diagnosed by some laboratory test which doesn't give
direct examination of hypertension but having one or other positive result may cause high blood
pressure that origin hypertension.
 Urinalysis, creatinine, urinary albumin test, glomerular filtration rate test: To check the
proper functioning of kidney
 Glucose level in blood: to diagnose diabetes and monitor the level at regular intervals for
checking the hypertension
 Calcium, TSH, potassium and lipid profiling: to detect the electrolyte concentration in
blood, because some blood pressure medications can disturb the balance of electrolyte by
the loss or gain of solutes. High lipid and cholesterol make the body lethargic and
lowering the metabolism.
Blood pressure test diagnosis the pressure most easily and effective way. Systolic and diastolic
blood pressure is measured (Narula, Chandrashekhar and Braunwald, 2018). Pressure of blood
applying against walls of artery during heartbeats is systolic pressure while pressure of blood
exerted opposite to artery wall when the heart is relaxing between beats.
Discuss the psychosocial factors that may affect his adherence to pharmacologic and non
pharmacologic interventions
The care plan is required to be established in context of Mr. A for obese condition and
hypertension for improving condition of patient. It includes the interventions and rationale of
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them in terms of making patient capable to improve with his health problems. However, the care
plan with effective pharmacological and non-pharmacological interventions for Mr. A related to
obesity and hypertension is given below.
Non-pharmacologic interventions for Mr. A
Obesity
 Initially, view the patient and maintain privacy while making communication which
should be free of criticism and judgement to understand condition.
 It is necessary to clearly outline responsibilities of nurse and patient to make them
understand their own duty to avoid situation of misinformation (Padwal and et. al., 2016).
 It includes to graph weight on weekly basis to gain visual evidence of changes in weight.
 Motivating the patient for utilising imagery to visualise self at desired eight and adopt
new behaviours including avoid parties or family functions where situation of eating
many foods take place.
 It consist to determine motivation for weight loss and guide them to set goals of reducing
body weight.
 Develop strategies of healthy eating and physical work out by enhancing dedication of
patient towards losing weight for improving their obese condition.
 Encourage family and friends to support patient to reduce body weight for maintain fit
human body (Jordan and et. al., 2017).
Hypertension
 Firstly, check laboratory data including complete blood cell count, electrolytes, ABGs,
blood urea nitrogen, creatine, cardiac enzyme & cultures and cardiac makers.
 Monitor blood pressure three times in both arms & legs which helps to understand proper
vascular involvement and scope of problem in patient.
 It is required to analyse presence of quality of peripheral and central pulses which
facilitate to determine effects of vasoconstriction including increased systemic vascular
resistance (SVR) and venous congestion.
 It is necessary to conduct auscultation of breathe sounds and heart tones along with
observing skin colour, moisture, temperature as well as capillary refill time.
 It is required to provide noiseless, restful and calm environment which improve
relaxation of patient.
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 Maintaining the activity restrictions by providing schedule of uninterrupted rest and
guide them for self activities that lessen stress and tension.
 Render comfort measures through massage of back & neck and elevation of head along
with instructing relaxation technique for improving patient condition.
 Monitoring of response to medications is essential in order control the blood pressure.
Pharmacologic interventions for Mr. A
Obesity
 It is favourable to provide anti obesity drugs with specific dosage in order to improve the
obese condition to maintain patient fit and fine (Susic and Varagic, 2017).
 It includes several mediations which should be provide to given patient like Lorcaserin
(Belviq), Phentermine and topiramate (Qsymia), Bupropion and naltrexone (Contrave),
Liraglutide (Saxenda, Victoza) and Orlistat (Alli, Xenical).
Hypertension
 The Thiazide diuretics including Niuril, Esidrix, naturetin and lozol which are favourable
in hypertension condition to reduce B.P with relatively normal renal function.
 Potassium sparing diuretics like spironolactone and triamterene are helpful to decrease
loss of potassium from body (Leggio and et. al., 2017).
 Alpha, beta or centrally acting adrenergic antagonists such as doxazosin, propanolol,
acebutolol, metoprolol and nadolol which are suitable people with reduced cardiac
output, inhibited sympathetic activity etc.
 Other medications that can used are Calcium channel antagonists, Adrenergic neuron
blockers, Direct-acting oral vasodilators, Direct-acting parenteral vasodilators,
Angiotensin-converting enzyme (ACE) inhibitors, Loop diuretics and Angiotensin II
blockers.
Psychosocial factors influencing adherence of pharmacologic and non-
pharmacologic interventions:
Stress: This factors is responsible for interrupt working of medications and other physical
therapies by reducing relaxing condition of patient.
Hostility: The unfriendly behaviour of care practitioners or people of society create a
mental disturbance for patient which impact negatively on effects of medicines provided.
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Depression: This condition includes depressed mood and loss of interest in activities
which may reduce carefulness of patient regarding their precautions or medications. This
behaviour may results into chance to miss dose of medication which affect patient outcomes.
Hopelessness: This factor of hopelessness reduce desire of an individual to become well-
being which impact on their behaviour of taking medicines and follow healthy schedule. It will
impact negatively on treatment outcomes and condition of patient as well.
Exemplify an appropriate patient education to increase his awareness and enhance adherence to
his care plan
The patient awareness is required to be improved in terms making them understand about
importance of following proper care plan to become well-being. It is necessary to provide
information about actual condition of patient and encourage them to take medication on time and
follow desired precautions in order to gain improvement in health as soon as possible. However,
it is essential to make Mr. A aware about their dosages of medication and daily life activities in
regards to reduce the extra fat of body which is helpful to maintain the problem of high blood
pressure (Haymes, 2016). Moreover, it is necessary to encourage patient to follow balanced diet,
physical work out daily and take medication on time for improving their obese condition and
hypertension.
In order to create awareness among Mr. A to deal with health issues, then it is important
for doctors to communicate and consult with him properly about their health issues, it is essential
that they must provide proper understanding about diet and other actions with which they can be
fit. While providing education, there must be positive vibes which provides complete and
specific information to consumers. It is important that there must be proper awareness about
avoiding facts. They must be educated to take proper diet, come for regular check up, do
physical work, etc. with the help of which they can overcome with health issues. They must be
communicated about facts which may lead to more health issues. Mr. A must be motivated and
provide positive attitude through which they get confidence of improvement and motivate them
to take care of their health. If there are some program organised for people suffering from
obesity. Then they must be communicated to attend it. This update their knowledge and get
direction about ways through which they can deal with issues.
Hypertension or high blood pressure is a chronic medical condition which occurs when
pressure of blood in the body increases to unhealthy states. Measurement of blood pressure
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accounts for the amount of blood passing into blood vessels and resistance it meet while heart is
pumping. Arteries which are narrow cause resistance for blood to flow properly. Narrow arteries
leads to high blood pressure. However, increased blood pressure cause a number of heart
diseases. Symptoms of hypertension include headache, dizziness, nose bleeding, visual changes
etc.
For example: In context to Mr. A who is a patient of hypertension and obesity need an
immediate medical attention. For hypertension the prior thing doctor will suggest for patient is to
change his lifestyle. Rather than that there are several medications and treatments available for
hypertension that could be taken into account. For hypertension, an individual need to try
different medicines until he get a correct medication for him. Some of the drugs which patient
should take to maintain his blood flow are Beta-blockers, Diuretics, ACE inhibitors, calcium
channel blockers etc. However, patient could also cure his condition by following some home
remedies rather relying on medicines. Mr. A needs to change his normal diet plan and should
follow a heart healthy diet which include fruits, vegetables, proteins, whole grains etc. Individual
should do some physical activities to strengthen his cardiovascular system and to reduce stress
(Sheng, Castro and Lewiss, 2016).
For instance: Being a patient of Obesity also Mr. A should maintain his weight which
will help him to lower his blood pressure level. Obesity or fatness is a condition of excess
amount of fat accumulation in human body. It is caused by consumption of high calories which
is not necessary for body. This high amount of calories then stored as fat or adipose tissue inside
the body. However, it leads to cause number of diseases such as diabetes, hypertension etc.
In order to treat obesity it is mandatory to remove excess body fat. Patient need to take
some medications such as Belviq, Qsymia etc. Patient should avoid excess intake of junk and
fatty foods. Healthy eating and daily physical exercises can help patient to reduce weight upto
some extent. Patient can join some weight management program in which experts and trainers
develop some customized plans as per the body type and help to maintain weight and introduce
these plans in his daily routine. Such plans mostly include low fat foods, physical exercises and
methods to bring changes in habits. It is totally up to the patient to work with trainers on site or
in person or in group. This information about treatment is required to be provide to Mr. A which
helps encourage him to adhere care plan in effective way.
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Mr. A must be updated with knowledge about tablets and diet which they have to take to
avoid any issue. In order to creates awareness about blood pressure, then it is important to
analyse ways through which they can avoid such situation. It is essential to provide positive
outcome with which Mr. A will be relevant for them. There must be group activities with
patients who have similar health issues, so Mr. A will better impact on his health. When there is
proper awareness with Mr. A then it is easy to deal with it. With proper and regular
communication, it is easy to educated Mr. A about health implication which has to be followed.
With managing and maintaining positive relations, it is easy for Mr. A to implement actions for
health care properly.
CONCLUSION
From the above report, it has been concluded that nursing health assessment can be
described as to conduct required clinical procedures to gather patient information to understand
entire medical condition. It includes the criterion of conducting nursing assessment diagnose
condition of patient such as Calculating body mass index, Checking waist circumference,
physical examination, Blood tests, Urinalysis, Glucose level in blood and Blood pressure test.
However, it includes care plan of obesity including pharmacologic and non-pharmacologic
interventions. Moreover, these interventions get influenced by several psychosocial factors
including stress, depression, hostility and hopelessness. Additionally, it consist use of various
medications in given case including, diuretics Potassium sparing diuretics, Alpha, beta or
centrally acting adrenergic antagonists, Calcium channel antagonists, Adrenergic neuron
blockers etc.
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REFERENCES
Books and journals
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health assessment class. Clinical Simulation in Nursing, 13(7), 309-313.
Bartlett, M. L., Taylor, H., & Nelson, J. D. (2016). Comparison of mental health characteristics
and stress between baccalaureate nursing students and non-nursing students. Journal of
Nursing Education, 55(2), 87-90.
Décary, S. & et. al., (2018). Validity of combining history elements and physical examination
tests to diagnose patellofemoral pain. Archives of physical medicine and
rehabilitation, 99(4), 607-614.
Durham Jr, H. E. (2017). History and physical examination. Cardiology for Veterinary
Technicians and Nurses.
Haymes, A. (2016). Venous thromboembolism: patient awareness and education in the pre-
operative assessment clinic. Journal of thrombosis and thrombolysis, 41(3), 459-463.
Jordan, J. & et. al., (2017). Improved insulin sensitivity with angiotensin receptor neprilysin
inhibition in individuals with obesity and hypertension. Clinical Pharmacology &
Therapeutics, 101(2), 254-263.
Leggio, M. & et. al., (2017). The relationship between obesity and hypertension: an updated
comprehensive overview on vicious twins. Hypertension Research, 40(12), 947.
Narula, J., Chandrashekhar, Y., & Braunwald, E. (2018). Time to add a fifth pillar to bedside
physical examination: inspection, palpation, percussion, auscultation, and
insonation. JAMA cardiology, 3(4), 346-350.
Padwal, R. S. & et. al., (2016). Epidemiology of hypertension in Canada: an update. Canadian
Journal of Cardiology, 32(5), 687-694.
Sheng, A. Y., Castro, A., & Lewiss, R. E. (2016). Awareness, utilization, and education of the
ACR Appropriateness Criteria: a review and future directions. Journal of the American
College of Radiology, 13(2), 131-136.
Sink, J. R. & et. al., (2016). Diagnosis of pediatric foreign body ingestion: clinical presentation,
physical examination, and radiologic findings. Annals of Otology, Rhinology &
Laryngology, 125(4), 342-350.
Susic, D., & Varagic, J. (2017). Obesity: a perspective from hypertension. Medical
Clinics, 101(1), 139-157.
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