Nursing Case Study: Hypertension, Treatment and Patient Outcomes

This nursing assignment presents a comprehensive case study on hypertension, a prevalent circulatory disorder. It begins by outlining the prevalence and risk factors of hypertension in Australia, including lifestyle, genetics, obesity, age, and ethnicity. The assignment then categorizes blood pressure values and discusses modifiable and non-modifiable factors influencing hypertension. The core of the assignment focuses on two patient education plans. The first plan addresses a patient named Trevor, detailing drug dosages, rationales, and potential side effects for Enalapril, Frusemide, and Digoxin. The second plan is for Katrina, outlining the use of Amoxicillin, Penicillin, and Cortisone, including their purposes and side effects. The assignment is supported by several references from reputable sources.

Running head: NURSING ASSIGNMENT
Case Study on Hypertension
Name of the Student
Name of the University
Author Note

1NURSING ASSIGNMENT
Answer 1
Hypertension is one of the most prevalent disorders of the circulatory system and is found
to affect close to 6 million individuals residing in Australia, in the year 2014-2015 (Heart
Foundation, 2015). Approximately 34% of people, aged greater than 18 years manifested
symptoms of higher blood pressure. Reports state that almost 31.6% (one-third) of adult
Australians suffered from hypertension in 2011-12 (Australian Health Survey, 2018).
Hypertension is seldom accompanied by symptoms, and is generally identified
through screening. Instances when an affected individual seeks healthcare for unrelated health
abnormalities also result in diagnosis of hypertension. While some with hypertension might
report headaches (at the back of the head), other associated symptoms are related to
vertigo, lightheadedness, altered vision, tinnitus or fainting episodes (McCollister et al., 2016).
The prevalence rates of hypertension have been found to be higher for males in Australia, and
affects more than three million or 35.3% of the male population. However, the prevalence rates
are found to be lower among females, and affects 2.9 million or 32.3% of adult female
Australians. Adult Australians living in rural or regional Australia have demonstrated a 27%
increased rate of hypertension, upon comparison to their counterparts who live in metropolitan
cities (38.6% versus 30.5%) (Heart Foundation, 2015).
The main causes of hypertension in Australia are given below:
 Leading a sedentary lifestyle that involves little or no physical activity and exercise
 High smoking rates

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 Interaction of genes and environment (Single Nucleotide Polymorphism)- A range of
genome wide association studies have been conducted that identified the role of 35
genetic loci that are found to be associated with blood pressure. Sentinel genetic loci have
also been found related to DNA methylation that occurs at Cpg islands, located nearby
(Ehret & Caulfield, 2013).
 Obesity or overweight that can be contributed to improper eating patterns
 High age. With an increase in age the arteries get stiffer and narrow down due to build up
of plaques. Hypertension, particularly systolic blood pressure is commonly found among
people aged 60-79 years of age, and older adults aged 80 years or more.
 Ethnicity makes certain Australian communities more susceptible to hypertension
(Ordinioha, 2013). Indigenous Australians have been reported to show marked
differences in the prevalence of chronic diseases such as, hypertension. Major risk factors
that increase the susceptibility of the indigenous people for the condition include poor
diet (high salt intake), alchohol consumption, low physical activity and obesity (Esler et
al., 2016).
 Alcohol consumption (Gabb et al., 2016)
 Family history
 Other factors such as, acromegaly, conn’s syndrome, drug abuse. renal artery stenosis
also increase risks of hypertension
Answer 2
Increased blood pressure is considered as an established risk factor that increases the
likelihood of a person of getting affected by cardiovascular abnormalities (Heart Foundation,
2016). There are several grades and categories of the blood pressure values that are given below:

3NURSING ASSIGNMENT
Category Systolic (mm Hg) Diastolic (mm Hg)
Optimal <120 <80
Normal 120-129 80-84
High-normal 130-139 85-89
Grade 1- mild 140-159 90-99
Grade 2- moderate 160-179 100-109
Grade 3- severe >or =180 > or=110
Isolated systolic >140 <90
The modifiable factors are given below:
Factors Primary management
Physical activity Muscle strengthening exercise, moderate
physical activity
Weight Reduce consumption of fat rich foods
Diet Reduce fat and salt intake, increase
consumption pf fruits and vegetables
Smoking Smoking cessation
Alcoholism Drinking less than two standard drinks any
day, and not more than four on occasions
(Heart Foundation, 2016)

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The non-modifiable factors are gender, family history, ethnicity and age of an individual,
which directly increases the likelihood of having hypertension. With an increase in age, the
person will be more prone to develop hypertension that would increase risks of coronary heart
disease or other cardiac events such as, angina, or stroke (Heart Foundation, 2016). A family
history of cardiovascular complications, obesity, smoking and drinking, diabetes and physically
inactive lifestyle increases risks of hypertension. Furthermore, African-Americans are more
likely to develop high blood pressure than people belonging to other races (Hicken et al., 2014).

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References
Australian Health Survey. (2018). Health Service Usage and Health Related Actions, 2011-12.
Retrieved from
http://www.abs.gov.au/ausstats/abs@.nsf/lookup/322DB1B539ACCC6CCA257B39000F
316C?opendocument
Chovel-Sella, A., Tov, A. B., Lahav, E., Mor, O., Rudich, H., Paret, G., & Reif, S. (2013).
Incidence of rash after amoxicillin treatment in children with infectious
mononucleosis. Pediatrics, 131(5), e1424-e1427.
Derya, E. Y., Ukke, K., Taner, Y., & Izzet, A. Y. (2015). Applying manual pressure before
benzathine penicillin injection for rheumatic fever prophylaxis reduces pain in
children. Pain Management Nursing, 16(3), 328-335.
Ehret, G. B., & Caulfield, M. J. (2013). Genes for blood pressure: an opportunity to understand
hypertension. European heart journal, 34(13), 951-961.
Esler, D., Raulli, A., Pratt, R., & Fagan, P. (2016). Hypertension: high prevalence and a positive
association with obesity among Aboriginal and Torres Strait Islander youth in far north
Queensland. Australian and New Zealand journal of public health, 40(S1), S65-S69.
Freeman, J. V., Yang, J., Sung, S. H., Hlatky, M. A., & Go, A. S. (2013). Effectiveness and
safety of digoxin among contemporary adults with incident systolic heart
failure. Circulation: Cardiovascular Quality and Outcomes, 6(5), 525-533.

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Gabb, G. M., Mangoni, A., Anderson, C. S., Cowley, D., Dowden, J. S., Golledge, J., ... &
Schlaich, M. (2016). Guideline for the diagnosis and management of hypertension in
adults—2016. mortality, 3, 4.
Heart Foundation. (2015). Get the facts on hypertension. Retrieved from
https://www.heartfoundation.org.au/images/uploads/main/HeartWeek_fact_sheet_for_pro
fessionals.pdf.
Heart Foundation. (2016). Guideline for the diagnosis and management of hypertension in
adults. Retrieved from
https://www.heartfoundation.org.au/images/uploads/publications/PRO-
167_Hypertension-guideline-2016_WEB.pdf.
Hicken, M. T., Lee, H., Morenoff, J., House, J. S., & Williams, D. R. (2014). Racial/ethnic
disparities in hypertension prevalence: reconsidering the role of chronic stress. American
journal of public health, 104(1), 117-123.
King, J. B., Shah, R. U., Bress, A. P., Nelson, R. E., & Bellows, B. K. (2016). Cost-effectiveness
of sacubitril-valsartan combination therapy compared with enalapril for the treatment of
heart failure with reduced ejection fraction. JACC: Heart Failure, 4(5), 392-402.
McCollister, D., Shaffer, S., Badesch, D. B., Filusch, A., Hunsche, E., Schüler, R., ... & Peacock,
A. (2016). Development of the Pulmonary Arterial Hypertension-Symptoms and Impact
(PAH-SYMPACT®) questionnaire: a new patient-reported outcome instrument for
PAH. Respiratory research, 17(1), 72.

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Ordinioha, B. (2013). The prevalence of hypertension and its modifiable risk factors among
lecturers of a medical school in Port Harcourt, south-south Nigeria: Implications for
control effort. Nigerian journal of clinical practice, 16(1), 1-11.
Straub, R. H., & Cutolo, M. (2016). Glucocorticoids and chronic
inflammation. Rheumatology, 55(suppl_2), ii6-ii14.
Triposkiadis, F. K., Butler, J., Karayannis, G., Starling, R. C., Filippatos, G., Wolski, K., ... &
Skoularigis, J. (2014). Efficacy and safety of high dose versus low dose furosemide with
or without dopamine infusion: the Dopamine in Acute Decompensated Heart Failure II
(DAD-HF II) trial. International journal of cardiology, 172(1), 115-121.

8NURSING ASSIGNMENT
Appendix
Education plan for Trevor
Drug Dosage Rationale
Enalapril 5 mg BD oral It is an ACE inhibitor and
used for treating high blood
pressure, thereby reducing
complications of associated
cardiac disorder. It will
improve the ability of the
heart to pump blood and will
also protect from
symptomatic heart failure.
However, some side effects
like cough, drowsiness,
dizziness, skin rash, itching
and nausea might occur (King
et al., 2016).
Frusemide 20 mg IV every 2 hours/first
12 hours
40 mg daily oral
It will reduce accumulation of
excess fluid in the body and
will also act as a diuretic. It
will prevent swelling
associated with heart failure.
Sensations of ringing in the