Hypertension And Hyperlipidemia: Clinical Reasoning Cycle And Nursing Essay.

Hypertension

Discuss about the Hypertension and Hyperlipidemia Condition.

Hypertension, also known as high blood pressure is a medical condition that causes a rise in the blood pressure within the arterial walls of an individual. According to Harrison et al. (2011), some people may have this condition for long periods without showing any symptoms until it gets so severe to the point that it becomes life-threatening (p. 134). Hyperlipidemia, on the other, is a condition that leads to an increase in the amount of cholesterol or fat proteins the in an individual’s bloodstream. These two conditions are more prevalent among the elderly as shoe by the presented scenario of Beryl. This essay aims at applying the clinical reasoning cycle in planning and assessing the most appropriate patient care. Additionally, the essay talks about the patient’s priority problems and the necessary nursing interventions to address each of these problems.  We will pay particular attention to hypertension and hyperlipidemia as the two main priority problems.

Hypertension is a condition of a high blood pressure that causes several health complications. It can even cause heart attack, stroke, and even death in the worst case scenarios. Medical guidelines describe hypertension as any blood pressure that is higher than 130/80 mmHg.  The amount of blood that the heart can pump and the magnitude of resistance offered by the arterial walls to blood flow is what defines blood pressure. As Harrison et al. ascertain (2011), blood pressure rises when the heart pumps more blood but the walls of the arteries are narrow (138). There are two types of hypertension that include primary and secondary hypertension. Primary hypertension tends to gradually develop in someone over a long period of time. Secondary hypertension, on the other hand, develops as a result of some underlying conditions such as sleep apnea, thyroid problems, and kidney problems (Pedrosa et al., 2011, p. 813).

As previously stated, the symptoms of hypertension may fail to reveal themselves in some instance.an inflatable arm cuff can, however, be placed around a patient’s arm to measure their blood pressure. Several studies reveal that the normal blood pressure should be 130/80 mmHg (Mitchel, 2014, p. 15). Beryl’s blood pressure conversely is 160/95 mmHg as revealed by the nursing assessment. This value is extremely high which could indicate that Beryl has stage 2 hypertension.

The main aim of these  nursing interventions is to lower the patient’s blood pressure and ensure that it is maintained at a normal range. Like in Beryl’s case, her blood pressure should be lowered to below 140/90 mmHg. According to Hacihasano?lu & Gözüm (2011), these interventions always focus on modifying the lifestyle of all the patients with conditions of prehypertension and hypertension (p. 695). In the following paragraphs, we will discuss some of the nursing interventions for hypertension.

Assessing and Monitoring Blood Pressure

The most important thing to identify before you start treating a patient with hypertension is their blood pressure. Assessing and monitoring a patient’s blood pressure, are very significant as they aid in obtaining a baseline, scrutinizing the variations in the blood pressure, diagnosing the condition, and to administer medication among others (Li et al., 2012, p. 780). The two main ways of performing assessment and monitoring of blood pressure are invasive and non-invasive measurements (Weber et al., 2014, p. 17).

The nurse is required to explain to the patient what they intend to do before they can embark on this procedure. As Li et al. (2012), confirms, this explanation helps the patient to become comfortable and relaxed to avoid any form of distress (p. 782). The attending doctor or the registered nurse must also note whether the patient might have been using any form of medication that could raise their blood pressure. 

The significance of this intervention lies in the fact that it helps in lowering the blood pressure thus preventing hypertension and other heart-related complications. This intervention is additionally fundamental in monitoring cardiovascular hemostasis. It is worth noting that assessment and monitoring of the blood pressure, gives both the nurse and the patient to assess, discuss and decide the probable treatment outcomes (Mirhosseini, Baradaran & Rafieian-Kopaei, 2014, p. 758). Through this intervention, the nurse can effectively establish the most appropriate treatment plan and even adjust drugs and medication if the need arises. Furthermore, assessment of the blood pressure gives the nurse the opportunity of observing any complications and recommending emergency treatment.

Beryl’s blood pressure, as documented in the nursing assessment form is 160/95 mmHg which is extremely high. This blood pressure, therefore, needs close observation to avoid any other complications like stroke or death at worse. The registered nurse tasked with caring for Beryl should, therefore, assess this blood pressure and develop an appropriate treatment plan.

It is important to always avoid a stressful life in order to reduce chances of hypertension and any other heart-related conditions. Several medical studies have revealed that stress may cause temporary spikes in an individual’s blood pressure (Lin et al., 2012, p. 8). As revealed by Grenard et al. (2011), stress may cause long-term hypertension (p. 1177). From the presented scenario of Beryl, we notice that depression may force a patient to engage in some self-destructive activities like non-adherence to medication.  Beryl has medication that she uses to control her blood pressure but she sometimes fails to take them due to depression. The control and management of stress are thus important to help in preventing spikes in the blood pressure. 

Managing Stress to Control Hypertension

Nonetheless, it is important to note that decreasing stress may not directly reduce blood pressure (Persell, 2011, p. 1078). Applying some strategies aimed at reducing stress can massively improve health. These strategies can influence some behavioral changes in a patient, which may help in managing hypertension and lower blood pressure.

There are several ways that can be used to lower stress and control blood pressure under the advisement of the registered nurse. One of the ways is through the simplification of one’s schedule (Parekh, J., Corley, D. A., & Feng, 2012, p. 2181). The revelations from Beryl’s assessment form indicate that her schedule is very tight and it involves working with 8am-5pm on a daily basis. She, therefore, does not have some time to relax and spend some quality time with her family. She, therefore, needs the nurse to tell convince her that her life should be her main priority. She could be further advised on some of the ways she could use to simplify her schedule. Exercise is another very crucial aspect of stress management and thus Beryl should spend some time exercising to get her mind off a lot of things.  Additionally, if by any chance she is sleep deprived, then it would be necessary to get enough hours of sleep every day.

Hyperlipidemia is a condition that leads to high cholesterol or fat protein levels in an individual’s bloodstream. According to Eliopoulos (2013), elevated levels of lipids in one’s bloodstream increases the risks associated with coronary heart diseases. As Mirhosseini, Baradaran & Rafieian-Kopaei (2014), confirm, there are two main abnormalities of lipids that are linked to hyperlipidemia. These abnormalities are hypercholesterolemia and hypertriglyceridemia. Hypercholesterolemia is characterized by elevated levels of cholesterols while hypertriglyceridemia can be defined as having increased levels of triglycerides in the blood (p. 758). Having increased levels of blood cholesterol can lead to some heart-related conditions like cardiovascular diseases (Nelson, 2013, p. 198). This happens because the cholesterol gets deposited on the arterial walls making the arteries narrow.

This condition is detected when a doctor performs a blood test referred to as lipid profile on the patient. Just like hypertension, hyperlipidemia may also lack obvious symptoms until the condition gets severe. The lipid profile test, therefore, is aimed at determining the levels of blood cholesterol. A normal amount of blood cholesterol is considered to be 0.05mmol/L. it is additionally important to note that the normal amount of high-density lipoprotein is considered to be 3.3mmol/L (Eliopoulos, 2013). It is preferable to have a higher quantity of high-density lipoprotein because it is described as good cholesterol. Low-density lipoprotein which is considered to be bad cholesterol should, on the other hand, be lower than 5.5mmol/L. From Beryl’s pathology results, we realize that she has a cholesterol level of 6mmol/L which is exceedingly high. Additionally, her high-density lipoprotein value is lower than the normal value at 0.8mml/L. we can further notice that her low-density lipoprotein is however within the normal range at around 3.2mm /L. These assessment results could be a clear indication of a condition of hyperlipidemia.

Hyperlipidemia

Nursing interventions can be classified as independent or collaborative, direct and indirect. Independent nursing interventions are those interventions that are endorsed by the professional nurse practice acts and may, therefore not require directions from other healthcare professionals. In the paragraphs below, we will discuss two nursing interventions that include nutrition education and increased physical activity.

There are numerous dietary factors that affect the level of an individual’s blood cholesterol. However, Last, Ference & Falleroni (2011), confirm that a reduction in the consumption of saturated fats is the most important strategy for ensuring reduced levels of lipids in the blood. The nurses need to be educated on several aspects that include nutrition education, patient counseling, and skills of dietary assessment (Tietge, 2014, p. 95). This ensures that the nurses can efficiently implement the strategies that are necessary for the treatment of hyperlipidemia. It is then the responsibility of the nurses to enlighten the public on healthy diets that are low in saturated fats to lower hyperlipidemia-associated risks. As revealed by Baljani, Rahimi, Amanpour, Salimi & Parkhashjoo (2011), nutrition education can inspire the patients and their families to consume more fruits and vegetables in place of already processed food. This, therefore, helps them to develop a clear perspective of health and wellness.

From the case study provided in Beryl’s scenario, it is clear that she never has time to prepare her food and instead buys take away food for her dinners. We are further informed that during lunch hours, she often consumes a large muffin and full cream milk coffee. This diet is clearly unhealthy and it has led to elevated levels of blood cholesterol. The importance of this intervention can, therefore not be understated because it helps to lower the number of lipids and maintain the level of blood cholesterol within the normal range (Baljani et al, 2011).

Physical activities are important in an individual’s daily routine because it is one of the crucial risk factors for coronary heart disease. Gao et al. (2012), ascertain that engaging in regular aerobic exercises is important as it helps in managing the levels of blood cholesterol (p. 55). The effectiveness of exercises, however, depends on a healthy diet. Exercising for around 120-150 minutes on a weekly basis is recommended for a start. For better results, every exercising session should last around 40 minutes. As Tucker et al. (2013) confirm, physical activities help to boost lipoprotein profiles as it helps to reduce the levels of triglycerides and increase the levels of high-density lipoprotein (p. 540). It is further important to note that physical exercises help to reduce the LDL-to-HDL ratio.

Nursing Interventions for Hyperlipidemia

There are numerous methods an individual, with the help of a nurse, can use to integrate physical activities into their daily routine. Some of these methods include running up and down the stairs, cycling, dancing, and preferring to walk over taking a car or bus for short distances among others (Navar-Boggan et al., 2014, p. 455). These physical activities should be aimed at maximizing the benefits with much-reduced risks if worsening a patient’s physical or health conditions. The nurse must, therefore, advise the patient on any possible concerns related to a specific physical activity to ensure patient safety and quality care (Wong et al., 2012, p. 567).

From the presented scenario, we are told that Beryl rarely engages in any form of exercise but occasionally taking a walk to the local restaurant.  The lack of routine physical activity in addition to her poor eating habits has put her at a risk of developing hyperlipidemia. We are additionally informed that she drives to work and packs just next to her office, an indication that she does not walk for long distances. It would, therefore, be important if she engaged in more physical activities to help reduce the level of blood cholesterol and maintain it at a normal range (Wong et al., 2012, p. 570). Using other forms of medication to reduce the levels of lipids can, however, cause discomfort with this intervention thus making it a challenge in some cases.  

Conclusion

Hypertension is a condition that leads to increased levels of blood pressure within an individual’s arterial walls. Hyperlipidemia, on the other hand, leads to elevated levels of blood cholesterol in the body. These two conditions could be life-threatening and they, therefore, require care and seriousness when managing them to avoid other critical conditions like stroke and cardiovascular disease. They, in most cases, arise as a result of lifestyle choices such as poor eating habits and lack of exercise. Other factors like stress and depression can also cause hypertension and hyperlipidemia. There are however some nursing interventions that can be appropriately applied to help in controlling and managing these conditions to improve the quality of care and enhance patient safety. The nursing interventions include physical activities, nutritional education, and stress reduction among others. They help in improving health and educating the patients on the ways of handling the diseases.

References

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Nutrition Education

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