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Priority problems of Hyperlipidemia and Hypertension

Discuss about the Inflammation, Dyslipidemia and Atherosclerosis.

Hyperlipidemia can be described as the condition that causes the level of fat proteins and lipids in the bloodstream of an individual to increase. Hypertension, on the other hand, can be defined as a condition that causes the blood pressure in the arteries of an individual to rise exceedingly. Hypertension may also be referred to as high blood pressure. These two medical conditions are most common among persons of old age like is the case with Beryl. It is possible for one to suffer from hypertension and hyperlipidemia without showing any signs until the conditions become severe (Harrison et al., 2011, p. 134). In this essay, we will apply the clinical reasoning cycle to plan and assess an efficient patient care for adults. Additionally, we will address the priority problems of the patient and the most appropriate nursing interventions to manage the priority problems. This essay further highlights hyperlipidemia and hypertension as the main priority problems.

Hyperlipidemia is a medical condition that is caused by an elevated level of fat proteins and cholesterol in the bloodstream of an individual. Increased amounts of lipids and fat proteins put an individual at greater risks of coronary heart diseases (Eliopoulos, 2013). Hyperlipidemia may be associated with two main abnormalities that include hypercholesterolemia and hypertriglyceridemia (Mirhosseini, Baradaran & Rafieian-Kopaei, 2014, p. 758). Hypercholesterolemia is an abnormality that leads to an increased amount of blood cholesterol while hypertriglyceridemia, on the other hand, is an abnormality that increases the levels of triglycerides in an individual’s bloodstream.  The increased levels of blood cholesterol and triglycerides may cause some conditions related to the heart such as cardiovascular diseases (Nelson, 2013, p. 198). The cardiovascular diseases are as a result of the deposition of cholesterol on arterial walls. 

Hyperlipidemia is realized through the performance of a blood test known as the lipid profile test that is normally performed by the attending doctor. This lipid profile test is done to determine the level of blood cholesterol in the body. Blood cholesterol under normal conditions of a healthy individual is around 0.5mmol/L. The lipid profile test can also be used to determine the amounts of high-density and low-density lipoproteins. The ideal level of high-density lipoprotein is ascertained to be 3.3mmol/L (Eliopoulos, 2013). High-density lipoprotein also referred to as good cholesterol is required to be relatively high. Low-density lipoprotein, on the other hand, is described to be bad cholesterol and should not exceed 5.5mmol/L. The assessment document reveals that Beryl’s blood cholesterol is 6mmol/L which is very high compared to the normal amount. A value of 0.8mmol/L as her high-density lipoprotein is also considered low given that the normal value is 3.3mmol/L. Her low-density lipoprotein may, however, be considered to be within the normal range at a value of 3.2mmol/L. From these assessment results, we can be able to conclude that Beryl has a possible condition of hyperlipidemia.

Assessing and Managing Hyperlipidemia

The nursing interventions are aimed at managing the level of blood cholesterol in Beryl’s body so as to ensure her safety and enhance quality care. Interventions can either be independent, collaborative, or direct. In the following paragraphs, we will discuss some of the nursing interventions that can be used to help Beryl.

The level of blood cholesterol in an individual’s bloodstream is affected by several dietary factors. Reducing the intake of saturated fats is among if not the most important technique of lowering the levels of lipids in the blood (Last, Ference & Falleroni, 2011). Tiete (2014), also approves that it is important to educate the nurses on matters concerning the counseling of patients, nutrition education, and dietary assessment skills (p. 95). As a result, the nurses can easily and with efficiency implement the strategies needed to treat hyperlipidemia. Nurses are additionally required to educate the public on healthy diets. Baljani, Rahimi, Amanpour, Salimi & Parkhashjoo (2011), confirm that nutrition education inspires individuals to consume fruits and vegetables instead of already processed food thus helping them develop a clear perspective regarding health and wellness.

From Beryl’s scenario, we notice that she rarely has time to make her food and instead buys take away food. Additionally, we realize that she eats large muffins and coffee made with full cream milk for lunch. It is clear that she is practicing an unhealthy diet which has led to a rise in the level of lipids. This intervention is therefore very important because it is useful in lowering the number of lipids and maintaining the level of cholesterol in the blood at a normal range (Baljani et al., 2011).

Physical activities should be incorporated into an individual’s daily routine to help in managing conditions like coronary heart disease. Gao et al. (2012), confirms that often engaging in aerobic exercises is essential as it helps in managing the levels of cholesterol in the blood (p. 55). Exercise must, however, be accompanied by healthy diets to guarantee good results. For starters, it would be appropriate to exercise for around 120-150 minutes on a weekly basis. Every session of exercising should last around 40 minutes for good results. Engaging in physical activities helps to raise lipoprotein profiles by reducing the triglycerides levels and increasing the amount of high-density lipoprotein (Tucker et al., 2013, p. 540). Another important aspect of physical activities is that they reduce the LDL-to-HDL ratio.

Nursing interventions for Hyperlipidemia

According to Navar-Boggan et al. (2014), there are several methods that can be used to incorporate physical activities into an individual’s daily routine. Some of these techniques include cycling, running up and down the stairs, dancing, and occasionally taking a walk (p. 455). Wong et al. (2012), ascertain that the aims of the physical activities should to maximize the benefits with much-reduced risks if deteriorating the health or physical conditions of a patient (p. 567). It is thus imperative that the nurse advises the patient on all the possible concerns that might be associated with a particular physical exercise.


From the case study, we can notice that Beryl seldom engages in physical exercises apart from occasionally walking to a nearby restaurant to buy some takeaway food. Her poor eating habits, in combination with her lack of physical exercise, have thus increased her chances of suffering from hyperlipidemia. At work, she parks just next to her office and thus, she doesn’t have to walk even for some short distance. The registered nurse tasked with caring for Beryl must, therefore, advise her to engage in routine physical exercises to help in the control and management of blood cholesterol (Wong et al., 2012, p. 570). It is nonetheless worth noting that other forms of medication used to reduce the number of lipids may cause discomfort during physical exercises.

Hypertension is also referred to as high blood pressure by several medical journals. It causes several health complications that include heart attack, stroke, and even death at worst. Medical guidelines indicate that a blood pressure higher than 130/80 mmHg could be an indication of hypertension. Blood pressure can further be defined as the amount of blood that is pumped by the heart against the resistance of the arterial walls. Harrison et al. (2011), ascertain that an increase in the blood pressure is experienced when the heart pumps more blood but the arterial walls are narrow (138). Pedrosa et al. (2011), further confirm that there are two types of hypertension that include primary and secondary hypertension. Primary hypertension is as a result of gradual development over the years. Secondary hypertension, in contrast, develops due to some primary conditions such as thyroid problems, sleep apnea, and kidney problems (p. 813).

Blood pressure is measured using an inflated arm cuff that is placed around the arm of the patient. This condition may not reveal its symptoms during early stages until it becomes severe and life-threatening. The normal blood pressure, as revealed by several studies should be 130/80 mmHg (Mitchel, 2014, p. 15). Beryl’s blood pressure, on the other hand, is 160/95 mmHg as indicated in the nursing assessment. This value is exceedingly high which could be an indication that Beryl could be suffering from hypertension stage 2.

Assessing and Managing Hypertension

Nursing interventions for hypertension aim at lowering the blood pressure of a patient and maintaining it at a normally safe range. Beryl’s blood pressure should be lowered to a value below 140/90 mmHg. As Hacihasano?lu & Gözüm (2011) ascertain, these interventions are meant to modify the lifestyle choices of all the patients with conditions of prehypertension and hypertension (p. 695). Below, we discuss some of the nursing interventions used to address hypertension.

As a registered nurse, it is important to assess the blood pressure of a patient before you start treating any condition related to hypertension. The assessment and monitoring of the blood pressure of an individual are very significant in obtaining the baseline, scrutinizing any fluctuations in the blood pressure, diagnosing the disease, and medication administration (Li et al., 2012, p. 780). Invasive and non-invasive measurements are the two key ways of assessing and monitoring the blood pressure of a patient (Weber et al., 2014, p. 17).

It is crucial that the nurse enlightens the patient on the procedures they intend to undertake before embarking on treatment. Explanation instills comfort in the patient and helps them in becoming relaxed and avoiding distress (Li et al., 2012, p. 782). Furthermore, it is essential if the attending doctor or the registered nurse notes whether the patient is using any form of medication that could increase their blood pressure.

This intervention is very useful in lowering the blood pressure and preventing other heart-related conditions. Additionally, this intervention can be used to monitor cardiovascular hemostasis. According to Mirhosseini, Baradaran & Rafieian-Kopaei (2014), assessing and monitoring the blood pressure, gives both the nurse and the patient the opportunity to assess, discuss and decide the possible treatment outcomes (p. 758). As a result, the nurse can effectively develop an efficient and appropriate treatment plan. Additionally, the nurse can possibly adjust drugs and medications whenever the need to do so arises. Furthermore, through blood pressure assessment, the nurse can easily observe any complications and recommend the appropriate emergency treatment.

From the nursing assessment form, Beryl’s blood pressure is indicated to be 160/95 mmHg. It is evident that this blood pressure is very high and thus should be closely observed to prevent the condition from escalating to other complications like stroke. The nurse should thus assess this blood pressure after which she needs to develop a treatment plan.

Stress avoidance is vital in avoiding hypertension and other heart-related conditions. As confirmed by Lin et al. (2012), stress has the capability of causing temporary spikes in the blood pressure of an individual (p. 8). Additionally, stress may lead to long-term hypertension (Grenard et al., 2011, p. 1177). Stress and depression may force a patient to practice some self-destructive like non-adherence to medication as presented by Beryl’s scenario. Beryl may sometime fail to take her drugs due to being depressed. Controlling and managing stress are therefore important in the handling of hypertension. 

Nursing interventions for Hypertension

Nevertheless, it is worth noting that decreasing stress may not reduce blood pressure directly (Persell, 2011, p. 1078). It is important to apply stress management strategies to help in health improvement. These strategies may be fundamental in influencing some behavioral changes in a patient, which may further assist in lowering blood pressure and managing hypertension.

A registered nurse can advise the patient on several ways of controlling their blood pressure and managing stress. As revealed by Parekh, J., Corley, D. A., & Feng (2012), one way of reducing stress is by simplifying one’s schedule (p. 2181). Beryl works from 8am-5pm on a daily basis implying that she has a very tight schedule. This implies that she seldom has time to relax with her kids and the nurse should, therefore, convince her that she needs to prioritize her health above any other thing. Furthermore, she needs to find some ways of simplifying her tight schedule. It is also important to note that she could engage in exercises to distract her a little beat as this could also be fundamental in managing stress. Finally, she has to get enough hours of sleep on a daily basis as sleep deprivation is known to cause depression.

Conclusion

Hypertension is a medical condition that is known to increase the pressure of blood within the arterial walls.  Hyperlipidemia, conversely, causes an elevation of the levels of blood cholesterol in the body. These two conditions are known to be life-threatening when they become severe. They, therefore, need to be managed with extreme care and seriousness to avoid escalation into a stroke and cardiovascular disease.  Poor eating habits and lack of routine physical exercises are believed to be some of the causes of these conditions, not forgetting stress and depression. The appropriate application of the necessary nursing interventions can, however, help in managing and controlling hypertension and hyperlipidemia to ensure patient safety and improve quality care. Some of these nursing interventions include nutritional education, physical activities, and stress and depression reduction among others. They educate the patients on the proper way of handling lifestyle diseases in addition to improving health.

References

Baljani, E., Rahimi, J. H., Amanpour, E., Salimi, S., & Parkhashjoo, M. (2011). Effects of a Nursing Intervention on Improving Self-Efficacy and Reducing Cardiovascular Risk Factors in Patients with Cardiovascular Diseases. Hayat, 17(1).

Eliopoulos, C. (2013). Gerontological nursing. Lippincott Williams & Wilkins.

Gao, W., He, H. W., Wang, Z. M., Zhao, H., Lian, X. Q., Wang, Y. S., ... & Wang, L. S. (2012). Plasma levels of lipometabolism-related miR-122 and miR-370 are increased in patients with hyperlipidemia and associated with coronary artery disease. Lipids in health and disease, 11(1), 55.

Grenard, J. L., Munjas, B. A., Adams, J. L., Suttorp, M., Maglione, M., McGlynn, E. A., & Gellad, W. F. (2011). Depression and medication adherence in the treatment of chronic diseases in the United States: a meta-analysis. Journal of general internal medicine, 26(10), 1175-1182.

Hacihasano?lu, R., & Gözüm, S. (2011). The effect of patient education and home monitoring on medication compliance, hypertension management , healthy lifestyle behaviours and BMI in a primary health care setting. Journal of clinical nursing, 20(5?6), 692-705.

Harrison, D. G., Guzik, T. J., Lob, H. E., Madhur, M. S., Marvar, P. J., Thabet, S. R., ... & Weyand, C. M. (2011). Inflammation, immunity, and hypertension. Hypertension, 57(2), 132-140.

Last, A. R., Ference, J. D., & Falleroni, J. (2011). Pharmacologic treatment of hyperlipidemia. American family physician, 84(5).

Li, P., McElligott, S., Bergquist, H., Schwartz, J. S., & Doshi, J. A. (2012). Effect of the Medicare Part D coverage gap on medication use among patients with hypertension and hyperlipidemia. Annals of internal medicine, 156(11), 776-784.

Lin, E. H., Von Korff, M., Ciechanowski, P., Peterson, D., Ludman, E. J., Rutter, C. M., ... & McCulloch, D. K. (2012). Treatment adjustment and medication adherence for complex patients with diabetes, heart disease, and depression: a randomized controlled trial. The Annals of Family Medicine, 10(1), 6-14.

Mirhosseini, M., Baradaran, A., & Rafieian-Kopaei, M. (2014). Anethum graveolens and hyperlipidemia: A randomized clinical trial. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences, 19(8), 758.

Mitchell, G. F. (2014). Arterial stiffness and hypertension. Hypertension, 64(1), 13-18.

Navar-Boggan, A. M., Peterson, E. D., D’Agostino, R. B., Neely, B., Sniderman, A. D., & Pencina, M. J. (2015). Hyperlipidemia in Early Adulthood Increases Long-Term Risk of Coronary Heart DiseaseCLINICAL PERSPECTIVE. Circulation, 131(5), 451-458.

Nelson, R. H. (2013). Hyperlipidemia as a risk factor for cardiovascular disease. Primary Care: Clinics in Office Practice, 40(1), 195-211.

Parekh, J., Corley, D. A., & Feng, S. (2012). Diabetes, hypertension and hyperlipidemia: prevalence over time and impact on long?term survival after liver transplantation. American journal of transplantation, 12(8), 2181-2187.

Pedrosa, R. P., Drager, L. F., Gonzaga, C. C., Sousa, M. G., de Paula, L. K., Amaro, A. C., ... & Lorenzi-Filho, G. (2011). Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension, 58(5), 811-817.

Persell, S. D. (2011). Prevalence of resistant hypertension in the United States, 2003–2008. Hypertension, 57(6), 1076-1080.

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Weber, M. A., Schiffrin, E. L., White, W. B., Mann, S., Lindholm, L. H., Kenerson, J. G., ... & Cohen, D. L. (2014). Clinical practice guidelines for the management of hypertension in the community. The journal of clinical hypertension, 16(1), 14-26.

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