George’s IIblood IIpressure IIis II189/110. I I His IILDL IICholesterol IIis II200 IImg/dL. I I He IIasks IIthe IIstudent IInurse IIif
IIhisIblood IIpressure IIis IIsomething IIhe IIshould IIbe IIconcerned IIabout
1. How IIshould IIthe IIstudent IIrespond?
A. Your IIblood IIpressure IIis IIvery IIhigh. I I You IIneed IIto IIsee IIyour IIhealthcare IIprovider IItoday.
B. You IIhave IIhypertension. IIYou IIneed IIto IIstart IImaking IIsome IIlifestyle
IIchanges. IIC. I I Please IIsit IIquietly IIfor IIa IIfew IIminutes. I I I IIneed IIto IIrecheck IIyour
IIblood IIpressure.
D. I I I IIneed IIyou IIto IIremain IIseated. I I I IIam IIgoing IIto IIcall IIfor IIthe IIemergency IIsquad.
A IIweek IIlater, IIGeorge IIhas IIan IIappointment IIwith IIhis IIHCP. I I After IIthe IIexam IIthe IIHCP IIexplains IIto IIGeorge
IIthatIhe IIhas IIstage II2, IIprimary, II(essential) IIhypertension.
5. Which IIinformation IIobtained IIduring IIthe IIassessment IIsupports IIthis IIdiagnosis?
A. Blood IIPressure IIof II184/98 IImmHg
B. Family IIhistory IIof IIHypertension
C. Irregular IIpulse IIrate IIof II110 IIbeats/min.
D. A IIauscultated IIheart IImurmur
, NUR II102 IIHypertension IICase IIStudy- IIGeorge IIThomas
• Family IIhistory IIof IIhypertension, IIdiabetes IImellitus, IIcardiovascular IIdisease,
IIhyperlipidemia, II or II renal II disease; II smoking; II stress; II obesity; II or II sedentary
II lifestyle
• Previous II documentation II of II high II blood II pressure, II including II age II at II onset,
II level II ofIelevation, IIand IIcurrently IIprescribed IImedical IIregimen
• History IIof IIall IIprescribed IIand IIover-the-counter IImedications II and II the IIclient's IIexact
IIcompliance I I with I I taking I I the II medications. I I NOTE: II Medications II that I I may II either
II raiseIb lood IIpressure II or II interfere II with II the IIeffectiveness IIof II antihypertensive
II medications
include IIoral II contraceptives, II steroids, II nonsteroidal II anti-inflammatory II drugs, II nasal
Idecongestants, II appetite II suppressants, II cyclosporine, II tricyclic II antidepressants,
• History I I of I I any I I disease I I or I I trauma II to I I target I I organs
• Results I I and I I side I I effects I I of I I previous I I antihypertensive I I therapy
• Clinical I I manifestations I I of I I cardiovascular I I disorders, I I such I I as I I angina,
I I dyspnea, I I orIc laudication
• History IIof IIor IIrecent IIweight IIgain, IIexercise IIactivities, IIsodium IIintake, IIfat IIintake,
IIalcoholIu se, IIand IIsmoking
• Psychosocial II and IIenvironmental II factors II(e.g., IIemotional IIstress, IIcultural
IIfoodIp ractices, IIeconomic IIstatus) IIthat IImay IIinfluence IIblood IIpressure
IIcontrol
Physical II Examination
Physical I I assessment I I should I I include I I an I I accurate I I determination I I of I I blood I I pressure I I as
I I well I I asIa n IIevaluation IIof IItarget IIorgans:
• Vital I I signs I I and I I weight
• Blood IIpressure—because IIblood IIpressure IIis IIvariable IIand IIcan IIbe IIaffected IIby IImultiple
Ifactors, IIit IIshould IIbe IImeasured IIso IIthat IIreadings IIare IIrepresentative IIof IIthe IIclient's
usual II level; II the II following IItechniques II are II strongly II recommended: II The II client
II should IIbe IIseated IIwith IIthe IIarm IIbared, IIsupported, IIand IIpositioned IIat IIheart IIlevel.
IIThe IIclient IIshould II not II have II smoked II tobacco II or II ingested IIcaffeine II within II the
II previous II 30 IIminutes. II Measurement IIshould IIbegin IIafter II at IIleast II5 II minutes IIof
IIon II the II floor IIwith IItheIl egs II uncrossed. II The II client II should II not II speak II while II the
II blood IIpressure II is II being IImonitored.
Use IIof IIthe II appropriate IIcuff IIsize II will IIensure II an IIaccurate II measurement. IIThe IIrubber IIbladder
IIshould I I encircle I I at I I least II 80% I I of I I the I I limb I I being I I measured. I I The I I bladder's I I width I I should II be
I I one-Ithird IIto IIone-half IIthe IIcircumference IIof IIthe IIlimb. IISeveral IIsizes IIof IIcuffs II(e.g., IIchild, IIadult,
• Both I I systolic II and I I diastolic I I blood I I pressures I I should I I be I I recorded. I I The
I I disappearance I I ofs I ound II (phase II V) II should II be II used II for I I the II diastolic II reading. II Two
II or II more II readings IIshould IIbe II averaged. II If II the II first II two II readings II differ II by II more
II than II5 II mm II Hg, II additional
readings I I should I I be I I obtained.
• Funduscopic IIexamination II for IIretinal II arteriolar IInarrowing, IIhemorrhages,
IIexudates,Ia nd IIpapilledema
• Examination IIof II the II neck II for IIdistended II veins, IIcarotid II bruits, IIand IIenlarged II thyroid
• Auscultation IIof IIthe IIheart IIfor II increased IIheart II rate, IIdysrhythmias,
IIenlargement,Ip recordial IIimpulses, IImurmurs, IIand IIS3 IIand IIS4 IIheart IIsounds
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