Posted: January 17th, 2023
Nursing Health Assessment.
Nursing Health Assessment
Obesity is defined as the body mass index of 30 kg/m2 or more. Obesity elevates the risk of a person having hypertension. Studies have shown that increased weight leads to increased blood pressure. A study conducted by Xi et al (2015) indicated that individuals within the highest MBI quartile were having 16 mmHg higher systolic blood pressure and a 9 mmHg higher diastolic blood pressure when compared to individuals within the lowest BMI quartile.
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This study showed that the systolic pressure elevated 4 mmHg for every 4.5 kilograms of elevated weight. Obesity-associated with hypertension is typified by abnormalities such as stimulation renin-angiotensin system, sodium retention, and stimulation of the sympathetic nervous system. This assignment presents a case study of a 50-year-old man who presented with persistent increased blood pressure in spite of lifestyle management and starting antihypertensive medication. Accordingly, this paper will describe the physical examination data and history that should be obtained from the client and discuss the psychosocial factors that may affect his adherence to the treatment regimen. The paper will conclude by discussing suitable patient education to improve his awareness and adherence to the care plan.Nursing Health Assessment.
History and Physical Examination Data
A full history of Mr. A, including the medication history, adherence to treatment, dietary account, as well as his activity level should be obtained. The patient was started on a regimen of antihypertensive medication one month ago and therefore it is important to enquire if the patient has been adhering to the prescribed. The reason for taking the history of the patient’s adherence to the treatment regimen is because a lack of adherence to the antihypertensive treatment regimen is very common. For example, a study conducted by Tilea et al (2018) indicated that for the 149 patients with hypertension, only 58% of them were adhering to the treatment regimen. Lack of appropriate adherence to medication is a major obstacle to achieving the benefits of pharmacologic treatment and better patient outcomes and thus nonadherence could be a barrier to this patient’s achieving control of his hypertension (Villalva et al, 2017). In addition, it is important to enquire about the antihypertensive medications the patient has been taking in order to establish if there is a need to discontinue the medications and prescribe another one that can help the patient achieve his blood pressure target.Nursing Health Assessment.
It is also important to take a history of the patient’sdietary intake. According to Schwingshackl et al (2017), any patient having hypertension is supposed to ensure high intake of vegetables, fresh fruits, low-fat dairy products and reduce intake of sodium. This is because these dietary modifications reduce the level of blood pressure and therefore it would be important to enquire if failure to adhere to the appropriate dietary modifications could be contributing to the persistent increased blood pressure. In addition, the nurse should take the history of the patient’s physical activity because lack of physical activity has been shown to be a contributing factor to increased levels of blood pressure (Schwingshackl et al, 2017.
Other important medical histories for this patient include the history of past medical conditions. For example, it would be important to inquire if the patient has had impairment of fasting glucose levels, hypothyroidism or obstructive sleep apnea. The rationale for this is because some of these conditions may be contributing to the patient’s persistent high blood pressure. It is also to take the history of the patient’s medication such as stimulant medications and anti-inflammatory medications. This is because medications such as stimulant medications and anti-inflammatory medications can induce hypertension, increase values of blood pressure, and reduce the efficacy of antihypertensive medication (Aronow, 2017).Nursing Health Assessment.
The physical examination data would include taking the blood pressure of the patient, pulse rate, weight, and body mass index. It will also be necessary to examine the sodium level, potassium level and creatinine level for this patient. This is because parameters such as sodium and potassium levels have been shown to have an impact on levels of blood pressure (Xi et al, 2015). Other necessary physical exams include electrocardiography and echocardiography. This is because hypertension is a major risk factor for cardiovascular diseases and thus electrocardiography can reveal if the patient has heart problems such as sinus bradycardia while electrocardiography can reveal aspects such as the normal functioning of the heart, ventricular thickness, and any valvular abnormalities (Ramaswamy et al, 2016).
Psychosocial Factors that may Affect the Patient’s Adherence to Treatment
Many people with obesity and hypertension have difficulties attaining the recommended standards for the management of these conditions. Long-term use of medication, especially for hypertension and lifestyle changes for both obesity and hypertension are essential for the successful management of these conditions (Gonzalez et al, 2016). Individuals with hypertension are progressively treated using multiple-drug regimens, and lifestyle changes such as weight loss, physical activities, and dietary modifications are an additional focus area in the management of both hypertension and obesity (Gonzalez et al, 2016). The multiple behavioral requirements for the self-management of hypertension and even obesity, including regular taking of medications, dietary and physical activity changes, and visits with healthcare providers may make the patient’s adherence to the treatment and the necessary lifestyle changes a challenge (Gonzalez et al, 2016).Nursing Health Assessment.
Adherence to treatment refers to the level to which the behavior of an individual matches the instructions provided by the medical practitioner in regards to taking medications, following the proposed diet, and making the recommended lifestyle changes (Huertas-Vieco et al, 2014). There are various risk factors associated with the lack of adherence to the appropriate treatment regimen. Psychosocial factors are among the key factors that affect compliance with the treatment regimen. Some of the psychosocial factors such as social support, self-beliefs regarding medication, depression, anxiety, self-efficacy, and cognitive impairment have been shown to affect treatment adherence among patients with chronic disease (Huertas-Vieco et al, 2014). Similarly, these psychosocial factors maybe affecting Mr. A’s adherence to pharmacologic and nonpharmacologic interventions.
One psychosocial factor that may be affecting the patient’s adherence to the treatment interventions is the lack of social support system. According to Adisa et al (2017), social support has been reported to play a big role in influencing adherence to treatment and health outcomes. Social support is a multi-layered experience that assists patients to stay active in their care and treatment when experiencing physical, economic, and social susceptibilities. For instance, support from the family members, friends, healthcare providers, and even organizations can provide the required support to ensure patients adhere to the treatment regimen. The patient in this case study may be lacking the appropriate family and support to ensure adherence to the treatment (Uchmanowicz et al, 2018). For example, the patient may sometimes forget to take his medication and therefore, it is necessary for the family members to remind him. It is normal for the family members to ensure full responsibility of the treatment routine for the patient in the family. Similarly, lifestyle modifications such as engaging in physical activities and dietary modifications require strong social support from the family, friends and even where possible health care providers. For instance, the family can support the patient by ensuring that the food that is prepared in the home or for the patient is according to the recommended diet. The family members and peers can also provide emotional support to ensure that the patient is motivated to exercise and adhere to all prescribed treatment interventions. According to Adisa et al (2017) good social support ensured by the whole family system lowers self-reliance and ensures better compliance with the treatment regimen.Nursing Health Assessment.
Another factor that may be affecting the patient’s adherence to the treatment regimen is maybe lack of financial support leading to the inability to afford the prescribed medications. Adisa et al (2017) provide that patients who cannot consistently afford the medical costs engage in various adaptive strategies that include skipping and delaying medication doses. Additionally, the patient might not be getting adequate support from the health care providers. According to Uchmanowicz et al, 2018,) steadfast financial status to pay for medical expenses whenever necessary, coupled with sufficient and clear information from healthcare practitioners are vital components of ensuring patients comply with the treatment regimen.
Beliefs and attitudes of the patient may also be affecting his adherence to the required treatment regimen. A study conducted by Jankowska-Polańska et al (2017) found out that side effects, forgetfulness and not liking the medication or the prescribed lifestyle modifications among the key reasons for poor adherence. The patient in this case study may also not be fully aware of the need and efficacy of the prescribed treatments and the serious risks associated with not adhering to the treatment regimen. For example, the patient might not be aware of the risk factors for high blood pressure and likely complications. Successful self-management of chronic conditions such as hypertension needs comprehensive knowledge for the patient and the family, which includes understanding how the condition affects the body, treatment goals, and the impact of various behaviors on the regulation of blood pressure.
Depression and stress associated with is another factor that may be affecting the patient’s adherence to the treatment regimen. The diagnosis of chronic diseases such as hypertension can cause significant distress to patients. As per Huertas-Vieco et al (2014), depression and stress are common factors allied to non-compliance with the anti-hypertensive. Depression and stress may affect the coping strategies of the patient which may also affect his ability to adhere to the treatment regimen, and especially with nonpharmacological treatment such as exercises. This is because stress and depression are associated with lack of motivation and thus the patient may lack motivation to adhere to the treatment regimen.Nursing Health Assessment.
The patient will be educated about his conditions (obesity and hypertension) and the treatment as well. The patient will be educated regarding hypertension and what the condition entails, the consequences associated with uncontrolled hypertension, and the importance of adhering to the treatment regime to attain blood pressure control. According to Pirasath et al (2017) patients who are educated and counseled regarding the management of hypertension manifest better adherence to treatment. The nurse should educate and always inform the patient about the blood pressure and allied diagnostic testing values in order to evaluate the patient knowledge, educate and determine clear treatment goals, and at the same time discuss how the treatment goals will be achieved with the patient. The patient also needs to be educated regarding the appropriate self-monitoring skills such as home blood pressure monitoring (Huertas-Vieco et al, 2014).
The patient will also be educated about the value of investing his time and effort in making lifestyle modifications and the risks associated with skipping medications and not adhering to the treatment regimen. The patient will be encouraged to take an active role in his own care in order to significantly improve his adherence to treatment (Pirasath et al, 2017). For example, the patient will be educated about the scientific rationale behind reducing sodium (salt) intake in patients with hypertension.Nursing Health Assessment. This will adequately fill in knowledge gaps on the part of the patient and demonstrate to him the significance and the weight of diet on controlling his hypertension (Huertas-Vieco et al, 2014). Patient education will thus involve explaining to the patient in detail regarding the importance and effect of all the recommended lifestyle changes as well as the mechanism of action of the prescribed medications; and what happens if the patient fails to adhere to both the pharmacologic and nonpharmacologic interventions. The nurse should listen actively to the patient and include him in the decision-making process; this has been shown to lower patient anxiety and improve adherence to treatment and lifestyle changes.
More importantly, the patient should be counseled about weight loss, because weight loss is the most vital nonpharmacological intervention for reducing the blood pressure, and entails a behavioral change in both physical activity and diet patterns. The patient should thus be helped to initiate and maintain exercise programs and reduce intake of high-calorie diet (Huertas-Vieco et al, 2014). The patient should also be provided with education on lipid reduction and smoking cessation to assist in further reducing his risk for cardiovascular disease. In order to ensure effective modification of the patient’s lifestyle behaviors, it will be important to assess his baseline behaviors, educate him on how to make the suitable changes, educate the patient on how to develop strategies like setting goals for achieving the target blood pressure values, and self-monitoring to make sure the patient achieves and maintains these changes. Pirasath et al (2017) further add that the nurse should work hand in hand with the patient to identify and resolve obstacles to treatment adherence and blood pressure control.Nursing Health Assessment.
To address the patient’s beliefs and attitude, the nurse should individualize patient education and the care as well, in order to motivate the patient to control his hypertension in the remaining, maintain a healthy lifestyle, take the prescribed drugs, and monitor progress towards treatment goals. the nurse should take into account the cultural and social factors, including self-care behaviors, the patient’s beliefs, health literacy, and skills essential to control hypertension and his response to the treatment regimen (Pirasath et al, 2017). The patient should be helped to integrate the treatment regimen into his daily lifestyle, in order to ensure long-term sustainability of the lifestyle modifications and medication intake as well. The nurse should mutually work with the patient to design realistic, outcomes-oriented goals and approaches for achieving the treatment goals. Of equal importance is the nurse following up with the patient to assess his progress towards achieving treatment goals, and if need be, to review strategies for achieving treatment goals (Maslakpak et al, 2018).
Lack of social support for this patient has been cited as a factor contributing to his nonadherence to treatment. Consequently, it would be important to have the patient’s family to participate in the education process of blood pressure control for this patient. Family plays an important role in reinforcing efforts of the patient to attain blood pressure control (Maslakpak et al, 2018). Therefore, if the patient is willing, it would be important to ensure family participation to enhance social support and motivation for the patient to adhere to the treatment regimen.Nursing Health Assessment.
The history that should be obtained from Mr. A, include the medication history, adherence to treatment, dietary account, as well as his level of activity this is because all these factors will provide important information regarding the persistently high blood pressure levels for the patient. It will also be important to take the history of his past medical conditions because some medical conditions can lead to high blood pressure. The relevant physical examinations include blood pressure of the patient, pulse rate, weight, body mass index, sodium level, potassium level and creatinine level for this patient. In addition, tests such as electrocardiography and echocardiography are necessary for this patient to reveal if he has any heart abnormalities because hypertension is a risk factor for cardiovascular diseases. Factors that may be affecting the patient’s adherence to treatment include lack of social support, lack of financial ability to cater for the medical costs, depression and stress associated with the diagnosis, patient’s attitude and beliefs, and also lack of knowledge and awareness regarding his conditions, the risks associated with not adhering to the treatment regimen, and also lack of awareness on the importance of being compliant with the treatment. The patient education should thus focus on increasing patient awareness, understanding his condition and treatments, and ensuring support for the patient.Nursing Health Assessment.
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