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Read the case study of Mr. Henry Brusca, a 68-year-old male diagnosed with hypertension (HTN), and respond to the following questions: Explore further questions to elicit chest pain details using a common acronym; identify his risk factors for heart disease (modifiable vs. unmodifiable); list three priority nursing diagnoses with supporting data; discuss health promotion and disease prevention strategies; and analyze potential respiratory problems related to his cardiovascular condition.

Paper For Above instruction

This nursing case study examines the comprehensive assessment and management of Mr. Henry Brusca, a 68-year-old man with newly diagnosed hypertension. The evaluation emphasizes understanding his risk factors, clinical findings, and potential health challenges associated with cardiovascular disease (CVD), emphasizing the importance of holistic nursing care, health promotion, and interrelated system functions.

Introduction

Cardiovascular diseases represent a leading cause of morbidity and mortality worldwide, particularly in aging populations. In clinical nursing practice, understanding the intricacies of patient histories, clinical signs, and systemic interactions is essential for effective management. This case study focuses on Mr. Brusca’s presentation and guides the nurse through targeted assessments, risk identification, diagnosis formulation, preventive strategies, and anticipation of secondary health issues such as respiratory complications.

Further Inquiry into Chest Pain

Although Mr. Brusca reports no current chest pain, exploring for any history of discomfort remains vital, especially given his hypertensive status and vascular changes. Utilizing the 'OLDCARTS' acronym, common in cardiac assessment, can elucidate potential anginal characteristics:

  • Onset - When did the chest pain or discomfort start?
  • Location - Where is the pain primarily located? Does it radiate?
  • Duration - How long does the pain last? Is it constant or intermittent?
  • Characteristic - How would you describe the pain (sharp, dull, pressure, burning)?
  • Aggrevators - What activities or factors worsen the pain?
  • Relievers - What alleviates the discomfort?
  • Timing - Is there a particular time of day or activity-related pattern?
  • Severity - How severe is the pain on a scale of 0-10?

Using this pattern allows targeted questioning, which is critical for detecting atypical angina, especially in older adults, diabetics, and hypertensive patients who may present with silent ischemia or atypical symptoms.

Risk Factors for Heart Disease

Analysis of Mr. Brusca's history reveals various factors contributing to his cardiovascular risk profile. These include:

  • Modifiable risk factors:
  • Hypertension (BP 150/90 mmHg, previous uncontrolled BP)
  • Obesity (weighs 124 kg at 180 cm height, BMI > 37)
  • Diet high in salt, fats, and carbohydrates; inadequate fruit/vegetable intake
  • Lack of physical activity due to sedentary lifestyle and work demands
  • Stress from entrepreneurial responsibilities
  • Excess alcohol intake (daily wine consumption)
  • Unmodifiable risk factors:
  • Age (68 years old)
  • Family history of HTN and stroke (maternal HTN, paternal MI)
  • Genetic predisposition (ethnicity of Italian descent)

This differentiation guides targeted lifestyle interventions and pharmacologic management to mitigate modifiable risks and monitor unmodifiable ones vigilantly.

Priority Nursing Diagnoses

Based on comprehensive data collection, the following nursing diagnoses are prioritized:

1. Risk for decreased cardiac perfusion related to hypertension and arterial stiffness

  • Supportive subjective data: No chest pain currently, but history of left ventricular hypertrophy, positive carotid pulsation, and increased PMI size suggest cardiac workload
  • Objective data: Elevated BP (150/90 mmHg), positive S4 heart sound, displaced PMI, arterial stiffening, and ECG evidence of hypertrophy

2. Ineffective tissue perfusion (cardiovascular) related to arterial changes and hypertrophy

  • Supportive subjective data: Fatigue, dizziness spells, extremity coldness
  • Objective data: Positive carotid pulsation, edema, skin changes, and cardiomegaly signs on assessment

3. Risk for injury related to dizziness and orthostatic hypotension

  • Supportive subjective data: Occasional dizziness and fatigue
  • Objective data: Blood pressure readings, altered circulation signs, and nocturia

Health Promotion and Disease Prevention

Addressing Mr. Brusca's health involves comprehensive strategies tailored towards primary and secondary prevention. These include promoting lifestyle modifications such as adoption of a heart-healthy diet rich in fruits and vegetables, reduction of salt intake, and the incorporation of regular physical activity suited to his capacity. Patient education about medication adherence, stress management, and smoking cessation (though he never smoked) is crucial. The nurse should encourage routine checkups, blood pressure monitoring at home, and screenings for lipid profiles and glucose levels.

Community resources, such as nutrition counseling and cardiac rehabilitation programs, can significantly aid in behavioral changes. Emphasizing patient empowerment through knowledge of early warning signs of cardiac compromise and respiratory distress ensures timely clinical intervention, vital in high-risk hypertensive patients.

Potential Respiratory Problems and Clinical Signs

Given the interconnected pathophysiology, Mr. Brusca's hypertensive and hypertrophic cardiac state can precipitate pulmonary issues such as pulmonary congestion and edema, especially if left-sided heart failure develops. Clinical signs of such respiratory compromise include dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and crackles upon auscultation, though these are not yet prominent in his current assessment. His reports of shortness of breath during activity, snoring, and fatigue may signal early signs of pulmonary hypertension or left ventricular failure.

Early detection of respiratory compromise allows for prompt pharmacologic and non-pharmacologic intervention, such as diuretics, oxygen therapy, and strategies to reduce cardiac workload, ultimately improving patient outcomes.

Conclusion

This case underscores the importance of a holistic approach to managing cardiovascular risk factors. Through targeted assessment, patient education, and systematic intervention, nurses play a pivotal role in mitigating disease progression, preventing complications, and promoting overall health and functional capacity in hypertensive older adults like Mr. Brusca.

References

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  • Johnson, E. J., et al. (2018). Hypertension and associated risk factors in older adults. Geriatric Nursing, 39(2), 177–182.
  • Kumar, P., & Clark, M. (2020). Clinical Medicine. Elsevier.
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  • Reynolds, K., et al. (2019). Lifestyle modifications in hypertension management. Journal of Clinical Hypertension, 21(8), 1144–1150.
  • Viglione, C., et al. (2021). Pulmonary complications in cardiovascular disease. Chest, 160(1), 144–155.
  • Whelton, P. K., et al. (2018). 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension, 71(6), e13–e115.
  • Yusuf, S., et al. (2019). Global burden of cardiovascular diseases. The New England Journal of Medicine, 380, 1251–1262.

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