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Hypertension Essay

Subject: Nursing
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Introduction

Nursing is an emerging sector, which is related with the well being of population. The skills, knowledge, and experience in nursing field are the prime aspects that help in managing the overall care procedures for the patients. Care management is important for an individual patient to improve their condition and well being (Barrett et al. 2012). To analyse the importance, here I stated about my personal care experience with a hypertension patient. Hypertension is the situation that elevates the blood pressure and can extend to damage multiple organs (Alexander 2017). My hypertension patient is suffering from chest pain, severe dizziness, breathing trouble, and lethargy. Hypertension is one of the most common and acute disease, which needs immense clinical care settings including emergency departments, acute care medical clinics, and urgent care centres. Hypertension is often identified from associated symptoms such as end-organ injuries, which cannot be managed without immediate treatment and medications (McNaughton et al. 2013). Schmieder (2010) depicted, “end organ damage in hypertension can be detected early, reflects accurately the hypertensive patient’s overall cardiovascular risk, and should be prevented and treated with antihypertensive treatment” (p.866).

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Rosendaal et al. (2016) noted that hypertension care, acute care, follow-up care, intervention, and reference for treatment along with others need financial assistance in those countries, wherein free healthcare provision is lacking. Doctors’ visits and prescription medication are some of the prime concerns during the treatment of hypertension, which is relatively cost-effective for a health insurance holder (High Blood Pressure Treatment Cost 2017). The roles of nurses in hypertension treatment and management include several aspects such as diagnostics and medication management. This also includes detection, referral, follow up, coordination of care, patient education, counselling, performance measurement, and quality improvement along with population health management (Himmelfarb et al. 2016). McCormac & Krause (2012) asserted that the patient-centred care facilities, as well as, the multidisciplinary care team can be effective for hypertension care management. The awareness regarding the hypertension and effective screening both are important for the treatment and disease management procedure (Himmelfarb et al. 2016). Considering these contexts, the study focuses on providing an in-depth care for my patient from his admission to the treatment process twice in a month. Therefore, I will choose Roper, Logan and Tierney’s (RLT) model for effective care setting for the patient with hypertension.

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Analysis of Underpinning Care Planning

Holistic nursing care practice must need significant activities including maintenance of safe environment, effective communication between care givers and patients. Additionally, it also require proper breathing, appropriate diet along with drinking, elimination of negative implications, patient hygiene including washing & dressing, controlling the body temperature, mobilising, working, and effective sleeping of individual patient. The situations can either be included or excluded as per the preferences of patients’ health related physical and psychological conditions. According to the RLT model, there are certain factors such as psychological, biological, environmental, socio-cultural, and politico-economic that can affect the condition of the patients (Medeiros et al. 2013).

Patient Presentation and Condition

My patient, named Mr. S (name is changed for confidentiality) is a 45 years old man suffering from the problem of hypertension. In the emergency unit of our health care organisation, he came with complain of chronic chest pain. Contextually, it is also observed that he has dizziness, lethargy, and have trouble while breathing such as shortness and shallow. Additionally, on the basis of clinical analysis, it is evaluated that he also developed problems relate to his eye sight and memory. Professionally, he was a teacher and dedicated towards his students and the educational system. For his recently developed health problems including hypertension, he took some medicines such as Diuretic and Beta blocker, which helped in controlling his blood pressure level. However, it has been observed by his family that he is an un-mindful person and most of the time, he forgets to take medicines. It can be stated that his severity of hypertension has emerged, which has further led the patients to gain weight, chest pain, vision problem, blurry memory, and difficulties in breathing as well. Due to his present critical condition, he booked an appointment for check-up twice a month. Currently the patient suffers from chest pain and other co-morbid symptoms, for which he needs further clinical assessment. The patient does not have any kind of surgical history. However, he has family history of hypertension. For better understanding the criticality of the patient, the following general aspects on hypertension are described thoroughly:

Onset: The onset symptoms of hypertension are essential factors for evading the future complications in case of an individual patient. According to the clinical practitioners, there is a specific time span, where individuals can be exposed to hypertension. If the appropriate treatment procedures can be taken, individuals can secure their well being avoid the problem related to hypertension. Based on the perceptions of clinicians, an individual is exposed to develop hypertension after the age of 18 years. Contextually, people ranging between 18 to 39 years age are often found to be highly prevalent to develop the symptoms of hypertension. At this age, individuals should check their blood pressure on a periodic basis to evade the critical consequences (Busko 2017).

Aetiology: There are two types of aetiology of hypertension, which includes primary hypertension and secondary hypertension. Primary hypertension is most often observed among the adults and is found to start gradually from many years. On the other hand, secondary hypertension is significantly developed for several reasons including obstructive sleep apnea, kidney problems, adrenal gland tumours, thyroid problems, congenital defects in blood vessels (by birth), medications such as birth control pills, certain prescription drugs, and over-the-counter pain relievers. In addition, it also includes the use of illegal drugs and dependency on alcohol among others (Mayo Foundation for Medical Education and Research 2017).

Burden: According to the global reports, it is observed that at the age of 45, high blood pressure is common among the men. If the patient has family history of blood pressure, there is a significant chance of developing this disease easily. Overweight, less physical activity, tobacco dependency, maximum salt, less potassium, vitamin D consumption, excessive stress, alcohol dependency, and chronic medical condition can be identified as the burden for hypertension (Mayo Foundation for Medical Education and Research 2017a).

Pathophysiology: It is complex, as well as, multi-factorial disease because it targets multiple organs and gradually creates hindrance on their activities. Genetics is one of the prime factors that can influence hypertension with respect to the individual’s medical history. Additionally, improper diet intake, obesity, excess salt consumption can increase the activities of neurohormonal system, which can ultimately result in hypertension (Hamrahian 2017)

Potential Complications: Due to high blood pressure, there are certain chances of severe other co-morbid scenarios including heart attack, heart failure, Aneurysm, weak & narrow blood vessels of kidneys, thick, and narrow blood vessels of eyes. Additionally, it also involves metabolic syndrome and problems in memory or understanding (Kennard & O’Shaughnessy 2016; Mayo Foundation for Medical Education and Research 2017b).

Reflect on the Nursing Assessment of the Patient – Gibbs Model of Reflection

Description: My patient has been suffering from chronic hypertension and has developed severe chest pain. Contextually, after consulting with patient and his family members, it is identified that he is suffering from obesity caused due to unhealthy food habit, which made his situation more complex. He is admitted in emergency unit of our health care organisation. Furthermore, he has also been facing the problem relating to his eye sight, as it has been affected. These problems have been observed over the period of three months. In the last month, he felt pain in his chest along with breathing problem, dizziness, and lethargy, which made him worried so that he came to the emergency unit.

Feelings: Considering Mr. S’s condition, personally, I feel that it is my priority to assess his appropriate problem areas (such as severe chest pain) including his co-morbid symptoms including breathing problem, dizziness, and lethargy). According to my perception, severe chest pain and its co-morbid symptoms are the prime reasons for his admission. I also understand that these problems are increased due to the lack of proper diet, physical activity, and improper medication. First I need to make him aware about his hypertension condition and his recent consequences such as severe chest pain and breathing problems. I need to make him concern about his weight, diet, physical activity, and medication. Personally, I feel bad because he still has remaining several years to his retirement and the health consequences may have an impact on his professional life. Additionally, I also feel that if he makes necessary changes in his lifestyle, there is a certain chance to live a better life.

Evaluation: Due to his long term unhealthy habits, it is difficult to make him habituated to live a healthy lifestyle, which would include healthy diet, exercise, and healthy habits. Therefore, to make him aware and educated, I can focus on providing clinical education relating to his conditions and consequences along with effective treatment. According to the proper treatment criteria, consumption of mineral enriched foods has to be reduced, as it can increase the hypertension for him. Regular medicinal and exercise schedule is also prepared for his betterment. The procedure is needed for proper cooperation of the patient and his family to meet the satisfactory outcomes.

Analysis: The patient’s long term unhealthy lifestyle, lack of awareness, less cooperativeness, and improper medication schedule are the major factors that that affected the outcome. The support of the family along with medical alignment and health care organisational structure are the factors that helped in treating the patients.

Reframe: The negative situation can be avoided by handling Mr. S’s pessimistic approach. To make him serious and positive towards the treatment schedules and other clinical framework, I need to provide him counselling on the overall treatment procedure, its functionality, effects, consequences, and the negative effects on the patients. During the counselling session, I can also provide him practical evidences of severe hypertension cases and its hazardous consequences along with the numerical statistics of positive events.

Action Plan: From this case, I learnt that the patients cannot always be cooperative. At times they not aware about the consequences, and are often found to be unenthusiastic. In the present case, the patient often forgets to take medicines, which has worsened his condition. However, it is the accountability of nurses and responsible care giver to guide the patients and their families accordingly. After the Mr S’s admission, medical education and communication with his families will be significantly incorporated for improving his condition. Next time, I will focus on care pattern and counselling session with patient and their families at the beginning of the treatment to develop an understanding regarding the patients’ behaviour and work on their awareness regarding the disease.

Recommendations for Future Practice

Based on my personal understanding, I can state that the necessity of counselling, psychological support, and clinical educational support to the patients and their families are able to develop a comprehensive health care framework. This can be used for addressing emergency consequences of hypertension and other symptoms. Additionally, the community visit for the nurses is recommended for developing a better concept of their practices. Moreover, multicultural effectiveness among the nursing group is also necessary for their transparent communication skills, which I also practically understand from this case scenario. Contextually, developing mobile charities for the remote areas and the patients are capable to get better treatment framework from them.

Conclusions

Based on the overall discussion, it is highlighted that the reflective study is stated about a case scenario, where the patient developed co-morbid symptoms of hypertension due to his non-cooperative behaviours towards the treatment procedures. Being a nurse, I will focus on developing comprehensive understanding regarding patient’s behaviour, preferences, outcomes, and nursing actions. The key problems of his situation are allied with unhealthy foods, less physical activity, maximum salty food, and non-maintenance of the medicinal schedules. His family was very supportive to the clinical framework, which helped the individual nurse to develop a counselling session to make him aware regarding his conditions. The clinical, therapeutic and supportive interventions are effectively utilised in his case and these interventions are provided individual care givers a better example for their future career in nursing.

RLT theory helps to gain knowledge regarding simple cognitive traits in nursing practice, while being a healthcare professional, it is learnt that it is difficult to hire less experienced nursing staff. During the discussion development on this case scenario, it is emphasised that the requirement of confidentiality of individual patients for maintaining the care protocols. The case scenario is aided in developing the understanding regarding the care protocols including onset, aetiology, burden, and pathophysiology. Hence, it has significantly enhanced individuals’ understanding regarding the emergency treatments of chest pain and breathing trouble, which can be co-morbid symptoms of hypertensions. Simultaneously, being a care professional, it is further learned about the treatment procedures along with the priority concerns, medication, therapeutic, and supportive interventions. It is able to develop a potential recommendation for the future pathways in nursing career.

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