J.K. is a 75-year-old female with a history of hypertension. However, it is well controlled with diuretic therapy. She has previously been diagnosed with peptic ulcer disease, which was resolved after three months on cimetidine. She has also been admitted to NYMC with presenting s/s of intermittent mid-sternal chest pain. EKG demonstrated 1st degree AV block, and CXR showed mild pulmonary congestion with cardiomegaly. She also has a history of mild Congestive heart failure (CHF) and allergic to penicillin, which makes her experience rash and hives.
The Patient’s Illness Patterns and Health Promotion Patterns
Health Promotion Patterns
The patient has a history of hypertension. However, she engages in some health promotion behaviors, which makes her live a healthier lifestyle. First, J.K. takes alcohol but moderately as seen from the one or two beers each weekend and one martini before dinner each night. People who take alcohol excessively increase their frequency of hypertension. As a remedy, she should reduce the consumption to one beer per weekend (Jarvis, 2016). However, when the alcohol consumption exceeds five drinks per day, it becomes dangerous.
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Illness Patterns
J.K also engages in some behaviors that lead to an unhealthy lifestyle. She has been smoking two packets of tobacco a day for forty years. In such a case, tobacco and alcohol consumption puts J.K at a higher risk of hypertension (Hawk & Evans, 2013). People with hypertension should not smoke at all because tobacco build-up spikes the blood pressure. Tobacco contains nicotine, which spurs the nervous system, generating chemical substances that constrict blood vessels, leading to higher levels of blood pressure. Therefore, J.K. should be worried because this behavior will increase her blood pressure levels which in increases her chances of developing cardiovascular disease. However, individuals who do not take tobacco and alcohol, there is less suffering (Jarvis et al. 2015). In turn, this maintains lower blood pressure and prevents serious complications.
NANDA Nursing Diagnosis
Nursing diagnosis refers to the clinical judgment about the patient’s responses to a health problem and is part of the patient’s nursing process (Jarvis, 2016). This section develops at least three nursing diagnoses based on NANDA system.
Problem: J.K. was well until 11 pm on the night before admission when she had an onset of “aching pain under her breastbone” while sitting and watching television. The pain was described as “heavy” resembling “a toothache.” It was not noted to radiate, nor increase with exertion. In the morning, she awoke free of pain, however, upon walking to the bathroom, the pain returned with increased intensity. Moreover, J.K. is psychosocially disturbed given her excessive use of beer and tobacco. She also rarely interacts with other people.
Symptoms: acute pain in some parts of the body. The intensity of the pain increases slowly. She denied nausea, vomiting, diaphoresis, palpitations, dizziness, or loss of consciousness.
Prioritizing the Problems, Nursing Interventions, and Expected Outcomes
The risk for reduced cardiac output associated with increased vasoconstriction and afterload.
The patient’s afterload did not increase. She did not have vasoconstriction, and myocardial ischemia was absent (Jarvis et al. 2015).
Nursing Interventions:
Regular monitoring and measuring blood pressure
Monitor reactions to medications to control blood pressure.
There should be restricted dietary and fluid sodium intake
Maintain restrictions activities like rest in chair or bed (Hawk & Evans, 2013).
Expected Outcomes:
The blood pressure will be maintained within acceptable range
Participation in activities which decrease blood pressure
Acute pain: J.K. experienced “aching pain under her breastbone” while sitting and watching television. The intensity of the pain increases slowly. The patient revealed the absence of nausea, vomiting, diaphoresis, palpitations, dizziness, or loss of consciousness and appeared comfortable.
Nursing Interventions:
Maintain bed rest
Reduce environmental stimuli and disruptions
Engage in relaxation techniques such as visualization as one of the effective relaxation techniques to lower blood pressure. Moreover, meditation can produce both relaxation and lower blood pressure throughout the day (Jarvis et al. 2015).
Expected Outcomes:
Reduced body pain
Enhanced patient comfort
Psychosocial problem: JK could be having psychological and social problems which have force her to used smoking and beer drinking as the escape option
Nursing Interventions
Link her with close and family friends to establish some social connection
Introduce vaping to minimize tobacco smoking
Encourage the taking of alternative fluids instead of beer
Expected Outcomes
Reduced psychosocial problems through socialization
Minimized addiction to beer and smoking
Enhanced friendships through problem sharing
References
Hawk, C., & Evans, W. (2013). Health promotion and wellness: An evidence-based guide to clinical preventive services . Philadelphia, PA: Lippincott Williams & Wilkins.
Jarvis, C. (2016). Physical Examination and Health Assessment, (7th Ed.). St. Louis, MO: Elsevier, Inc.
Jarvis, C., In Forbes, H., In Watt, E., & Jarvis, C. (2015). Jarvis's physical examination & health assessment . Retrieved Feb 28 2018 from https://nls.ldls.org.uk/welcome.html?ark:/81055/vdc_100052716487.0x000001 .
