Question

Brian Estes is a 52-year-old Caucasian male with a past medical history of hypertension and hyperlipidemia. He is at the clinic today for a yearly physical examination at the urging of his wife. He is a mid-level manager at an electronics company and has been under considerable work stress in the past six months. He admits to being a “couch potato”. He was prescribed amlodipine (Norvasc) at his last physician appointment 15 months ago. He admits to taking his medication on “most days”. His total cholesterol is 224 mg/dL; HDL 45 mg/dL; LDL 179 mg/dL; and triglycerides 200 mg/dL. He is 5’ 10” and weighs 201 pounds with a BMI of 28.8, He has a positive family history of CAD. His father had a myocardial infarction at age 54, and his grandfather died of a myocardial infarction at age 42. His current vital signs are temperature 97.6 orally; pulse 86 and regular; blood pressure 178/96 mmHg; and respirations 14/min.

In your initial post, please address the following questions:

1. What are the three questions the nurse should ask to determine how the client feels about his current health status?
2. What are two possible nursing diagnoses for this client?
3. Develop a health teaching plan for Mr. Estes; include four nursing interventions and rationales to address his modifiable risk factors for CAD.

Answer 1

The questions which can be asked to determine the current health status are

The following complaints in general can be asked to assess the possibility or risk for organ damage

• Any complaints of headache, dizziness, confusion (central nervous system)
• Complaints of chest pain ,palpitations (cardiovascular system)
• Any bleeding from nostrils, ears or in urine (sensory and renal system)
• Complaints of breathlessness (respiratory)

The nursing diagnosis are

• Risk for impaired/decreased cardiac output related to vasoconstriction as evidenced by elevated blood pressure
• Risk for coronary artery disease related to vascular consistency of the blood as evidenced by increased cholesterol level secondary to hypertension and hyperlipidemia

Nursing intervention and rationale

• Monitor vital signs, as it is the baseline to plan for care
• Administer vasodilator as per order to reduce blood pressure
• Assess the patient for complications as it is expected in a diastolic blood pressure raise beyond 90 mg
• Monitor cardiac profiles or cardiac markers to rile out infarction
• Administer oxygen in case of decreased oxygen saturation level

Patient teaching

• Medication to be taken as per order
• Regular exercise
• Salt restricted, low fat diet
• No fast foods, deep fried foods, oily item