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Hypertension in Newly Diagnosed Diabetic Patient, Research Paper Example

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Research Paper

Clinical Analysis of Hypertension in Newly Diagnosed Diabetic Patient

GM came to the clinic complaining of dizzy spells and intermittent blurred vision, dull headaches and more nosebleeds than normal on March 31, 2014. GM is a 35 year old African American female born on April 15, 1979 who is a housewife. She is overweight and has tried to lose weight for a long time, but has not managed since she gained weight with her pregnancy. Her son is now 3 years and at birth he weighed 9 pounds 5 ounces. Her pain started three days ago and with time has gotten worse progressively. She associated the symptoms to having overworked herself since she was raising three other children who are at their adolescent stage alone. Her past medical history shows she has had to fight obesity and seasonal allergies of penicillin that caused anaphylaxis. This resulted in having breathing difficulty and dizziness. She is a single-parent and does not smoke or drink alcohol. Furthermore, no special diets and lives in a three two bedroom apartment on a building on the fourth floor, but has an elevator. She does extra work by helping neighbors by looking after their children, but also gets support from her former husband. She has arthritis, but is a hard worker who in very active and alert. Currently, she does not understand her medical condition and is very anxious.

Building the patient’s history is important since it gives the clinicians an overview of the problem defined (subtle and obvious). Establishing a sense of reliability from the patient is vital as she becomes the events interpreter. Therefore, the symptoms discussed under related history, gives a review. Thereby, a list of targeted topics is also included in the history of present illness. By responding to question about provided topics, clues are given that focus on patient’s physical examination and development of a diagnostic evaluation appropriate for the illness. Medication use and therapies (alternative and complementary) are also relevant. The present complaint by GM is assessed by using past medical history (Seidel et.al, 2010). Immediate concerns are blood relatives and consideration is taken into account when looking at the family history. Systems review is conducted to identify the absence and or presence of issues related to health in each of the body system.

GM’s physical exam showed that she had blood pressure of 140 to 159 mm Hg showed stage 1 hypertension. Her vital signs had temperature recordings of 100.2 and her pulse was regular (96), but occasional extra beat was monitored and her respiration was at 24 (CDC, 2012). There were no significant findings for posterior segments and optic discs. The ears/nose/throat had no significant findings. On inspecting her gums, teeth and lips, several teeth were missing and broken dentures. Otherwise, no significant findings were found in oropharynx. Her neck has thyroid due to tenderness, enlargement, and mass plus lymph nodes. Her respiratory had palpation of chest and auscultation of the lungs. Depression was a past medical history that has affected her and is under medication. The health risks of hypertension is obesity that increases heart strains, raises triglyceride and blood cholesterol levels. At the same time, HDL levels of cholesterol are lowered.

For her last pregnancy, she was operated on, and this contributed to her obese state. Obesity is a challenge for GM, and she has been struggling with this disorder for some time now. In reality, obesity has contributed to her current state because she was not able to manage her eating habits. Furthermore, her stress levels caused her to gain weight. GM was brought up by her older sister since her mother died from kidney failure when she was ten years. Her father died of a heart attack at age 41. Her husband divorced her three years ago. She has another brother who lives in South Carolina. Depression, anxiety and eating disorders are the psychosocial factors of GM. She confesses to using over-the-counter pain relievers often and has resulted in high blood pressure (hypertension). She has very few friends and this has contributed to her introvert nature. This has made her not gain knowledge through sharing from other people on how to determine her glucose levels at an early stage.

She has stage 1 hypertension and was given thiazide-type diuretic. She was given angiotensin converting enzyme (ACE) inhibitors that will be able to lower her blood pressure. GM was referred to a private hospital that will be able to treat her condition under a program that caters for single-parents. GM was educated on a simple and affordable diet to follow. This diet offered appealing and diversified menu with food choices that will lower her blood pressure and reduce her obese state. She was also advised to engage in physical activity per week for 150 minutes, which will enable her reduce the chances of having cardiovascular diseases. In a span of three days each week, the physical activities should be performed. These interventions are cost effective and have specific clinical indicators that will improve her health.

Behavioral theoretical base is the intervention plan that GM will follow since it pertains to aspects of discipline (Nicolson ET.AL, 2004). GM has to ensure that the food she adopts to the DASH diet. This encompasses consuming diets rich in vegetables, fruits, and low fat dairy products. Also, GM will limit saturated and fat intake in total in order to reduce systolic blood pressure by 2 to 8 mm Hg. GM needs to strive to achieve a body weight that is ideal of between 18 and 25. By maintaining body weight decrease of 10-kg can also lower systolic blood pressure by 5 to 20 mm Hg.

GM treatment will be coordinated by her clinician who is close friend of her brother. Therefore, she will be able to give GM free services like counseling and sharing knowledge. Furthermore, she will be able to give GM a list of associations that deal with diabetes in the community.

The potential barriers of the treatment for GM will be in terms of funds. She is a dependent and will require financial help to be able to afford the medicines and food that are in accordance to the American Dietary Association. This barrier goes a long way in restoring the health of GM.

In this region, several resources are available for GM’s family and the patient. A Free Clinic is opened every Tuesday for community members to be able to access health needs and meets those of the uninsured patients like GM. In this clinic, no charges are paid for since it is a community clinic. Moreover, a mobile clinic visits the neighborhood every last Thursday of the month. Additionally, by participating in the Community Care Plan, GM will be able to have access to all her medications by visiting the pharmacy. The objective of the mobile clinic is to meet the needs of all people in the community and promote the well-being of their members. This will facilitate economic growth and ensures that all individuals are catered for in terms of health care facilities.

APRN role will emphasize on evidenced-based practices, informatics, and quality improvement. Nurses in the senior-level should be given leadership roles and positions that will enable them participate in executive decision-making processes. They look at patient safety and will use their knowledge and skills to communicate to the patient the need to adhere to the health care system.

Quality is of importance to APRNs because their aim is to attain interdisciplinary practice approaches that require revolutionary change. This will flatten the cultural and educational silos between nursing and medicine education. For decades, the nursing profession has had to untangle the unique roles and value of nursing within the hospital. Thereby, has decoupled the professionally registered nurses from costs of the hotel to that of a hospital stay. The knowledge of this clinical examination gives APRNs the ability to give a diagnosis on what the patient is suffering from; hence medication will be given in accordance to the information collected. The role of APRN in this review is to share their knowledge and use it in diagnosing the patient. This knowledge will give them an opportunity to elaborate to GM the importance of having regular check-ups for blood pressure. The patient and nurse will educate each other and sharpen their knowledge on how to treat the problem. This also enables them have a good working relation that will foster quick recovery process for GM.

References

Centers for Disease Control and Prevention (CDC). (2012). Vital Signs: Awareness and treatment of uncontrolled hypertension among adults – United States, 2003-2010. MMWR 61(35): 703-709.

Gu, Q., Dillon, CF, Burt, VL. & Gillum, RF. (2010). Association of hypertension treatment and control with all-cause and cardiovascular disease mortality among US adults with hypertension. Am J Hypertens 23:38–45.

Nicolson, DJ., Dickinson, HO. & Campbell F, et al. (2004). Lifestyle interventions or drugs for patients with essential hypertension: a systematic review. J Hypertens 22:2043-2048.

Seidel, H., Ball, J., Dains, J., Flynn, J. & Solomon, B. (2010). Mosby’s guide to physical examination. Canada: Elsevier.

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