Care Plan for Hypertension

Cerebrovascular disease, also known as vascular dementia, is the second to most common form of dementia. It is characterized by blood vessels changing over time in the cerebrum (brain). The most common reason for vascular dementia is due to aging of the body; but it is also tied to cholesterol and the state of the walls of the blood vessels. Too much cholesterol and overall poor health of blood vessels can cause a thickness in the lining of the vessel walls, therefore cutting off some of the blood flow to the brain.

S.P. is admitted to the orthopedic ward. She has fallen at home and she has sustained an intracapsular fracture of the hip at the femoral neck. The following history is obtained from her: She is a 75-year-old widow with three children living nearby. Her father died of cancer at age 62; mother died of heart failure at age 79. Her height is 5’3 and weighs 118 pounds. She has a 50 pack year smoking history and denies alcohol use. She has severe Rheumatoid Arthritis (RA) and had an upper GI bleed in 1993 and had Coronary Artery Disease with CABG 9 months ago. Since that time, she has engaged in “very mild exercise at home.” Vital signs are 128/60, 98, 14, 99 degree farenheight (32.7 degrees C) SAO2 94%

Skin integrity is an important concept that’s nurses assess on their patients. A key skill in nursing practice is to frequently assess the skin for possible breakdown or decreased skin integrity. Skin assessments should be conducted thoroughly once a shift and frequently reassessed for any signs of change. Skin discrepancies may be the first sign of an underlying issue. Early detection of any breakdown can help to implement interventions sooner. Unfortunately, unless there is a major skin discrepancy, skin issues can easily get overlooked, specifically in documentation and report. The focus of this paper is to research new skin integrity assessments to improve documentation effect and accuracy, resulting in decreased prevalence of skin breakdown in hospitalized patients. Topics discussed include reviewing current practices and new skin assessment techniques that decrease the prevalence of skin breakdown and pressure ulcers.

The patient has no family history of heart disease or diabetes, however both her parents are on medication for high blood pressure. Her paternal grandmother died of breast cancer at age 47. Her maternal grandmother

Patient complained she was short of breath and experiencing severe pain between her shoulder blades. She stated that she has been feeling nasuseated for the past 3 hours. She states she has a history of stable angina and is currently taking medication as needed. She states she did not take the nitroglycerin because she was not experiencing chest pain, just back pain. She states that her last check-up with the Pulmonologist showed that her EKG did not show any changes since her last visit. She denies episodes of syncope. The patient does report that she tripped over something on the floor, which resulted in her falling and hitting her back on a large table. In addition, she states that her heart rate has been ranging from 130/ 90 to 140/92. Patient states her Primary care physician placed her on blood pressure medication 2 months ago due to the increase.

As cited by Jarvis (2012, p.203), “the skin is the sentry that guards the body from environmental stresses and adapt it to other environmental influences.” Maintaining the elderly patient’s skin integrity requires a holistic care approach. As a nurse, one of our best practices is performing a thorough skin assessment of the whole body of our patients. A detailed head-to-toe skin assessment and clear documentation can help the interdisciplinary team in generating individualize plan of care. I perform a thorough assessment by inspecting the patient’s skin color, temperature, texture, moisture, and for presence of wounds. I ensure that the information I obtained from the skin inspection is clearly documented in the patient’s chart and plan of care, and any skin changes are communicated to the physician or nurse practitioner.

The patient was a female on her 80s who was admitted to the hospital because of the COPD exacerbation. She had a history of stroke with minor residual effects, smoking, hypertension, and schizoaffective disorder - a chronic mental condition that is manifested mainly by the symptoms of schizophrenia, such as hallucinations or delusions, and mood disorder symptoms like manic or depressive episodes (NAMI, 2017). Patient length of stay was more than 300 days. She had two daughters who visited her everyday.

She converses appropriately. Blood pressure 92/60 supine. Blood pressure decreased to 72/50 standing. Pulse is 90 and regular. Weight 113 pounds. She has a normal appearance of her face and does not have a masked appearance of her face. She has good strength throughout her face. She has good strength of her extremities. She has only minimal cogwheel rigidity at the left wrist, but no cogwheel rigidity at the right wrist. She has no tremor of her hands. She moves her extremities freely and with normal speed. She is able to rise on her own from a sitting to a standing position, only minimal bradykinesia of standing. She walks fairly freely and there is a normal cadence of her gait. She did not have dyskinetic movements of her extremities. She is able to walk, including turning without losing her balance. She does not shuffle her feet when walking. She does not have en bloc turning. She has good posture stability

A review of her medical record indicates that she has a history of functional decline, dementia, weakness, MRSA, cognitive communication deficit, presence of right artificial hip joint and HTN.

The patient is an 85-year-old female who is brought to the ED by her family because of increasing confusion and supposedly she had a degree of altered mental status of two hours previous to presentation. In the ED she is completely worked up. CT shows advanced atrophy with microvascular changes and several lacunar infarcts nothing acute. Specific gravity in the urine reveals her to be markedly dehydrated. She culture completely, started on IV antibiotics, IV fluids and B12. On the day after admission she still presents as persistently confused. She is evaluated by PT. The patient who was formerly ambulating with a walker and allegedly driving a car is unable to be ambulated. Before the history indicates that she has a slow downward

Blood pressure -138/88, HR 71, Lung sounds –clear, temperature 98.8 F, radial pulse and pedal pulses +1 bi-laterally, normoactive bowel sounds. No history of smoking, drugs, alcohol use or diabetes; takes no daily medications. Surgical history: Hernia surgery September 2016 and cataract surgery September 2013. Moderately active, walks every day, sometime incorporating hand weights. Patient presents with minimal trembling unilaterally, (left side) when fingers stretched out, reports movements have been slower than normal. Patient’s wife reports “He’s been eating more slowly and it has been taking longer for him to get dressed in the morning.”. Upon examination it was determined that patient has reduced arm swing, slight stiffness in neck, difficulty rising from sitting position in the chair, masked facial features and deteriorated balance. No signs or symptoms of stroke.

At today’s visit she is accompanied by her husband and private aide. Her husband reports that she is doing much better. He states that her pain has improved and she has not taken her pain medication since last visit. He states that her anxiety had improved extremely with the recent change in her Xanax. He states that he has hired 24 help for the patient and since she has not fallen. She reports that she is feeling well. The caregiver reports that the patient continue to suffers from hypotension and hypertension with variation in blood pressure. The patient also continues to suffer from chronic tremors as a result of her Parkinson.

Patient Y is known to have suffered many myocardial infarctions in the past which she has been treated for and made a full recovery. She had also been referred to the hospitals cardiac rehabilitation service after her previous heart attacks but refused to attend.

The patient, Ms. Wanda Johnson was treated Humana Hospital now Glen of Virginia for six weeks before

My interviewee was a 70-year-old female who was re-admitted to CCC in March 7th, this year. Her primary diagnosis was status post CVA with left hemiplegia. Other past medical history includes major depressive disorder, hypertension, hypothyroidism, COPD, anxiety, GERD,