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Hypertension Nursing Case Study: Mr. David Miller
Part 1: Introduction and Initial Presentation
Student Instructions: Read the following case study carefully. Answer
the questions that follow, using critical thinking and evidence-based
practice. Rationales for each answer are provided in the analysis section.
Patient Profile
Name: David Miller
Age: 58 years old
Gender: Male
Ethnicity: African American
Height: 5'9" (175 cm)
Weight: 225 lbs (102 kg)
BMI: 33.2 (Obese Class I)
Chief Complaint: "I've been having terrible headaches for the past
week, especially in the morning, and I feel dizzy."
History of Present Illness
Mr. Miller presents to the primary care clinic with a one-week history of
occipital headaches that are most severe upon waking and improve as
the day progresses. He reports associated dizziness and one episode of
nosebleed (epistaxis) two days ago. He denies chest pain, shortness of
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breath, or vision changes. He states he has not seen a healthcare provider
in over 5 years.
Past Medical History
• Hypertension: Diagnosed "about 10 years ago" but has not taken
medication consistently.
• Type 2 Diabetes Mellitus: Diagnosed 8 years ago.
• Hyperlipidemia: Diagnosed 8 years ago.
Social History
• Smoking: 1 pack-per-day for 35 years.
• Alcohol: Reports drinking "a few beers" every night
(approximately 4-5 beers).
• Diet: Diet consists mainly of fast food, processed meats, and
canned soups. He adds salt to most meals.
• Exercise: Sedentary; no regular physical activity.
• Occupation: Long-haul truck driver.
Medications (per patient report)
• Lisinopril 10 mg daily: "I take it when I remember, maybe once
or twice a week. It makes me cough."
• Metformin 500 mg twice daily: Takes it "most of the time."
• Ibuprofen: Takes 400-600 mg almost daily for "aches and pains
from driving."
Review of Systems (ROS)
• General: Fatigue, no weight changes.
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• HEENT: Headaches, one episode of epistaxis.
• Cardiovascular: No palpitations, chest pain, or orthopnea.
• Respiratory: Dry, hacking cough (which he attributes to the
lisinopril).
• Musculoskeletal: General body aches.
Vital Signs & Physical Examination
Vital Signs (taken after 10 minutes of rest):
• Blood Pressure (BP): 182/104 mmHg (Right arm, seated)
• BP (Left arm): 178/102 mmHg
• Heart Rate (HR): 92 bpm, regular
• Respiratory Rate (RR): 18 breaths/min
• Temperature: 98.4°F (36.9°C)
• Oxygen Saturation (SpO2): 97% on room air
Physical Exam Findings:
• General: Obese male in no acute distress, but appears tired.
• Head/Neck: No jugular venous distention. Carotid pulses are 2+
bilaterally without bruits.
• Cardiovascular: Regular rate and rhythm. S4 heart sound audible
at the apex. No murmurs, rubs, or gallops. Peripheral pulses are 2+
in all extremities.
• Lungs: Clear to auscultation bilaterally. No crackles or wheezes.
• Abdomen: Obese, soft, non-tender. No abdominal bruits.
• Extremities: Trace (1+) pitting edema in bilateral ankles. No
cyanosis or clubbing.
• Fundoscopic Exam: Arteriolar narrowing and arteriovenous
nicking noted. No hemorrhages or papilledema.
Hypertension Nursing Case Study: Mr. David Miller
Part 1: Introduction and Initial Presentation
Student Instructions: Read the following case study carefully. Answer
the questions that follow, using critical thinking and evidence-based
practice. Rationales for each answer are provided in the analysis section.
Patient Profile
Name: David Miller
Age: 58 years old
Gender: Male
Ethnicity: African American
Height: 5'9" (175 cm)
Weight: 225 lbs (102 kg)
BMI: 33.2 (Obese Class I)
Chief Complaint: "I've been having terrible headaches for the past
week, especially in the morning, and I feel dizzy."
History of Present Illness
Mr. Miller presents to the primary care clinic with a one-week history of
occipital headaches that are most severe upon waking and improve as
the day progresses. He reports associated dizziness and one episode of
nosebleed (epistaxis) two days ago. He denies chest pain, shortness of
,2|Page
breath, or vision changes. He states he has not seen a healthcare provider
in over 5 years.
Past Medical History
• Hypertension: Diagnosed "about 10 years ago" but has not taken
medication consistently.
• Type 2 Diabetes Mellitus: Diagnosed 8 years ago.
• Hyperlipidemia: Diagnosed 8 years ago.
Social History
• Smoking: 1 pack-per-day for 35 years.
• Alcohol: Reports drinking "a few beers" every night
(approximately 4-5 beers).
• Diet: Diet consists mainly of fast food, processed meats, and
canned soups. He adds salt to most meals.
• Exercise: Sedentary; no regular physical activity.
• Occupation: Long-haul truck driver.
Medications (per patient report)
• Lisinopril 10 mg daily: "I take it when I remember, maybe once
or twice a week. It makes me cough."
• Metformin 500 mg twice daily: Takes it "most of the time."
• Ibuprofen: Takes 400-600 mg almost daily for "aches and pains
from driving."
Review of Systems (ROS)
• General: Fatigue, no weight changes.
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• HEENT: Headaches, one episode of epistaxis.
• Cardiovascular: No palpitations, chest pain, or orthopnea.
• Respiratory: Dry, hacking cough (which he attributes to the
lisinopril).
• Musculoskeletal: General body aches.
Vital Signs & Physical Examination
Vital Signs (taken after 10 minutes of rest):
• Blood Pressure (BP): 182/104 mmHg (Right arm, seated)
• BP (Left arm): 178/102 mmHg
• Heart Rate (HR): 92 bpm, regular
• Respiratory Rate (RR): 18 breaths/min
• Temperature: 98.4°F (36.9°C)
• Oxygen Saturation (SpO2): 97% on room air
Physical Exam Findings:
• General: Obese male in no acute distress, but appears tired.
• Head/Neck: No jugular venous distention. Carotid pulses are 2+
bilaterally without bruits.
• Cardiovascular: Regular rate and rhythm. S4 heart sound audible
at the apex. No murmurs, rubs, or gallops. Peripheral pulses are 2+
in all extremities.
• Lungs: Clear to auscultation bilaterally. No crackles or wheezes.
• Abdomen: Obese, soft, non-tender. No abdominal bruits.
• Extremities: Trace (1+) pitting edema in bilateral ankles. No
cyanosis or clubbing.
• Fundoscopic Exam: Arteriolar narrowing and arteriovenous
nicking noted. No hemorrhages or papilledema.
