NURSING nur265 Tina jones cardio1 Lifespan

NURSING nur265 Tina jones cardio1 Lifespan Activity Time: 14 min Tina’s 5-year-old cousin comes into the clinic and you notice that her heart rate increases with inspiration and decreases with expiration. What is your differential diagnosis and treatment plan for this finding? Student Response: Many children have a cyclic pattern in which heart rate is faster on inspiration and decreases on expiration. This is a sinus arryhthmia and is a common finding in your children. If the patient is not complaining of any pain or shortness of breath, then the most likely treatment would be to not do anything. The doctor can suggest an echo if there are symptoms. Model Note: Differential diagnosis includes benign sinus dysrhythmia, increased intracranial pressure, increased vagal tone, and myocardial ischemia. Her blood pressure should be monitored to ensure perfusion to rule out myocardial ischemia. She should be assessed for other symptoms that may indicate an underlying problem. With no other symptoms, it can be assumed that the dysrhythmia is benign since it is so common in children. Tina’s 68-year-old paternal aunt struggles with controlling her hypertension and high cholesterol. What concerns might you have concerning all body systems, and how would this change your assessment? What teaching points would you review with Tina’s paternal aunt? Student Response: When blood pressure is high for long periods of time it can lead to strokes. I would teach Tina's aunt about ways to control blood pressure and signs and symptoms of a stroke. When blood pressure if high it can damage the artery and blood vessel walls over time. Some of the most common and dangerous complications besides death can be: aneursym, dementia, choroidopathy, STEMI, heart failure, kidney damage and/or failure, sleep apnea, vaginal dryness or lowered sexual desire and osteoporosis. So teaching would be quite extensive, but primarily focused on taking the medications prescribed regularly and not to stop unless instructed by the doctor. Eating a healthier diet with a decrease in saturated fats, then walking at least 30 minutes each day or at least 4 days per week. Then also non-pharm ways to decrease stress and high blood pressure including meditation, yoga or deep breathing. Teaching about checking blood pressure at least twice a day and go to the hospital when you are having symptoms and/or if blood pressure is above 180/90 or how to take other medications such as clonidine to decrease blood pressure. Model Note: High cholesterol leads to atherosclerosis which worsens hypertension and increases the risk of cerebrovascular disease and thrombosis. High triglycerides leads to pancreatitis. Hypertension has detrimental effects on all body systems. Hypertension puts a person at risk for cardiovascular and peripheral vascular disorders, renal failure, stroke, dementia, vision loss, sleep apnea, bone loss, and sexual dysfunction. During the assessment, special attention should be directed to visual acuity, retinal health, and perfusion to extremities. The patient should be asked about sleep disturbances, morning headaches, and daytime fatigue to rule out sleep apnea. The provider should also ask about chest pain, forgetfulness, exercise habits and sexual health. The provider needs to stress the importance of healthy eating, exercising regularly, and complying to treatment plans to avoid life-threatening consequences of hypertension.