week 4 discussion

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School

South University, Savannah *

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Course

6020

Subject

Nursing

Date

May 24, 2024

Type

docx

Pages

3

Uploaded by corgimom1430

The first question I would ask if the patient has any financial difficulty obtaining any prescribed medications since the patient does not have health insurance due to his career. Many studies show many people with low income cannot afford health insurance which means they are unable to adhere to medications (Rohatgi et al., 2021). Without health insurance, the patients mostly pay their medication out of pocket which is unaffordable for them. They may get one month's supply of medication and use it for 2 or 3 months. Some of them may not even pick up the medication in the first place. As responsible providers, it is our responsibility to understand patient’s financial struggles and help them to locate local resources to help them manage their chronic illnesses. The second question I would ask about is his exercise routine. Since the patient is a taxi driver who would sit in the driver's seat about 12 hours a day, the patient’s lifestyle is sedentary. A sedentary lifestyle is a major risk factor for cardiovascular disease and develop hypertension. In a study analyzing the mortality rates of people with more than 10 hours of sitting time a day, the sitting time was significantly correlated with all causes of mortality (Park, et al., 2020). It is important to understand if the patient would be able to add an exercise routine in his daily life after work or his day-off. The additional questions that I would ask the patient is whether he experienced any chest pain after exercise and I would also ask him if he thinks he has good eating habits, such as how he and his family prepare their meals. Since the patient has not been in a doctor office in years, a comprehensive physical assessment is needed for the patient. Even though the patient is only concerned about his blood pressure, a comprehensive physical assessment and focus assessment are performed. The patient’s physical exam is within normal range. HEENT system does not have an abnormality. The cardiovascular system is within normal range, no edema, regular rate and rhythm, the patient did not complain of chest pain. Regular S1 and S2. No murmurs, thrills and rubs. The respiratory system is clear to auscultation bilaterally. No cough is noticed. No crackles, no wheezing. The gastrointestinal system is within normal range. The patient is alert and oriented x 3 and has no nerve or neurological complaints. Diagnosis instruments are needed for this examination: a platform scale with height capability a blood pressure (BP) cuff with a sphygmomanometer a stethoscope with a bell and diaphragm end pieces
a thermometer a flashlight or penlight an otoscope, an ophthalmoscope a reflex hammer clean gloves Hypertension Hypertension can be cause by increased salt absorption resulting in volume expansion, an impaired response of the renin-angiotensin- aldosterone system (RAAS), and increased activation of the sympathetic nervous system. These changes lead to the development of increased total peripheral resistance and increased afterload, which in turn leads to the development of hypertension (Iqbal & Jamal., 2023) Anxiety The amygdala plays an important role in tempering fear and anxiety. Patients with anxiety disorders have been found to show heightened amygdala response to anxiety cues. The amygdala and limbic system structures are connected to prefrontal cortex regions, and prefrontal-limbic activation abnormalities may be reversed with psychological or pharmacologic interventions (Chand & Marwaha., 2023). Renal Artery Stenosis In patients with renal artery stenosis, the chronic ischemia produced by the obstruction of renal blood flow leads to adaptive changes in the kidney which include the formation of collateral blood vessels and secretion of renin by juxtaglomerular apparatus. The renin enzyme has an important role in maintaining homeostasis in that it converts angiotensinogen to angiotensin I. Angiotensin I has then converted to angiotensin II with the help of an angiotensin-converting enzyme (ACE) in the lungs. Angiotensin II is responsible for vasoconstriction and release of aldosterone which causes sodium and water retention, thus resulting in secondary hypertension or renovascular hypertension. The patient has not been in the doctor office for over 5 years. I would order CBC, CMP, PT/ INR, BNP and lipid, A1C and thyroid levels for the patient to check for any underlying health issues. Reference: Bokhari MR, Bokhari SRA. (2023, July 23) Renal Artery Stenosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430718/
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