High blood pressure nursing case sample

For a 62-year-old community-based elderly patient with grade 2 essential hypertension (very high risk), poor medication compliance, and abdominal obesity, priority is given to individualized precision nursing intervention rather than direct adjustment of the medication regimen. The patient's blood pressure can be reduced from 158/9 within 8 weeks. The average level of 9mmHg dropped to 132/81mmHg, with a compliance rate of 100% without increasing the burden of medication. At the same time, the patient's misconception that "health products replace antihypertensive drugs" was corrected. This program has been included in the chronic disease care demonstration case database in our community.

This case was received by me in the community chronic disease department in September last year. The patient Zhang, a retired machine factory worker, has a 7-year history of hypertension. He used to take amlodipine besylate tablets 5mg qd regularly, but his blood pressure has been fluctuating at 150-165/95-105mmHg in the past six months, BMI28.7, abdominal circumference 94cm, he drinks 2 taels of white wine every day, with homemade pickled radish with meals, and has a 5-year history of smoking (5 cigarettes a day). I spent 3,280 yuan to buy "pure herbal antihypertensive tea" during a health class. I stopped taking antihypertensive medication for a week without permission. I felt dizzy and went to the emergency room. My blood pressure was measured at 178/109mmHg. After I was discharged, I was transferred to our center for follow-up.

When we got his case, there was a little dispute in the department: the expert from the Department of Cardiology felt that his blood pressure had been below the standard for more than 6 months, which was in line with the indications for combined medication. He suggested adding valsartan 80mg qd.； But our nursing team chatted with him for half an hour and found that his poor blood pressure control was not a problem with the medicine at all - he often remembered to forget to take medicine after breakfast. Sometimes he would skip taking medicine when he went out to play chess. He ate half a plate of pickled radish at each meal. Calculated, the daily salt intake exceeded 12g, which was more than twice the recommended amount. He still drinks the anti-hypertensive tea and feels that he "doesn't feel dizzy after drinking it and is milder than Western medicine." We proposed at that time that we would first carry out four weeks of precision nursing intervention, and then add medication if the blood pressure was still not up to standard. The experts agreed and said that we could try it.

I was particularly impressed when I visited him for the first time. There was half a can of blackened pickled radish strips on his dining table, and there was half a glass of white wine left next to him. When he saw us coming, he hid, thinking we were here to sell some product. It wasn’t until we took out his medical records from his last emergency room visit that he sat down and chatted with us.

We didn't start by preaching and telling him to quit this or that. After all, he has been eating pickles for decades, so how can he just quit? I specifically looked up how to make low-sodium pickles suitable for the elderly, and taught him how to pickle radish with white vinegar, spicy millet, and a small amount of light soy sauce. He can pickle the radish for 24 hours without adding heavy salt, and it has enough sour and spicy taste. He asked his wife to buy the ingredients that day to try. The problem of drinking did not stop him immediately. He first reduced it from 2 taels a day to 1 tael, and drank up to 5 days a week, and then gradually reduced it to 2 times a week. He did not feel any burden. He had degenerative disease in his knees during exercise and it hurt when he ran or jumped, so he accompanied his wife to the community square every day after dinner to dance slow-paced square dancing. He danced for 20 minutes at first and then gradually increased it to 40 minutes. He later told me that after dancing for half a month, he lost 2 pounds and walked lighter than before.

In the meantime, his daughter came to ask if she wanted to buy a magnetic therapy anti-hypertensive watch sold online for more than 2,000 yuan. The merchant said that wearing it can reduce blood pressure without taking medicine. We didn’t directly say no, so we told her that currently all domestic and foreign hypertension guidelines do not recommend physical blood pressure-lowering functions of wearable devices. There is no evidence-based basis for the blood pressure-lowering effect of such products. If you want to buy them to measure blood pressure and heart rate, it is no problem. Don’t believe the propaganda of “replacing medicine”. She later bought an ordinary smart bracelet to measure the blood pressure of the elderly, and automatically uploaded the data to our chronic disease platform every day, which also saved us a lot of effort in visiting the patient.

Of course, it wasn't completely smooth. During the third week, he had a party with his old colleagues and couldn't help but drink 3 taels of white wine. The next day, his blood pressure soared to 156/97. He was so frightened that he called us early in the morning. We didn't scold him. We just told him that it's okay once in a while and that he should be light in the next few days and take medicine on time. He later paid special attention to it and took the initiative to drink sugar-free drinks during gatherings.

By the 4th week of follow-up, his average blood pressure had dropped to 138/88mmHg, basically reaching the standard. The cardiologist was surprised when he saw the data. He said he didn't expect the nursing intervention to be so effective, so he didn't add any medication and kept the original dose. By the 8th week, his average blood pressure stabilized at 132/81mmHg, he had lost 4.2 kilograms in weight, and his abdominal circumference had shrunk by 3cm. Now he has become a volunteer for hypertension prevention and control in our community. He often tells other old patients about his experience, saying, "Don't believe those who sell anti-hypertensive tea. Listening to the nurse is better than anything else."

After working in chronic disease care for 12 years, my biggest feeling is that there is really no unified template for high blood pressure care. Some patients just can't keep their mouth shut, and some patients just can't remember to take their medicine. You can't just follow the rules and regulations in the guide, you have to find a solution according to his living habits. Of course, this does not mean that all patients do not need to add medication. If the blood pressure is still not up to standard after 1-2 months of intervention, the medication must be added. After all, individualization is the core of chronic disease care. We later compiled this case into a teaching case and used it during training for new nurses. We told them not to make a list of "don't dos" for patients when they first came up, but to ask more about "what do you like to eat" and "what kind of exercise do you like to do", which is more effective than anything else.