Larry Garcia is a 45years old Hispanic male who was newly diagnosed with hypertension during a work-related physical exam. He has been married for eighteen years and has three children. He has been employed as a sales rep for ten years with the same company. His current position is a high pressured position, but he is performing very well at this present time. His is Catholic but only attends church on holidays. Larry likes to fish in his spare time. His mother has a history of high blood pressure but refuses to take her blood pressure medication, but otherwise she is well. His father has a history of CHF and impaired vision due to macular degeneration.
He is an only child who supports his parents financially, assist with their shopping and transportation needs as well. Larry has an associate’s degree in business and wants to further his education, but he is unable to due to his labor and household responsibilities. Larry does state that “I feel stressed sometimes” during the exam. He has never smoked and has an occasional drink of alcohol on the weekends. Larry has no known allergies and takes one multivitamin a day.
Identified risk factors for hypertension on Larry Garcia
Age: Larry is 45 years old; more men than women at age 45 have hypertension. Family: his mother has high blood pressure;his father has CHF. Heredity plays an important role in having essential hypertension. Sedentary lifestyle: Larry is 12 lbs. over his model weight and does not exercise on a regular basis. An inactive lifestyle escalates the risk for hypertension and other serious disorders. Race: Larry is Hispanic. Racial/ethnic disparities exist in blood pressure, awareness, treatment, and control, with Mexican-Americans having a lower awareness and treatment of hypertension, as well as less health-care coverage, compared with blacks and whites (CDC, 2013). Stress: Larry has increased stress from work and also in supporting the need of his parents
Describing the disease process
Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure (Mayo Clinic). High blood pressure is a known and unsafe chronic illness. Hypertension indicates that the pressure of the blood in your blood vessels is greater than it should be. Hypertension is having a blood pressure reading that is greater than 140 over 90 or higher on a consistent basis. If left untreated, having high blood pressure can become a front-runner to many problems such as a heart diseases, stroke, or renal failure. Many factors can contribute to high blood pressure such as the way you live, nutrition, heredities and some other unidentified origin. Helping to lower your blood pressure can assist in avoiding health disasters in the present and near future.
Age, ethnic, cultural background, spiritual and developmental issues to the disease
Men and women are equally likely to develop HBP during their lifetimes. However, before age 45, men are more likely to have HBP than women. After age 65, the condition is more likely to affect women than men (NIH, 2012). The increased stress from having made his quota at work as a sales representative along with the increased stress of having to support his parents can contribute to his high blood pressure as well. Mr. Garcia is twelve pounds over his ideal weight and does not exercise which is another major risk factor for hypertension. If he were to exercise that could aid in lowering his blood pressure as well. Being Catholic has no significance on high blood pressure. With his mother having a history of high blood pressure, this can genetically have an effect of his current condition.
Effect on quality of life
Hypertension is a progressive disease that may not have any signs or symptoms, so they patient may feel fine for a long period of time. On the other hand, high blood pressure can change a person’s quality of life for the worse. Heart failure can occur which cause the heart to become larger and weaker over time. Aneurysms can occur as well in major blood vessels which can transport blood away from the heart. Blood vessels in the kidneys can become narrowed which can cause kidney failure. The kidney failure can be acute or chronic, but this can have the patient needing a kidney transplant or end up needing dialysis. Vision can become impaired and blood vessels in the eyes can rupture or bleed due to the increased pressure in the artery. All of these can affect the quality of life and can change a person’s entire life-style. Educational needs of the patient and how it can be met
Larry needs a lot of education on his newly diagnosed chronic disease. Larry needs to be educated about the potential risk factors and complications related to hypertension. The nurse can provide information on hypertension, the causes, risk factors and the lifestyle changes that can help in the control of high blood pressure. The nurse can educate Larry on the need for regular check-ups with his primary care physician. Larry’s last eye exam was eight years ago and he has never had a colonoscopy. Also, his family history of some chronic illnesses such as hypertension, CHF, and macular degeneration should aid in making this discussion be of importance to focus on.
Stress management is an educational need as well. The nurse can educate Larry on the significance of decreasing the stress in his life and providing stress relieving technique and support groups. High blood pressure involves long term management and control which can involve life-style and medication adjustments. Larry needs to learn how to monitor and record his blood pressure accurately. He needs to become aware of when to take his medications and what signs to become of aware to notify his physician. Providing information on the medication, side effect and resources to aid in purchasing the medication is of importance as well. He also needs to make a nutritional adjustment which should include a low fat, low to no salt, low cholesterol, low calorie diet. An exercise program needs to be introduced as well to help him maintain his ideal weight and lose the extra pounds he may be carrying around.
Patient’s Perceived Challenges
Larry has a lot of challenges that he faces due to controlling his high blood pressure. The stress of his position at work along with supporting his parents has been an added stressor in his life. Larry is going to have to find a way to decrease the stress in both of these situations. Decreasing his work load by delegating more responsibilities to others can be of some much needed relief. He has to support his parents financially along with financially supporting his household can be a major challenge. Larry has two teenagers at home that he has to assist in leading and guiding in the right
direction. The patient has to deal with his weight as well and is unable to do an exercise program due to his demands at work. Changing his dietary intake can also be challenging since he is always on the go. Larry does not retain verbal information easily and learns best by reading the material. Handouts would mostly likely be the best teaching mechanism for the patient. Helping to break the barrier of these challenges can assist the patient in the control and management of his blood pressure.
Plan of care and potential patient outcomes
Mr. Garcia needs to start losing weight. Creating an exercise program that can he incorporate into his daily routine is of importance. Seeing if his job has a gym, going to a gym near his job or taking a walk with his family in the evenings can aid in him starting an exercise regimen that can fit into his busy lifestyle. Providing information on a healthy diet that includes a low sodium, low calorie, and low fat is significant as well. An educational tool provided by the National Lung and Blood Institute that can aid in this teaching is the Dietary Approaches to Stop Hypertension (DASH) plan. By changing his diet, he can lower blood pressure and begin to live a healthier life.
Encouraging the importance of taking his blood pressures as scheduled should be a focus. Since he doesn’t like verbal teaching and does have an Associate’s degree than written materials such as booklet and pamphlets can assist in this medication educational process. Teaching stress relieving exercises and stress relieving mechanisms can aid in decreasing his stress. His wife is helping his parents and should continue if she can to assist him in the transportation of his parents.
Larry Garcia, a 45 year old male who was newly diagnosed with hypertension was the focus of this case study. As the nurse, I was able to identify Larry’s educational requirements to support him in living a fairly good life regardless of him having hypertension. An educational plan was developed to help him in complying with these needed changes in his life. High blood pressure is called the “silent killer” because it often has no warning signs or symptoms and many people do not know they have it. That’s why it is important to check your blood pressure regularly (CDC, 2015). Race, genetics, age and being overweight are some of the contributing factors of hypertension. Although there is no cure for high blood pressure, management can consist of exercise, medication, dietary modifications and weight loss.
Center for Disease Control and Prevention. (2015). High Blood Pressure. Retrieved from
Center for Disease Control and Prevention (2013). Racial/Ethnic Disparities in the Awareness, Treatment, and
Control of Hypertension — United States, 2003–2010. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6218a2.htm
Mayo Clinic. (2014). High Blood Pressure (Hypertension). Retrieved from http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/basics/definition/con-20019580 National Heart, Lung and Blood Institute. (2012). Who is At Risk for High Blood Pressure? Retrieved from
http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/atrisk Redman, B.K (2007). The practice of patient education: A case study approach (10th ed.). Retrieved from
The University of Phoenix eBook Collection Database.
The Dash Diet Eating Plan. (2015). What is the DASH Diet? Retrieved from
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