Discussion on Primary Care

  • Uncategorized

Discussionon Primary Care


Discussionon Primary Care

CaseStudy #1: Acute Health Condition- Asthma

Kim- Leng Hills was diagnosed with asthma by the time she was 12years old. She was so fit and sporty having trained karate for sevenyears. Her parents were confused why she developed breathingdifficulties. She got so scared to participate in sports and by thistime people were not aware of asthma and how it threatens life. Inher adulthood, her asthma was caused by stress and anxiety. She hadto change her lifestyle, regularly attend Asthma Reviews and use anemergency inhaler. In addition, she closely monitored her lungcapacity after every month. The paper will discuss a case study ofacute health condition of asthma and another case study of chronichealth condition in hypertension.

ClientDemographic Data

Personal information was collected for each patient. Theinformation will help in keeping history for future use. In our casestudy, the patient`s demographic data that was to be recordedincluded, her initials. For instance, Kim- Leng Hills, age was 12years, race was white and she was from European culture.

AsthmaEpidemiology, Incidence, and Prevalence

Asthma is a lung disease that is characterized by obstruction ofairways that is reversible, exacerbates inflammation of airways andincreased airways response to stimuli. However, this not the exactepidemiology of the disease but it relies on the report afterdiagnosis. Common symptoms of asthma infection include wheezing,other patient experience coughing without wheezing and the responseof bronchial activity after an exercise (Croisant,2014).


Measurement of the incidence rates of a disease and its probabilityof developing in a given population shows its incidence. Theincidence of asthma has been estimated to be 3 to 4 people out of apopulation of 1000 people. The condition is common in children belowfive years of age and more common in boys than in girls. Thedifference usually disappears in adulthood. Besides, a report fromWorld Health Organization states that there are 230 million peopleaffected by asthma every year.


Measurement of asthma prevalence is usually for over the past 12months. The prevalence of asthma is low in non-industrialized areaswhile it is relatively high in industrialized areas. The diseaseprevalence has been reported to increase in the world. The increaseis accounted for differences in awareness of the disease, access tomedical care and medical diagnosis change. New Zealand has reportedhighest cases of asthma than any other country.


Effect on theairways

The disease affects the lower respiratory tract, which includestrachea, bronchi, and the bronchioles. It causes bronchoconstrictiondue to damage of the epithelial, mucus over-production, Oedema,muscle damage and bronchospasm (Doeing,&amp Solway, 2013).

In epithelial damage, the layer of the cells becomes damaged, andthey peel off. Shedding of epithelial wall in the cells cause`shyper-responsiveness. Once the wall is shed off, there is a loss ofbarrier function, which may allow penetration of allergens. There isalso a loss of enzymes that lysis inflammatory mediator. In addition,the sensory nerves are exposed that may cause reflex neural effectson the airways.

Overproduction of mucus is as a result of the disease, which causesmucus-secreting cells in the airways to multiply and expansion ofmucus glands. Overproduction of mucus results to the development ofviscid mucous plugs that obstruct the airways. Oedema occurs as aresult of capillaries in the airways dilating and starts leaking. Itresults to increased secretions in the airways and impairingmucociliary activity.

Bronchospasm also occurs as indicated earlier. It is sharpconstriction of the bronchiole smooth muscles and narrowing theairways. If these conditions are not treated promptly, they result toremodeling of the airways, which result in permanent fibrotic damage.

Applicationof Nursing Theory

Nurses can use individual healthcare plan (IHP) which ensures thatthe health needs of the patient are taken care of without wastingmuch time. Time wasting would further lead to the destruction ofrespiratory pathways. In addition, it prevents the patient fromcarrying out with their daily activities. In addition, the nurse canuse ‘best practice` approach. It requires the nurse to cooperatewith other stakeholders like the parents, health care providers, andmarriage partners among others. The stakeholders help in managing thedisease.

Medical diagnosis

To diagnose the medical condition, the physician should use differentmethods. They use personal history to examine. The doctor asksquestions to understand the symptoms. The patient should share theirfamily history and regarding any medication.

In addition, doctors can use physical examination. They examine eyes,ears, skin, nose, and lungs. They can carry lung function test tomonitor how they are functioning (Gershon,Victor, Guan &amp Aaron, 2012). An x-ray can also becarried.


Additional laboratory tests

The patient can be done a methacholine challenge. It is an asthmatrigger which when inhaled cause airways constriction and if there isa reaction it shows the presence of asthma. Nitric oxide test canalso be carried which measures the amount of nitric oxide in thebreath. An elevated level of the gas is a sign of asthma. Inaddition, an allergy test is carried on a sample of blood or skin. Ifallergy triggers are identified, then there will be a recommendationof allergen therapy. Other tests include sputum eosinophil,provocative test and imaging test.

Drug Therapy

Pharmacists should obtain medication history before embarking onasthma treatment. Type of treatment to be offered depends onpatient’s age, comorbidities and the severity of the infection.Common drugs to treat asthma include beta-blockers, cholinergic,diuretics, and angiotensin-converting enzyme blockers among others.The drugs could be contradicted depending on the condition of thepatient and the asthma agents a patient is using.

Quick- relief drugs can be used in case of a short-term symptom. Thedrugs cause quick bronchodilation and are used to control asthmadisease, and their action is quick. The rescue drugs includeatrovent, beta agonists, and oral corticosteroids. However, forlong-term control of asthma, leukotriene modifiers, theophylline,inhaled corticosteroids are used to manage the disease. The drugstake long to meet maximal effect. The nurses should also educate thepatients and other stakeholders how to use a peak flow meter, observeenvironmental controls and understand symptoms and signs of asthma.

Patient Education

Patients and other stakeholders should be educated how to manageasthma. Patients should have a written action plan for all asthmaticchildren and train parents how to follow it. Patients and the publicshould be educated on signs and symptoms of asthma, asthma drugs andon how to use inhalers’ correctly.

In summary, asthma is a disease that results from a hypersensitivereaction to allergens. It results in narrowing of respiratorypathways. The disease should be managed promptly, as a delay wouldresult in permanent damage to the airways. Rescue drugs can be usedor long-term control method. In addition, the patients should beeducated on proper lifestyle and environmental optimization controls.Stakeholders should also be educated on how to manage the patient andhow to recognize symptoms of asthma.

In conclusion, asthma is a prevalent disease that is common toseveral people in the world. The disease has no cure, but controlmeasures and proper lifestyles help to manage it. Physicians shouldeducate the society on understanding the signs and symptoms ofasthma. The patients should have quick-relief drugs in case they areattacked in a compromising situation.

CaseStudy 2: Chronic Health Condition- Hypertension

Mr. Bill is an African-American who is 41 years. His family has apositive history of hypertension, his father died at the age of 59from high blood pressure- related cardiovascular disease. Besides,his maternal grandparents had heart disease. At first physicianvisit, he reported having headache and body weakness. He smokesseveral cigarettes daily and drinks four-packs of beer during theweekends. He fears that blood pressure will interrupt with hismarriage life. From the objective data, physical examinationindicated he sustained apical impulse and grade I/IV Keith-Wagenerretinopathy. Diagnostic studies reported left ventricularhypertrophy, urinalysis showed protein 31 mg/dl, and serum creatininelevel was 1.6 mg/dl. A collaborative care required him to take adiet low in sodium and hydrochlorothiazide 12.5 mg/day.

Overviewof Hypertension

Hypertension is a common health problem in various parts in the worlddespite the advances in antihypertensive therapy. The disease is arisk factor for cardiovascular mortality and morbidity. It is commonamong the old black Americans than in non-Hispanic whites. The blackAmericans have reported a regular incidence of stage 3 hypertensionthan whites. In addition, there is a high incidence ofhypertension-related end-stage renal disease (ESRD), stroke andcardiovascular disease among the black Americans than in otherpeople. Aging is another condition raises the prevalence and severityof hypertension.

Epidemiology,Incidence, and Prevalence


Hypertension is a disease affecting one billion people and the mostcommon risk factor for death in the world. The condition is higher inmales (29%) and lower in females (24%). The disease is common to agedpeople mostly at the age of 80 to 85. The disease is common in bothdeveloped and developing countries (McGoon,Benza, Escribano-Subias, 2013).


A study carried by Framingham Heart Study found that in a period oftwo years, the incidence was 5 % for age of 50 – 59, 6 % for age of70 – 79 and 9% for ages of 70 – 79. Another study carried byEPIPorto in Portugal found that there is an annual incidence rate of6% for women and 7% for men between the ages 45 – 64 years.


As indicated earlier, the rate is higher in men than in women.However, the sex-related variation flattens with the increase in age.At the age of 60 to 90 years, hypertension is slightly higher inwomen than in men. The prevalence is attributed to the function ofsex hormones. The condition is also reported to increase with time,where at the age of 18 – 39 years prevalence is 7.2% while at theage of 60 years and older, the prevalence is 66.5%. High hypertensionprevalence is due to the unhealthy lifestyle like smoking, takingalcohol and reduced physical activity.

Hypertension Pathophysiology

The real cause of hypertension is unknown, but it is attributed tovarious abnormalities. They include cell membrane defects, heredity,abnormal sympathetic nervous system activity, endothelial celldysfunction, vascular hypertrophy among others. In addition, there isevidence relating ‘local renin-angiotensin` paracrine factors withthe development of hypertension (Burnier&amp Wuerzner, 2015). However, hypertension is relatedto various changes. An increased systemic vascular resistance withregular cardiac output, there is also an increased sympatheticresponse to stress. In addition, there is an elevated blood pressureduring systole and a decrease in blood pressure with dilation.

Nursing Theory of Hypertension

Two approaches can be used in minimizing the incidences ofhypertension among the population. It makes use of populationapproach that aims at reducing cases of hypertension in thepopulation. It includes increasing physical activities, improvingdiet and nutrition, reduce salt intake and reduce overweight andobesity.

The other approach is the use of an individual approach that aimsreducing rates of hypertension at the individual’s level.Individuals should be offered advice on how to reduce the risk ofhaving hypertension. They should be supported to reduce weight andincrease physical activity.

Medical diagnosis

To measure blood pressure, physicians uses an inflatable arm cuffaround the patient`s arm. The pressure is recorded in two numbers.The first number shows vasoconstriction pressure and the secondnumber shows vasodilation pressure. Blood pressure falls in fourcategories. The first case is normal blood pressure which is 120/80mmHg. The other is prehypertension where vasoconstriction pressurerange from 120 to 139 mmHg and vasodilation pressure ranges from 80to 89 mmHg (Hackam,Quinn, Ravani, &amp Rabi, 2013).

The third is stage 1 hypertension where vasoconstriction pressurevaries between 135 to 155 mmHg and diastole from 89 to 100 mmHg.While the last one is stage 2 hypertension, it is more severe. Thesystolic pressure ranges from 159 mmHg or higher and diastolicpressure range 101 mmHg and above. The blood pressure should berecorded two to three times before diagnosing for hypertension.Besides, blood pressure should be measured from both arms to identifyif there is a difference.

Management Plan

AdditionalLaboratory tests

Routine test is carried in the laboratory to test factors that couldbe exacerbating hypertension. The tests also help to monitor andevaluate organ functions. Common tests include urinalysis to test theprotein level and evaluate kidney function. Creating a test tomonitor the kidney problems and effects of drugs on the kidneys isimportant. Fasting blood test is also done to monitor the level ofglucose especially for diabetic patients. Electrocardiography test isalso done to monitor the rhythm and the heart rate.


To treat hypertension thiazide diuretics are used. They act on thekidney helping the body to release water and sodium, thus reducingblood volume. Beta-blockers like acebutolol are used to minimize theworkload of the heart and open the blood vessels. Angiotensin IIreceptor blocker like losartan and candesartan assist in relaxingblood vessels. They act by inhibiting an enzyme that narrows theblood vessels. Other commonly used drugs are calcium channelblockers, renin inhibitors among others.


In some conditions, there would be the use of combinationantihypertensive drug therapy. Two drugs can be used where one isdiuretic, or calcium channel antagonist. It is applied when the levelof systolic pressure is consistently above 15 mmHg and diastole with10 mmHg.


Even after treatment, patients should change their lifestyles. Theyshould feed healthy and food lows in salts, have physical exerciseregularly, avoid smoking, reduce the amount of alcohol and maintain ahealthy body weight.


Hypertension is a chronic disease and common among most people. Thedisease is common in men than in females. It frequently attackselderly people. The disease is caused by poor lifestyles, taking foodwith a lot of salts, and smoking. Also excessive drinking of alcoholand been overweight cause hypertension. It can is diagnosed in healthfacilities to monitor the causative factor. After diagnosis, it iscontrolled through taking appropriate drug therapy. Hypertension isa risk factor resulting in many deaths in the world. It is the dutyof everyone to live a healthy lifestyle to prevent incidences ofhypertension. In addition, health personnel and the government shouldconsider having programs to educate the public on better lifestyleand preventive measures of hypertension.


Burnier,M., &amp Wuerzner, G. (2015). Pathophysiology of Hypertension.In&nbspPathophysiologyand

Pharmacotherapyof Cardiovascular Disease&nbsp(pp.655-683). Springer International


Croisant,S. (2014). Epidemiologyof asthma: prevalence and burden of disease.

In&nbspHeterogeneityin Asthma&nbsp(pp.17-29). Springer US.

Doeing,D. C., &amp Solway, J. (2013). Airwaysmooth muscle in the pathophysiology and treatment

ofasthma.&nbspJournalof Applied Physiology,&nbsp114(7),834-843.

Gershon,Victor, Guan, Aaron (2012). Pulmonaryfunction testing in the diagnosis of asthma: a


Hackam,Quinn, Ravani, &amp Rabi, (2013). The2013 Canadian Hypertension Education Program

recommendationsfor blood pressure measurement, diagnosis, assessment of risk,prevention, and treatment of hypertension.&nbspCanadianJournal of Cardiology,&nbsp29(5),528-542.

McGoon,Benza, Escribano-Subias, (2013). Pulmonaryarterial hypertension: epidemiology and

registries.&nbspJournalof the American College of Cardiology,&nbsp62(25),D51-D59.