NUR-300 Lincoln University – Case Study B: Janice  Janice is a 52-year-old woman that recently moved to the area and came into the clinic for a wellness visit.

QUESTION

Case Study B: Janice

Janice is a 52-year-old woman that recently moved to the area and came into the clinic for a wellness visit. The nurse checks Janice’s vital signs and notices her blood pressure is slightly elevated. Janice explains that it is likely due to doctor’s offices making her nervous especially since this is her first time to this clinic. The nurse explains that high blood pressure can be very serious and that it is important for Janice to track her blood pressure readings.

1. What measures could Janice take to provide blood pressure data to the doctor’s office?
2. What are 3 modifiable risk factors that the nurse could educate Janice about to try to prevent high blood pressure?

The nurse notices Janice has a cough and Janice explains it is probably because she has smoked a pack of cigarettes per day for 30 years. The nurse tries to explain the bad effects of smoking, but Janice expresses that she doesn’t think it will change anything if she stop smoking now.

1. What further questions should the nurse ask to assess Janice’s cough?
2. What education should the nurse provide to explain that smoking cessation could help Janice’s health?

The nurse asks Janice several questions about every body system including urinary function. Janice explains that she is slightly incontinent of urine when she coughs, sneezes, or laughs.

1. What type of urinary incontinence does Janice display?
2. What are three interventions the nurse can teach Janice for urinary incontinence?

ANSWER

Case Study B: Janice – Blood Pressure Monitoring, Smoking Cessation, and Urinary Incontinence

Measures to Provide Blood Pressure Data

Home Blood Pressure Monitoring: The nurse could advise Janice to purchase a reliable home blood pressure monitor and regularly check her blood pressure at home (George & MacDonald, 2015). She should be instructed on how to properly use the device, including positioning the cuff correctly and taking multiple readings for accuracy.

Blood Pressure Journal: Janice can keep a record of her blood pressure readings in a journal or a digital app (George & MacDonald, 2015). This will allow her to track any changes or trends over time and provide the doctor with accurate data during follow-up visits.

Wearable Devices: The nurse could suggest using wearable devices such as smartwatches or fitness trackers that have blood pressure monitoring capabilities. These devices can provide continuous monitoring and automatically record blood pressure readings, allowing for convenient data collection.

Modifiable Risk Factors to Prevent High Blood Pressure

Diet and Nutrition: The nurse could educate Janice about the importance of maintaining a healthy diet that is low in sodium (salt), saturated fats, and cholesterol. Encouraging the consumption of fruits, vegetables, whole grains, lean proteins, and low-fat dairy products can help lower blood pressure.

Physical Activity: Regular exercise plays a significant role in preventing high blood pressure. The nurse could recommend Janice engage in moderate-intensity aerobic exercises, such as brisk walking or swimming, for at least 150 minutes per week. Additionally, incorporating strength training exercises two or more days a week can further benefit her blood pressure.

Stress Management: Chronic stress can contribute to high blood pressure. The nurse could discuss stress reduction techniques with Janice, such as deep breathing exercises, meditation, yoga, or engaging in hobbies and activities she enjoys. Encouraging a healthy work-life balance and promoting relaxation techniques can help manage stress levels and potentially reduce blood pressure.

Further Questions to Assess Janice’s Cough

Duration and Frequency: How long has Janice been experiencing the cough, and how often does it occur? Determining the duration and frequency can provide insights into the potential causes and severity of the cough.

Cough Characteristics: Does the cough produce phlegm or mucus? Is it dry or productive? Understanding the nature of the cough can help determine if it is related to smoking, respiratory infections, or other underlying conditions.

Associated Symptoms: Does Janice experience shortness of breath, chest pain, wheezing, or any other symptoms along with the cough? Exploring additional symptoms can help identify potential underlying causes or complications.

Education on Smoking Cessation

The nurse should explain to Janice that quitting smoking can have significant positive effects on her overall health, including reducing the risk of various diseases and improving her respiratory and cardiovascular health. Here are some key points to include in the education:

Health Benefits: Quitting smoking can lead to immediate and long-term health benefits. The nurse can explain that blood pressure and heart rate start to decrease within hours of quitting, and within weeks, lung function improves (Golechha, 2016). Over time, the risk of developing serious conditions such as heart disease, lung cancer, and respiratory infections decreases significantly.

Financial Impact: Smoking is an expensive habit, and quitting can save a substantial amount of money. The nurse can help Janice calculate how much she spends on cigarettes annually and discuss how she can utilize the saved money for more rewarding purposes, such as travel, hobbies, or improving her overall quality of life.

Support and Resources: The nurse should inform Janice about the various resources available to support smoking cessation. This can include counseling services, support groups, nicotine replacement therapies (such as patches or gum), prescription medications, and helplines. Providing information on local smoking cessation programs or referring Janice to a specialized tobacco cessation counselor can increase her chances of successfully quitting.

Urinary Incontinence Type

Janice displays stress urinary incontinence. This type of incontinence occurs when there is increased pressure on the bladder, causing leakage of urine during activities that put stress on the pelvic floor muscles, such as coughing, sneezing, or laughing.

Interventions for Urinary Incontinence

Pelvic Floor Muscle Exercises (Kegel exercises): The nurse can teach Janice how to perform pelvic floor muscle exercises to strengthen the muscles that support the bladder and control urine flow (Harris, 2022). Regularly practicing these exercises can improve bladder control and reduce episodes of leakage.

Lifestyle Modifications: The nurse can advise Janice to make certain lifestyle changes that can help manage stress urinary incontinence. These may include maintaining a healthy weight, avoiding excessive fluid intake before bedtime, and limiting caffeine and alcohol consumption, as they can irritate the bladder and increase urine production.

Bladder Training: The nurse can educate Janice about bladder training techniques, which involve scheduled voiding and gradually increasing the time intervals between urination. This helps train the bladder to hold larger volumes of urine and reduce the frequency of urges and episodes of incontinence.

In conclusion, Janice can provide blood pressure data to the doctor’s office by using home blood pressure monitoring devices, keeping a blood pressure journal, or utilizing wearable devices with blood pressure monitoring capabilities. Additionally, the nurse can educate Janice about modifiable risk factors for high blood pressure, including maintaining a healthy diet, engaging in regular physical activity, and implementing stress management techniques. Regarding Janice’s cough, the nurse should ask about the duration, frequency, and characteristics of the cough, as well as any associated symptoms. When discussing smoking cessation, the nurse should emphasize the health benefits, financial impact, and available support resources. Lastly, for Janice’s stress urinary incontinence, the nurse can recommend pelvic floor muscle exercises, lifestyle modifications, and bladder training techniques as interventions to manage the condition.

References

Golechha, M. (2016). Health promotion methods for smoking prevention and cessation: A comprehensive review of effectiveness and the way forward. International Journal of Preventive Medicine, 7(1), 7. https://doi.org/10.4103/2008-7802.173797 

George, J., & MacDonald, T. T. (2015). Home Blood Pressure Monitoring. European Cardiology, 10(2), 95. https://doi.org/10.15420/ecr.2015.10.2.95

Harris, S. (2022, July 18). Mixed Urinary Incontinence. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK534234/