CASE SCENARIO

Mr. X is admitted to the hospital for the first time. He is 55 years old, married, obese, administrator of an English tutorial
center. He is sitting upright in bed, with tense posture and facial expression.

Nursing History
As reported, he has a five-year history of slightly elevated blood pressure. One year PTA he experienced dizziness which
lasted 12 hours and started medication. Two other episodes of dizziness were relieved by rest. He seeks treatment at
the emergency room and numbness of left arm.

He viewed health as good until one year ago when diagnosed as having high blood pressure. Had headaches for the last
6 months and 2 episodes of dizziness, one at work and one a home lasting about 2 hours. Rested and symptoms went
away. Delayed seeking care because he was “too busy.” Thought it was overwork, not high blood pressure. Discontinued
blood pressure medication and check-up about 6 months ago because he “felt better.” Came to emergency room today
because of left arm numbness and fear of stroke. Mother died of stroke 15 months ago. Takes no medicine currently,
except Alka-Seltzer and a laxative. Doesn’t smoke. Drinks socially.

Sample diet related: excess carbohydrate (more than 2 cups of rice per meal). High fat diet (mostly fried meat – pork,
chicken, beef). Eats big supper and evening snack, sandwich and cake at lunch, eats at desk while working. Reports
gradual weight gain over last 15 years. Considers self as “too old for exercise.” Minimal intake of fruits and vegetables.
Approximately 3 cups of coffee per day. Water intake less than 6 glasses per day. Some indigestion and heartburn after
lunch attributed to days with multiple problems; takes Alka-Seltzer. Dieting unsuccessful. Problem is “probably stress
from job.” “I get home and eat big supper and snacks in the evening.” No food dislikes or allergies. Takes lunch to work
and eats at desk.

Daily bowel movement pattern, with two or three episodes of constipation per month lasting 2 days; hard stools,
straining, and laxatives used. Attributes this pattern to his diet. Report no problem in voiding.

Uses car when going to work. Minimal walking because of time schedule, sedentary job. Increasing fatigue last few
weeks, less energy 2 months before admission. Recreation consists of reading novels, watching television, dinner with
friends. Drives 5 kilometers to work.

Average 4-6 hours sleep/night. Quiet atmosphere, own room with wife, double bed. Pre-sleep activities include
watching TV or completing paper work from job. Difficulty with sleep onset 1 month; awakens in early morning many
times thinking about job-related problems.

Sees self as needing to do things well (job, father, husband). Describes family as happy and understanding his job
commitments. Job demanding, 9-10 hours/day. Wife formerly a social worker; kids “good.” States fear of stroke, “this
thing today has scared me. Mother died of stroke 15 months ago.”

Physical Exam
BP: 205/118 PR: 90, regular and strong T: 36.8OC R: 18 Weight: 230 lbs Height: 5’11”
Skin: no area of redness over bony prominences; no lesions; dryness noted; discomfort from calluses on feet
Oral mucous membrane: moist, no lesions Gait: steady Posture: well-balanced
Muscle tone, strength-coordination: hand grip firm (left & right); lifts legs; can pick up a pencil; tension in neck and
shoulder muscles.
ROM: (joints): some tightness when bending forward Prostheses/ assistive device: none
Perceptual: Hears whisper: yes Reads newsprint: with glasses
Language: English, grasps concrete and abstract ideas. Speech clear, attention span good
General appearance: well-groomed, good hygiene
Nervous/relaxed: 2 (scale of 1-5 with 1 as relaxed); tensed, some relaxation during history taking
Eye contact: yes Attention span: good
Interactions: communication with wife supportive; both somewhat tense; children not present