Question

214 CHAPTERO Cardiovascular Medications CASE STUDY 1 CASI Hypertension Management A 62-year-old Caucasian male, CW, is an established patient at a free primary care clinic where you are volunteering. The clinic serves only persons without health insurance CW works as a general handyman in a rural farming community and is quite physically active most days of the week doing his jobs. He did not complete high school and reads at approximately a sixth-grade level. He is single, does not use tobacco products or recreational/illicit drugs, and rarely drinks alcohol His medical history is significant for primary or essential hypertension, prediabetes, and osteoarthritis he is extremely hard of hearing. He was last seen six months ago for a routine check-up his BP at that time was 140/84. Today CW is worried about his blood pressure after discovering it was 200/110 when he checked it last night at the local grocery store. He denies headache dizziness. palpitations, chest pain, or shortness of breath. On further questioning, he tells you that he has not taken his blood pressure medicine for several months' because I ran out and couldn't afford to buy more" He admits that he has not been eating right for the last few months. He drinks only coffee for breakfast, then typically stops at a convenience shop for lunch choosing a packaged snack food Coke, and a fried meat product. For supper, he eats scrambled eggs with sausage or frozen burritos most nights. He drinks four to five caffeinated beverages daily. Medication list: Lisinopril 20 mg one tab daily in AM, initiated 2 years ago Ibuprofen 200 mg (OTC) 1-2 tabs every 6 hours proint pain Allergies: NKDA Vital signs: BP: left arm 200/110.right arm: 190/110: P: 86/minute, regular: Respirations 1/min regular: Oral temperature 98.4"F: Weight: 185# Ht: 69": BMI 273 Upon assessment, you notice that CW is sitting comfortably and is in no acute distress. The healthcare provider reports no unusual findings upon funduscopic exam and evaluation of heart sounds, peripheral pulses, lungs, abdomen, and extremities. Lab values from today's visit: CMP all within normal range: hemoglobin Alc5.796 consistent with prediabetes): Lipid panel all values within normal range (normal values in parentheses Total cholesterol: 152 (125-200 mg/dL): LDL-C 75 (<130 mg/dL): HDL 54 (240 mg/dL) Triglycerides 14 <150 mg/dL) The healthcare provider decides to prescribe two antihypertensive agents Lisinop 40 mg and hydrochlorothiazide 125 mg daily. CW is to return in two weeks for a nurse visit to rechechis blood pressure and assess for adherence. He asks you to instruct the patient regarding the importance on adherence to this regimen expected side effects and any other relevant teaching points. He asks you to teach Cw about the DASH diet. Cose Questions 1 Watate two nursing diagnoses (NANDA format you would make concerning w here ment and eating patterns 2 Recording to current hypertension management guidelines what is the blood 3. What will you tell about why the provider h a d two m ontado Dys Cwis you a a two pressu and is school of recre hyperte has take once last explainin Sad Hes snack food Medica Lisinopr Ibuprote Allergies Vital sign regula His lipid in pare (240 m Nis sitting You have learn wch as you 99.10 years meanicou s knowing that was uninsured what formulation of these medications would be most appropriate to cook Ce Questions Lors blood Sarding this medication What would be the 2. Even though des ASC

pharmacology case study about hypertension management

Answer 1

In the present case study of Mr.CW, is a hypertensive patient and didn't take his hypertensive medication for the past several months because it cannot be affordable to him.

Presently he is not complaining then also he denies of headache, chest pain, dizziness, palpitations and shortness of breath.

The main two nursing diagnosis for the present scenario is'

1. Pain (Acute headache) related to increased cerebral vascular pressure

2. Deficit knowledge related to the treatment plan and the DASH diet.

2. In the present situation, his B.P in the left is 200/110mmHg and in the right hand is 190mmHg, that means he is at a peak or high blood pressure. By taking the present prescribed medication ie, Lisinopril 40 mg and hydrochlorothiazide 12.5 mg makes a reduction of B.P to a range of 140/90 to 150/90 mm Hg.

3. We have to educate the patient regarding the after-effects of withdrawal of antihypertensive medications, that can cause rebound hypertension and hypertensive crisis. We have to tell him that he is in a stage of crisis and to make the B.P to a convenient range and to prevent further complications the doctor added two antihypertensives instead of one.

4. Lisinopril 40 mg is a medicine coming under the class of medication used to treat high blood pressure. It may be required for the case of high B.P with diabetes is present. This medicine will control or reduce the B.P

Hydrochlorothiazide 12.5mg is also a medicine used to treat high B.P. This medication also helps to excrete extra fluid in the body thus can reduce the symptoms such as shortness of breath. It may be used in association with other drugs to reduce BP. This medicine helps to potentiate the effects of other antihypertensive agents as well, by limiting fluid retention and may reduce the incidence of strokes and heart failure.

5. In the case, CW is uninsured and difficult to buy these two drugs(Lisinopril and hydrochlorothiazide) separately because he can't afford the medicine cost. Instead of these, we can prescribe a combined formulation of Lisinopril and hydrochlorothiazide. Eg: Zestoretic

6. As a nurse, we have to confirm that he will surely take the medication by asking a question: "During the next visit after taking the medication properly will you come without any sufferings related to high B.P?

7. As a nurse, we have to inform the patient regarding the effectiveness of taking the medication regularly to maintain the B.P from the highest level to an average level and as well as inform him regarding the after-effects when skipping the medication. The expected outcome is to maintain the B.P to the extent of 140/90 to 150/90 mmHg.