Question

PN 105 Fundamentals of Nursing I Case Study-Hypertension/Heart Failure g George, a 72-year-old African-American patient, has heart failure and diabetes. His vital signs are blood pressure 176/94, pulse 92, and respirations 30. His medications include hydrochlorothiazide 50mg/day, atenolol S0mg/day and digoxin 0,25mg/day. Why was the hydrochlorothiazide prescribed for Mr. George? Explain the effects of hydrochlorothiazide on the blood pressure. Gre 1. 2. Abnormal electrolytes and other laboratory test results may occur when hydrochlorothiazide. Would the following serum electrolytes and laboratory values be expected to increase or decrease? Explain your answer. a. Sodium b. Potassium c. Calcium d. Magnesium e. Glucose f. Uric Acid Why should Mr. George's blood glucose be monitored while taking hydrochlorothiazide? 3. What effect may result when Mr. George takes digoxin and hydrochlorothiazide together? Explain your answer. 4. 5. Atenolol is what type of an antihypertensive? Would atenolol by effective in lowering Mr. George's blood pressure if given as the only antihypertensive drug? Explain your answer. How effective is the combination of hydrochlorothiazide and atenolol for controlling Mr George's blood pressure? Explain your answer. 6.

Answer 1

For Mr Greg George,

1. Mr George was prescribed with the medication hydrochlorothiazide because the action of this drug is diuretics which are one of the class of medications prescribed for the patients with hypertension.

The effect of hydrochlorothiazide on the blood pressure is it lowers down the high blood pressure and also helps in other conditions such as stroke, heart attack and kidney problems. The medication causes the patient to make more urine which will help the body to get rid of extra salt and water, it reduces the sodium reabsorption which occurs in the distal convoluted tubule in the nephron.

2. A. Sodium: the sodium level will be decreased in the blood especially in the elderly people because their kidney will not be able to filter all the free waters which they consume causing the sodium in the urine to exceed the sodium level in the blood hence causes the lowering of the blood sodium level.

B. Potassium: the potassium will be lost by the increase use of hydrochlorothiazide because there will be increase in the sodium delivery to the distal segment because of which there will be stimulation of aldosterone sensitive sodium pump in order to increase the sodium reabsorption.

C. Calcium: hydrochlorothiazide causes the hypercalcaemia because of its calcium retaining effect which will not allow the calcium to be released in the urine.

D. Magnesium: there will be depletion of magnesium in the patient who takes hydrochlorothiazide medication because of the increase in the release of magnesium through urine.

E. Glucose: it causes hyperglycaemia in the patient because of the decrease in the insulin release.

F. Uric acid: it causes increase in the uric acid crystals formed on the joints because of increase in the urine and decrease in the amount of fluid present in the body.

3. Mr George's blood glucose should be monitored while administering the hydrochlorothiazide medication because this medication causes hyperglycaemia in the patient releasing large amount of glucose in the blood. The actual mechanism of action is idiopathic, however the other supporting factors may include: aggravation of the insulin resistance, reserve of glucose uptake and decrease in the release of insulin. Hence, all these aspects causes in the increase in the glucose level which makes it mandatory to check the glucose level of the patient during the treatment with this medication

4. When the mediations like digoxin and hydrochlorothiazide are given together there may be some severe effect in the patient such as digoxin tpxicity. The hydrochlorothiazide causes the loss of calcium in the patient because of the increase in the urine output. The effect of the digoxin starts with the binding of the drug molecules with potassium ions. Hence if the two drugs are given together the loss of potassium ion in the body will cause the decrease in the binding of the digoxin molecules causing the toxicity in the patient.

5. Atenolol is a type of hypertensive drug which falls under the category of beta blockers. It functions by blocking the action of certain chemicals which are present in our body such as: epinephrine.

Atenolol can be given with the other drugs or without the other drugs in order to treat the high blood pressure in the patients

6. It is more effective to use the combination of drugs of hydrochlorothiazide and atenolol to treat the hypertension in Mr George as the effect of atenolol or hydrochlorothiazide when used single is less comparatively. Also as Mr George has several other conditions like heart failure accompanying the high blood pressure effect of two drugs together is more recommendable.

7.