Question

The husband of an elderly woman, who had become incoherent over the past day, called emergency medical services (EMS). When they arrived at the house and asked the woman’s husband for her history, he told them his wife had diabetes and hypertension for many years. Before calling EMS, he had checked her medicines and, based on the number of pills still left in the bottle, he estimated she had not been taking her antihypertensive medication for about 2 weeks. On examination, the EMS team found that she was afebrile, her pulse rate was 112 beats/min, her respirations were 24 breaths/min, and her blood pressure was 230/160 mm Hg. Primary care was started.

Critical thinking Questions

1. What might be the results of this patient stopping her antihypertensive medications so abruptly?

2. What consequences could a long-term blood pressure of 230/160 mm Hg have for this patient?

3. What questions would you ask the patient and her family to help guide ongoing treatment and adherence to the medication regimen?

4. What is available to help people take their medication as prescribed? Think of the elderly or people that have short-term memory problems.

Answer 1

1.Stoping antihypertensive medication abruptly can increase or lead to withdrawal symptoms causing high elevations of blood pressure . This range can lead to stroke,heart attack and death.

2A systolic pressure of 230mmHg and Diastolic pressure of 160mmHg is a hypertensive emergency which cam to consequences of

• CNS:fatigue,loss of consciousness, blackout,severe mental impairment, seizure,stroke
• CVS:increased blood pressure, bleeding,heart attack
• Lungs:pulmonary edema,epistasis
• Renal system:decreased elimination or complete cessation of the kidney ,finally leading to anasarca
• Irreversible organ damage causing organ failure followed by death

3.Some of the question which can be asked for better treatment are

• Medical history
• Lifestyle (smoking,alcohol, poor diet habits ,etc)
• Allergic history (drug and food)
• Mental health status assessing for the reason for stoping the medication
• Socioeconomic and financial status to assess for the availability and usage

4.Some of the technique which are available to take medication as prescribed are as following

• Visit by a home health care nurse periodically on weekly basis
• A care taker can help in administration of medication daily if patient has memory loss
• Health educating the family members usually the spouse
• Alarm system can be used as a reminder
• Use of electronic devices like smart devices which can be linked to a healthcare professionals and get alert for variation and abnormal values and support the patient and prevent from complications.