Case Study 2
1. M.P.’s blood pressure is falling under stage 1 classification (140-159/90-99)
2. M.P. could be taking her medication too late in the day (HCTZ) as opposed to the morning, which is causing her to have nocturia.
3. The risk factors that M.P. has that increase her risk for cardiovascular disease include:
- Family history – brother has CAD, father died from MI, mother died of CVA.
- Hysterectomy – postmenopausal
- Age – patient is 65
- Patient has sedentary lifestyle
- Current HTN
4. The drug categories that are recommended for M.P. current are:
Calcium channel blockers and thiazide-type diuretic. When initiating therapy, patients of African descent without CKD should use CCBs and thiazides instead of ACE inhibitors.
5. M.P.’s BMI is 18.9 and within normal weight range.
6. Nonpharmacological alteration measure that might help M.P. control her blood pressure include:
- More active lifestyle – aim for 30mins/day at least 5 times per week
- Dietary changes – sodium restriction, following DASH diet: less red meat, salt, sugar, added sugars and sugar-containing beverages. Emphasis on fruits, vegetables, fat-free or low-fat milk products, whole grains, fish, poultry, seeds, and nuts.
7. The internist decrease the patient’s dose of HCTZ because her latest blood pressure recording was 140/90, so it has decreased. Also, patient is complaining of nocturia, and a decrease in the prescription could help with this while still providing similar results. The internist also started M.P. on benazepril (Lotensin) which is an ace inhibitor. Lowering the dose of HCTZ can help prevent electrolyte imbalances (specifically potassium) which is a side effect of benazepril.
8. Common side effects of benazepril include:
9. H/A, b. Cough, c. SOB, d. Constipation, and e. Dizziness.
10.Techniques to help M.P remember to take her medications include:
- Pill box – this includes each day’s pills and she would have to sort them at the beginning of the week and then would know whether she has taken her medications for the day by whether the day’s box was empty or not.
- Medication app reminders, taking it at the same time of the day or setting reminders on her phone. There are many medication reminder apps available.
11. The statement that indicates a need for further instructions is:
C – It’s okay to skip a few doses if I am feeling bad as long as it’s just a few days. Patient should not skip any doses.
12. The laboratory tests that should be monitored when taking HCTZ and an ACE inhibitor include: BUN, creatinine, blood glucose levels and serum electrolytes, specifically sodium and potassium.
13. The laboratory results that are of concern right now are M.P.’s potassium levels. It is currently 3.6 mEq/L, which is still within normal limits but towards the lower end. With her taking a diuretic that is not potassium sparing, she could only lose more potassium. Her glucose is slightly elevated; however, all other labs are within normal ranges.
14. You base your response on her previous readings, current medication regime and plan, and her target goal blood pressure. Her blood pressure seems to be decreasing indicating she is prescribing to her treatment plan and it is working as expected.
15. I can help M.P. main her success through:
- Medication adherence
- Increasing her physical activity
- Diet – decreasing sodium intake, following DASH diet.
16. Different patients are prescribed different medications depending on their medical history, family health history, history of blood pressure results, other co-morbidities, etc. There are many different factors that determine what medication is best to prescribe each patient.
17. Hypertension can cause damage to the small blood vessels in the eye. By having regular eye examinations, the doctor can determine if the hypertension has caused any damage, specifically retinopathy.
This problem has been solved.
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