Coppin_Cardiac_Case_studies

Case Study 2 MANAGING HYPERTENSION Scenario M.P. is a lively 78-year-old African-American woman who comes to your clinic for a follow-up (F/U) visit. She was diagnosed (Dx) with hypertension (HTN) 2 months ago and ...

Case Study 2 MANAGING HYPERTENSION Scenario M.P. is a lively 78-year-old African-American woman who comes to your clinic for a follow-up (F/U) visit. She was diagnosed (Dx) with hypertension (HTN) 2 months ago and was given a prescription for hydrochlorothiazide (HCTZ) 25 mg/day but stopped taking it because “it made me dizzy and I kept getting up during the night to empty my bladder.” She comes to the clinic because her mother died of a cerebrovascular accident (CVA, stroke) at her age and she is afraid she will suffer the same fate. Vital signs (VS) during her initial visit were as follows: 160/102, 78, 16, 36.8° C. She is a lifetime nonsmoker, nondrinker. Her father died of a myocardial infarction (MI) at 67 years of age. One brother is alive but has coronary artery disease (CAD), diabetes mellitus (DM), and HTN. Her sister is alive and well (A&W) at 62 years of age. Her basic metabolic panel (BMP) and fasting lipids were within normal limits (WNL). Instructor Note: Talk to the students about timing of medications. M.P. may have taken her diuretic at bedtime (hs), thereby causing her to get up several times during the night to void. Please refer the students to JNC guidelines for the staging of HTN. These guidelines are important because they ensure the highest quality care based on state-of-the-knowledge research. National guidelines are developed by teams of well-known scientists and clinicians who specialize in the relevant clinical area. The guidelines are also supported by national professional organizations. 1. After a 10-minute waiting period, you take M.P.’s blood pressure (BP) and get 156/96 mm Hg. According to the most recent Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) Risk Stratification and Treatment Recommendations, what risk group is she in, and what stage of HTN does her BP represent? • M.P. risk group is major because of hypertension, age (>55 men, >65 women), gender (men and postmenopausal women), family history of cardiovascular disease (<65 women, <55 men). She is in stage 2 hypertension (SBP>/= 160, DBP >? = 100 mmhg). • She is at risk for coronary, cerebral, renal, and peripheral vascular disease • She goes on to ask whether there is anything else she should do to help with her HTN. Remember, she is 54≤ and weighs 110 pounds. She has never smoked. Her glucose and lipid levels are within normal range. 2. Look up M.P.’s height and weight for her age on a body mass index (BMI) chart. Is she considered overweight? Why or why not? Explain which method you used to determine your answer and where you got your information: - • M.P. is not considered overweight because her BMI is 19, which is desirable weight range. According to Black and Hawks Medical Surgical Book, I used the formula ( divide weight in pounds by height in inches, then divide height in inches again, and multiply by 703. Example: (110 lbs/ 64 inches (5x12=60+4) / 64 x 703)= 18.879 3. What nonpharmacologic lifestyle alteration measures might help someone like M.P. controls her BP? List one and explain:- • Sodium Restriction because most people with high blood pressure are sensitive to sodium and blood pressure may rise after sodium intake. To reduce complications of sodium intake of 2-3 g can be used to lower blood pressure. Also, medication may be reduced if sodium levels are controlled and prevent potassium depletion associated with diuretic therapy. ✽Note: Not everyone responds the same way to lifestyle modifications or medications. There is ............................................Continued...............................