|
Case Study 1
CF
is a sixty-year-old African American male who presents as a new patient
for initial evaluation and follow-up. He has been diagnosed with
hypertension for the last twelve years and Type 2 diabetes for the same
period of time. His current blood pressure is 162/90, with a pulse of
76. His body mass index (BMI) is 32. He is currently taking Maxzide
37.5/25 mg every morning. This is the only antihypertensive medication
he has taken.
For
this question, focus on the treatment of hypertension. Discuss the
influences of his age, gender, and ethnicity on hypertensive
medications. On the basis of an analysis of those factors, provide one
option for improvement of his blood pressure and provide a clear and
specific justification for that choice. Be sure to include dosage and
scheduling. Include highlights of patient teaching and/or
recommendations for any lifestyle changes. Support your decisions with
at least one reference to a published clinical guideline and one
peer-reviewed publication.
ANSWER
High
blood pressure is a life-threatening condition where the blood’s
long-term force on the walls of your artery is powerful enough to cause
some heart disease (Go et al., 2014). It depends on the amount of the
blood pumped by your heart and the resistance this blood encounters in
your arteries. The narrower the arteries are, the higher the blood
pressure. High blood pressure develops over the years. Fortunately, it
is detectable and controllable. High blood pressure that is uncontrolled
for a long time causes serious health problems such as heart attack,
kidney failure, heart failure and stroke. However, hypertensive
medication is influenced by the patient’s age, his or her gender, and
ethnicity. Lifestyle changes boost the control and treatment of high
blood pressure (Woo & Wynne, 2012).
The
ideal blood pressure for people aged 60 years and above is 150/90. CF’s
blood pressure is 162/90 which means it is high despite his daily
intake of Maxzide 37.5/25. The ideal body mass (IBM) for an adult is
between 18 and 24. CF is 32 meaning he is obese.Studies reveal that high
blood pressure affects men more than women (Go et al., 2014). After the
age of 55 years, women tend to suffer from blood pressure more than
men.However, more male suffers from complications related to blood
pressure more than females (Liao, at el., 2016). Most males with high
blood pressure suffer from heart attack, heart failure, and other heart
diseases if not controlled. Studies show that fewer people aged 39 years
and below suffer from high blood pressure as compared to above 40. It
is therefore correct to conclude that age influences the presence of
high blood pressure. Several types of research have revealed that if one
comes from a family history that has had blood pressure, there is a
likelihood that they too are at an elevated risk of having high blood
pressure at one time in their life. It is therefore evident that
ethnicity has an influence in the presence or absence of blood pressure.
Most
people with the diabetic condition, renal impairment, elderly or
severely ill suffer from hyperkalemia, that is, high potassium in the
blood. Maxzide should not be administered to patients with hyperkalemia
and should discontinue immediately. There’s a likelihood that CF could
be suffering from hyperkalemia following the fact that he is diabetic
and elderly. That could be the reason why his blood pressure is still
high despite taking the treatment. I recommend Calcium channel blockers.
They are drugs that lower blood pressure by slowing calcium movement in
the heart’s cells and in the walls of the blood vessels. It enables the
heart to pump the blood and widen its vessels. With enlarged blood
vessels, the heart needs not overwork hence the blood pressure is
lowered (Liao et al., 2016). Norvasc (Amlodipine) is one of the best
Calcium channel blockers used to treat high blood pressure. It is taken
orally with or without food only once daily. Most people prefer taking
it with water or milk. I would recommend that CF takes it with some milk
of food. Dosage may be increased or decrease it depending on CF’s
reaction. Calcium channel blocker is ideal for the black and elderly
patients such as CF. He should avoid grape juice of fruit as it
interferes with the drugs reaction on the body. I would ask CF to ensure
that he eats a balanced diet and, a lot of fruits and vegetables. He
should also ensure that he does lighter exercises like walking 30
minutes daily. He should also reduce his sodium intake, red meat, and
cholesterol.
References
Go,
A. S., Bauman, M. A., Coleman King, S. M., Fonarow, G. C., Lawrence,
W., Williams, K. A., & Sanchez, E. (2014). An effective approach to
high blood pressure control. Journal of the American College of Cardiology, 63(12), 1230-1238. doi:10.1016/j.jacc.2013.11.007
Liao,
Y., Siegel, P. Z., White, S., Dulin, R., & Taylor, A. (2016).
Improving actions to control high blood pressure in Hispanic
communities—Racial and Ethnic Approaches to Community Health Across the
US Project, 2009–2012. Preventive medicine, 83, 11-15.
Woo, T. & Wynne, A. (2012). Pharmacotherapeutics for Nurse Practitioner Prescribers. Philadelphia, PA: F.A. Davis Company
|
