A 61-year-old Black male with a history of hypertension presents to your clinic for complaints of headaches and blurred vision x 4 days. He denies any weakness, numbness, chest pain, shortness of breath, palpitations, or recent, illicit drug use. He states he has been compliant with his medications (hydrochlorothiazide and metoprolol), and he took his meds this morning.
His V/S include: B/P 190/100, P- 90, T- 98.9, R- 22. Recent labs show that TC- 260, LDL-190, HDL- 35, Trig- 320. He did not return for these results and did not start any new meds.
What are your diagnoses and plan of care for this patient? Remember to include your rationales.
Prior to the visit, the patient was diagnosed with hypertension and is now receiving medication. A high blood pressure reading of 190/100 indicates that the patient is currently suffering from hypertension, which can cause headaches and blurred vision (Kobeissi et al., 2019). The patient has hypertriglyceridemia and hypercholesterolemia, as indicated by the test findings. Despite being prescribed metoprolol and hydrochlorothiazide, patients might develop hypertension if the underlying cause is not addressed while on these medications.
Plan for Care
The care plan for the patient will involve both pharmacological and non-pharmacological interventions. Pharmacological interventions will include the continued use of hydrochlorothiazide and metoprolol to treat hypertension (Zhou et al., 2021). In order to decrease cholesterol, the patient will be prescribed any statins. In addition to statins, fibrates will also be recommended to reduce triglyceride levels. Pharmacological medications are given in order to treat the patient underlying medical condition. They help to control hypertension.
Non- pharmacological interventions will include lifestyle modification. This will involve taking food with low cholesterol, sodium, and sugar. Also, physical exercise will be recommended, for instance, walking. Other lifestyles modifications involve avoiding alcohol and smoking (Ritchey et al., 20218). In order to ensure that the care plan is working, the patient will be required to repeat lab testing every month for three months. The primary test will be lipid profiling.
One of the most remarkable ways to avoid high blood pressure is to make lifestyle changes. It also aids in lowering the patient’s cholesterol (Ritchey et al., 20218). To find out if your cholesterol levels have dropped, the patient needs to repeat the tests in the lab. If the attending physician decides to visit the patient again, it will be as soon as one month or as long as three months (Hamlin, 2019). Because the drug may be stopped if cholesterol levels are normal, the doctor can stop all except the hypertension medication.
Hamlin, R. (2019). Nursing Care Plan for Hypertension. https://digitalcommons.psjhealth.org/cgi/viewcontent.cgi?article=3504&context=publications
Kobeissi, E., Hibino, M., Pan, H., & Aune, D. (2019). Blood pressure, hypertension and the risk of abdominal aortic aneurysms: a systematic review and meta-analysis of cohort studies. European journal of epidemiology, 34(6), 547-555. https://link.springer.com/article/10.1007/s10654-019-00510-9
Ritchey, M. D., Gillespie, C., Wozniak, G., Shay, C. M., Thompson‐Paul, A. M., Loustalot, F., & Hong, Y. (2018). Potential need for expanded pharmacologic treatment and lifestyle modification services under the 2017 ACC/AHA Hypertension Guideline. The Journal of Clinical Hypertension, 20(10), 1377-1391. https://onlinelibrary.wiley.com/doi/full/10.1111/jch.13364
Zhou, B., Carrillo-Larco, R. M., Danaei, G., Riley, L. M., Paciorek, C. J., Stevens, G. A., … & Breckenkamp, J. (2021). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet, 398(10304), 957-980. https://www.sciencedirect.com/science/article/pii/S0140673621013301