Discussion Post 2
R. S., a 65-year-old African-American man, was referred to the APRN-NP in the hypertension clinic for evaluation of high BP noted on an initial screening. He reports having headaches and nocturia. He states that he has gained 8 pounds over the last year. Past medical history: Appendectomy 30 years ago, Peptic ulcer disease 10 years ago, Type 2 diabetes mellitus for 10 years; Family history: Father had hypertension; died of myocardial infarction at age 55, Mother had diabetes mellitus and hypertension; died of cerebrovascular accident at age 60; Physical examination: Height 69 in, weight 108 kg; BP: 140/89 mm Hg (left arm), 138/82 mm Hg (right arm); Pulse: 84 beats/min, regular; Funduscopic examination: mild arterial narrowing, sharp discs, no exudates or hemorrhages; Laboratory findings: Blood urea nitrogen: 24 mg/dL, Serum creatinine: 1.5 mg/dL, Glucose: 95 mg/dL, Potassium: 4.0 mEq/L, Total cholesterol: 201 mg/dL, High-density lipoprotein cholesterol: 30 mg/dL, Triglycerides: 167 mg/dL, Urinalysis: 1+ proteinuria; Electrocardiogram and chest radiograph: mild left ventricular hypertrophy; Social history: Tobacco: 35 pack years, Alcohol: pint of vodka/week, Coffee: 2 cups/day.
In this discussion forum:
1. Discuss the patient’s diagnosis of hypertension, including the stage, comorbidities, and family history.
2. Discuss specific goals for pharmacotherapy for treating R. S.’s hypertension and cholesterol
3. Discuss what you would consider to be first-line pharmacotherapy for R. S., and why.
4. Discuss the parameters for monitoring the success of the therapy.
5. Discuss health promotion recommendations you would consider for R. S.
6. Does the presence of Diabetes Mellitus impact your treatment selection?
Provide two very full paragraphs supported with evidence from the literature. Use journal articles as key sources of citation only. Avoid use of direct quotes. Paraphrase and provide end of text line citation. This patient has HTN so look at national clinical guidelines such as JNC. Integrate those guidelines in your management plan. 75% of your posts must be original work. Synthesizing the literature and paraphrasing is acceptable, but more than 25% use of quotes is unacceptable. Plagiarism is not acceptable. Use original work only. APA 6th edition only. Answer each question thoroughly. Do not use any references older than 10 years. (U.S) English only.
Discussion Post 2
The elderly patient presented in the case referred to the hypertension clinic complains of headaches and nocturia, which in a way indicates hypertension. Research has shown that blood vessels certainly ‘harden’ with age, losing their resistance. This can be a good explanation for why older individuals are more in danger of developing high blood pressure (Writes 2017). The patient also stated that gaining 8 pounds of weight is associated with hypertension. As the bodyweight rises, an individual’s blood pressure may rise. Being overweight may make one more likely to develop high blood pressure than with an average weight. Other patients’ information attained, such as past medical and family history and physical assessments completed, can very well help set the patient’s treatment plan for excellent outcomes.
The headaches may indicate that the patient is in a severe hypertensive crisis where the blood pressure as his BP ranges at 140/89 mm Hg and 138/82 mm Hg in the left and right hand, respectively. Therefore, his diagnosis may include ambulatory monitoring, a 24-hour blood pressure test used to approve high blood pressure. Lab tests can also be completed by recommending urine tests and blood tests, counting cholesterol tests. This can be an ideal test to define his condition in in-depth analysis and supported by his family history data revealing that his parents had hypertension. An electrocardiogram can be recommended as well to measure his heart’s electrical activity. Besides, the glycated hemoglobin (A1C) test can be ideal for this patient in relation to define existence of his 10years Type 2 DM. This is because having type 2 diabetes raises hypertension risk (Mortada 2017).
Specific pharmacotherapy goals for managing the patient’s hypertension and cholesterol may be maintaining his blood pressure less than 130/80 mmHg, cholesterol level lesser to 200 mg/dl, and the level of triglycerides below 150mg/dl. Also, another goal can be preventing cardiovascular complications and improving the HDL levels.
The first treatment line I would consider for the patient in relation to his hypertension may include ACE inhibitors like lisinopril and the calcium channel blockers such as Amlodipine (Lin et al., 2017). This is because these medications are very effective antihypertensive agents and are used as the first treatment line to help in reducing high cholesterol levels.
The parameters for monitoring the success of therapy for the patient can involve monitoring blood pressure regularly to have a clearer picture of other risks such as stroke, lab test to evaluate cholesterol, triglycerides, and HDL via lipid profile, and besides periodic electrocardiography to measure heart electrical activity and any other changes in the functioning of the heart.
The health promotion behaviors may help sustain BP and cholesterol in the physiological range. They similarly help reduce the risk factors for diabetes and cardiovascular illnesses development. Such health promotion recommendations I would consider for the patient may include regular exercises like aerobic exercises (walking and jogging), consuming a well-balanced diet, avoiding fatty, oily, and junk foods, and avoiding packed food and those that encompass artificial sugars. I would also consider him limiting sodium intake in his diet, avoiding smoking and alcohol have sufficient sleep of about 7-8 hours at night, and an hour nap at daytime (Dong 2018). Besides, it would be good for this patient to avoid very tireless physical activities.
Diabetes mellitus is characterized by high levels of blood glucose following insulin resistance or else minimized increased production. Thus, DM presence may impact the treatment selection since antihypertensive medications like metoprolol may increase the glucose levels, which must be avoided. Thiazide diuretics similarly may raise the levels of blood glucose, and ACE inhibitors must rather be used.