NR 508 HYPERTENSION CASE STUDY GUIDE: NR 508 Chamberlain College of Nursing

HYPERTENSION Chamberlain College of Nursing NR 508 Rachel Avisrur June 10th 2018Case Study • David a 54 yo Caucasian male went to his primary care providers office for his yearly physical. The nurse came in and took Davids vitals. His blood pressure was 150/92, HR 75, RR 16, 98 kg. His blood pressure was repeated 2 times five minutes apart and the systolic pressure remained 150 and diastolic 90. While discussing the elevated blood pressure, David mentioned to the practitioner that he has been having dizzy spells and headaches off and on for the past 5 months. David works three jobs to support his family. He is a non smoker but admits to having other bad habits like eating fast food on a daily basis and avoiding the gym. Upon assessment the provider notices bilateral lower extremity +1 pitting edema. Davids routine lab work (CBC, CMP, urinalysis) shows all values are within normal limits. There is no past medical history and Davids surgical history includes a tonsillectomy at the age of 4.Hypertension JNC 8 Clinical Guidelines • In the general population 60 years, initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg and treat to a goal SBP 140 mm Hg. (James et al., 2014) James PA, Oparil S, Carter BL, et al. (2014) Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–520. doi:10.1001/jama.2013.Hypertension Most commonly prescribed drugs •Thiazides Inhibit reabsorption of Na and Cl ions in distal convoluted tubules in the kidneys •ACE Inhibitors Inhibits the conversion of angiotensin I to angiotensin II •ARBS Prevents angiotensin II from binding to angiotensin II receptors •Beta Blockers Inhibits epinephrine and norepinephrine from binding too beta-adrenoceptors •Calcium Channel Blockers Inhibit Ca+ entry into excitable cells