Case Study Hypertension Patho

Case Study: Hypertension Difficulty: Beginning Setting: Outpatient clinic Index Words: hypertension (HTN), patient education, lifestyle modification HESI Concepts: Adherence Behaviors, Perfusion, Patient Education Scenario M.P. is a 65-year-old African American woman who comes to the clinic for a follow-up visit. She was diagnosed with hypertension (HTN) 2 months ago and was given a prescription for a thiazide diuretic but stopped taking it 2 weeks ago because “it made me dizzy and I kept getting up during the night to empty my bladder.” During today’s clinic visit, she expresses fear because her mother died of a cerebrovascular accident (CVA, stroke) at M.P.’s age, and M.P. is afraid she will suffer the same fate. She states, “I’ve never smoked, and I don’t drink, but I am so afraid of this high blood pressure.” You review the data from her past clinic visits. Chart View Family History Mother, died at age 65 years of CVA Father, died at age 67 years of myocardial infarction (MI) Sister, alive and well, age 62 years Brother, alive, age 70 years, has coronary artery disease (CAD), HTN, type 2 diabetes mellitus (DM) Patient Past History Married for 45 years, 2 children, alive and well, 6 grandchildren Cholecystectomy, age 42 years Hysterectomy, age 48 years Blood Pressure Assessments January 2: 150/92 January 31: 156/94 (given prescription for hydrochlorothiazide [HCTZ] 25 mg PO every morning) February 28: 140/90 1. According to the most recent guidelines from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, M.P.’s blood pressure (BP) falls under which classification? 140/90 falls under the classification of Stage I Hypertension. 2. What could M.P. be doing that is causing her nocturia? Diuretics could be a factor in causing nocturne because they cause a loss of fluids in the body which leads to the person feeling thirsty frequently. The person then drinks a lot more liquids to the quench the thirst and increases the urine output. CASE STUDY PROGRESS During today’s visit, M.P.’s vital signs are as follows: BP: 162/102; P: 78; R: 16; T: 98.2°F (36.8 ° C). Her most recent basic metabolic panel (BMP) and fasting lipids are within normal limits. Her height is 5 ft, 4 in (163 cm), and she weighs 110 lb (50 kg). She tells you that she tries to go on walks but does not like to walk alone and so has done so only occasionally. 3. What risk factors does M.P. have that increase her risk for cardiovascular disease? Her age and race are both risk factors as she is 65 and African American. She also has a family history of CVD which is another risk factor. Another risk factor is her high blood pressure. CASE STUDY PROGRESS Because M.P.’s BP continues to be high, the provider decides to start another antihypertensive drug and recommends that she try again with the HCTZ, taken in the mornings. 4. According to the JNC 8 national guidelines, describe the drug therapy recommended for M.P. at this time. MP’s blood pressure is in Grade A which has a recommendation of pharmacological interventions to help treat it. Grade B suggests for black patients that they have initial drug therapy with a calcium channel blocker or thiazide diuretic.