NR 501 Hypertension Summary/ Chamberlain College of Nursing

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Hypertension “I’m here to see my new doctor for a checkup. I’m just getting over a cold. Overall, I’m feeling fine, except for occasional headaches and some dizziness in the morning. My othe... r doctor prescribed a low-salt diet for me, but I don’t like it!” James Frank is a 64 year old African-American man who presents to his new family medicine physician for evaluation and follow-up of his medical problems. He generally has no complaints, except for occasional mild headaches and some dizziness after his morning medications. He states that he is dissatisfied with being placed on a low-sodium diet by his former primary care physician. 1a. Create a list of this patient’s drug-related problems, including any medications that may be contributing to his uncontrolled HTN.  F.’s main problem is his uncontrolled hypertension. One of his big issues is that he is noncompliant with trying to adhere to a low-sodium diet. More education on the importance of this is required. He also has AV nicking noted upon examination. AV nicking is a “a vascular abnormality in the retina of the eye, visible on ophthalmological examination, in which a vein is compressed by an arteriovenous crossing” and is a sign of “hypertension, arteriosclerosis, or other vascular conditions” (The Free Dictionary, n.d., para. 1). The following describe his prescribed medications for his high blood pressure. o First is triamterene/hydrochlorothiazide. Triamterene is a potassium-sparing diuretic and hydrochlorothiazide is a thiazide diuretic (Drugs.com, 2012). His dosage of 1 tablet of 37.5mg/25mg PO Q am appears appropriate. com (2012) states that certain chronic conditions might be unsafe in combination with this medication. Those that apply to J.F. include diabetes, gout, COPD, and an allergy to penicillin (Drugs.com, 2012). This use of this drug should be reevaluated to make sure it is safe for J.F., especially with his allergy to penicillin. Also the use of salt is discouraged in patients who use this medication due to it causing the body to retain more water which increases blood pressure and reduces the effectiveness of the drug (Drugs.com, 2012). o F. is on doxazosin which works to help both his hypertension and benign prostatic hyperplasia (BPH). His dosage appears on the lower end of the spectrum for both hypertension and BPH. It has been found that Doxazosin causes dizziness in approximately 3-14% of patients, so is best to take at bedtime (Drugs.com, n.d.). Also, according to data from ALLHAT “indicated that users of doxazosin had 25% more cardiovascular events and were twice as likely to be hospitalized for congestive heart failure compared to users of chlorthalidone” (Drugs.com, n.d., para. 5). This might be correlated, along with the patient’s history of HTN for the past 14 years, to the mild left ventricular hypertrophy found on his ECHO 6 months ago and a lower than normal EF of 45%. o Carvedilol is a beta blocker that also treats for hypertension. F. is on the maximum dosage for patient with left ventricular dysfunction which is 12.5mg po BID (Drugs.com, 2014).  His diabetes appears to be well controlled with his insulin glargine and insulin lispro. His blood sugar was 110 which is slightly elevated but not to where any adjustments would need to be made. Also, his A1C is 6.1%- just slightly elevated (norm= 4-6%). This should be continued to monitor as well.  F.’s COPD appears to be stable. He states his shortness of breath is “usual” for him and that his breathing treatments help. However, he has had 2 COPD exacerbations in the past 12 months. Upon auscultation, a few basilar crackles and mild expiratory wheezing is heard. Also, he states he is unable to exercise regularly due to his COPD. o F. is on albuterol, tiotropium, and fluticasone/salmeterol to help with his breathing. His dosages appear to be appropriate for an individual with COPD. J.F. should be asked how often he is using his inhalers to see if a treatment is needed for the mild expiratory wheezing heard in the office. The crackles may be a sign of congestive heart failure along other causative factors such as his mild LVH, EF 45%, and HTN. A BNP should be obtained to assess this possibility.  His BPH appears to be controlled with doxazosin. F. stated that he used to have trouble urinating until being prescribed this medication. (Possible complications from this medication are listed above)  F. states he is taking naproxen for PRN pain from gout and headaches. However, Naproxen can cause increased kidney disease and elevate blood pressure (Drugs.com, 2015). The use of this medication should be discussed and discontinued due to these reasons. A different medication should be recommended for treatment of headaches and gout flare-up pain.  F.’s gout is being treated with allopurinol with the correct dosage of 200mg po daily. He should be watched carefully on this medication due to side effects being more severe and common in patients with poor renal function (Drugs.com, 2010). J.F. has chronic kidney disease. His BUN is normal but is SCr is slightly elevated (2.2mg/dL; norm 0.7-13mg/dL). However, no intervention is needed at this time. 1b. How would you classify this patient’s HTN, according to current HTN guidelines? According to Weber et al. (2014), hypertension classifications are as follows:  Prehypertension o Systolic BP between 120-139 o Diastolic BP between 80-89  Stage 1 hypertension o Systolic BP between 140-159 o Diastolic BP between 90-99 [Show More]

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