How can you explain the difference to M.P.?
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 stroke (cerebrovascular accident [CVA]) 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?
2. What could M.P. be doing that is causing her nocturia?
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?
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.
5. M.P. goes on to ask whether there is anything else she should do to help with her HTN. She asks, “Do I need to lose weight?” Look up her height and weight for her age on a body mass index (BMI) chart. Is she considered overweight?
6. What nonpharmacologic lifestyle alteration measures might help M.P. control her BP? List 2 examples and explain.
Case Study Progress The provider decreases M.P.’s HCTZ dose to 12.5 mg PO daily and adds a prescription for benazepril (Lotensin) 5 mg daily. M.P. is instructed to return to the clinic in 1 week to have her blood work checked. She is instructed to monitor her BP at least twice a week and return for a medication management appointment in 1 month with her list of BP readings.
7. Why did the provider decrease the dose of the HCTZ? 8. You provide M.P. with education about the common side
effects of benazepril, which can include which of these? Select all that apply.
a. Cough b. Dizziness c. Headache d. Constipation e. Shortness of breath
9. It is sometimes difficult to remember whether one has
taken one’s medication. What techniques might you teach M.P. to help her remember to take her medicines each day? Name at least 2.
10. After the teaching session about her medicines, which statement by M.P. indicates a need for further instructions?
a. “I need to rise up slowly when I get out of bed or out of a chair.”
b. “I will leave the salt shaker off the table and not salt my food when I cook.”
c. “I will call if I feel very dizzy, weak, or short of breath while on this medicine.”
d. “It’s okay to skip a few doses if I am feeling bad as long as it’s just for a few days.”
11. Describe 3 priority problems that will guide M.P.’s nursing care.
Case Study Progress M.P. returns in 1 month for her medication management appointment. She tells you she is feeling fine and does not have any side effects from her new medication. Her BP, checked twice a week at the senior center, ranges from 132 to 136 systolic, and 78 to 82 diastolic.
12. When someone is taking HCTZ and an angiotensin-converting enzyme (ACE) inhibitor, such as benazepril, what lab test results would you expect to be monitored?
Chart View
Laboratory Test Results (Fasting)
Potassium 3.6 mEq/L (3.6 mmol/L)
Sodium 138 mEq/L (138 mmol/L)
Chloride 100 mEq/L (100 mmol/L)
CO2 28 mEq/L (28 mmol/L)
Glucose 112 mEq/L (6.2 mmol/L)
Creatinine 0.7 mg/dL (61.9 mcmol/L)
Blood urea nitrogen (BUN) 18 mg/dL (6.4 mmol/L)
Magnesium 1.9 mEq/L (0.95 mmol/L)
13. What lab test results, if any, are of concern at this time? 14. You take M.P.’s BP and get 138/88. She asks whether these BP
readings are okay. On what do you base your response? 15. List at least 3 important ways you might help M.P. maintain
her success.
Case Study Progress M.P. tells you she was recently at a luncheon with her garden club and that most of those women take BP pills different from the ones she does. She asks why their pills are different shapes and colors.
16. How can you explain the difference to M.P.? 17. During the visit, you ask M.P., “When was your last eye
examination?” She answers, “I’m not sure, probably about 2 years ago. What does that have to do with my blood pressure?” What is your response?
Case Study Outcome M.P. comes in for a routine follow-up visit 3 months later. She continues to do well on her daily BP drug regimen, with average BP readings of 130/78. She participates in group walking program for senior citizens at the local mall. She admits she has not done as well with decreasing her salt intake but says she is trying. She visited an ophthalmologist last week and had no problems except for a slight cataract in one eye.