Case Study 1
CF is a sixty-year-old African American male who presents as a new patient for initial evaluation and follow-up. He has been diagnosed with hypertension for the last twelve years and Type 2 diabetes for the same period of time. His current blood pressure is 162/90, with a pulse of 76. His body mass index (BMI) is 32. He is currently taking Maxzide 37.5/25 mg every morning. This is the only antihypertensive medication he has taken.
For this question, focus on the treatment of hypertension. Discuss the influences of his age, gender, and ethnicity on hypertensive medications. On the basis of an analysis of those factors, provide one option for improvement of his blood pressure and provide a clear and specific justification for that choice. Be sure to include dosage and scheduling. Include highlights of patient teaching and/or recommendations for any lifestyle changes. Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication.
High blood pressure is a life-threatening condition where the blood’s long-term force on the walls of your artery is powerful enough to cause some heart disease (Go et al., 2014). It depends on the amount of the blood pumped by your heart and the resistance this blood encounters in your arteries. The narrower the arteries are, the higher the blood pressure. High blood pressure develops over the years. Fortunately, it is detectable and controllable. High blood pressure that is uncontrolled for a long time causes serious health problems such as heart attack, kidney failure, heart failure and stroke. However, hypertensive medication is influenced by the patient’s age, his or her gender, and ethnicity. Lifestyle changes boost the control and treatment of high blood pressure (Woo & Wynne, 2012).
The ideal blood pressure for people aged 60 years and above is 150/90. CF’s blood pressure is 162/90 which means it is high despite his daily intake of Maxzide 37.5/25. The ideal body mass (IBM) for an adult is between 18 and 24. CF is 32 meaning he is obese.Studies reveal that high blood pressure affects men more than women (Go et al., 2014). After the age of 55 years, women tend to suffer from blood pressure more than men.However, more male suffers from complications related to blood pressure more than females (Liao, at el., 2016). Most males with high blood pressure suffer from heart attack, heart failure, and other heart diseases if not controlled. Studies show that fewer people aged 39 years and below suffer from high blood pressure as compared to above 40. It is therefore correct to conclude that age influences the presence of high blood pressure. Several types of research have revealed that if one comes from a family history that has had blood pressure, there is a likelihood that they too are at an elevated risk of having high blood pressure at one time in their life. It is therefore evident that ethnicity has an influence in the presence or absence of blood pressure.
Most people with the diabetic condition, renal impairment, elderly or severely ill suffer from hyperkalemia, that is, high potassium in the blood. Maxzide should not be administered to patients with hyperkalemia and should discontinue immediately. There’s a likelihood that CF could be suffering from hyperkalemia following the fact that he is diabetic and elderly. That could be the reason why his blood pressure is still high despite taking the treatment. I recommend Calcium channel blockers. They are drugs that lower blood pressure by slowing calcium movement in the heart’s cells and in the walls of the blood vessels. It enables the heart to pump the blood and widen its vessels. With enlarged blood vessels, the heart needs not overwork hence the blood pressure is lowered (Liao et al., 2016). Norvasc (Amlodipine) is one of the best Calcium channel blockers used to treat high blood pressure. It is taken orally with or without food only once daily. Most people prefer taking it with water or milk. I would recommend that CF takes it with some milk of food. Dosage may be increased or decrease it depending on CF’s reaction. Calcium channel blocker is ideal for the black and elderly patients such as CF. He should avoid grape juice of fruit as it interferes with the drugs reaction on the body. I would ask CF to ensure that he eats a balanced diet and, a lot of fruits and vegetables. He should also ensure that he does lighter exercises like walking 30 minutes daily. He should also reduce his sodium intake, red meat, and cholesterol.
Go, A. S., Bauman, M. A., Coleman King, S. M., Fonarow, G. C., Lawrence, W., Williams, K. A., & Sanchez, E. (2014). An effective approach to high blood pressure control. Journal of the American College of Cardiology, 63(12), 1230-1238. doi:10.1016/j.jacc.2013.11.007
Liao, Y., Siegel, P. Z., White, S., Dulin, R., & Taylor, A. (2016). Improving actions to control high blood pressure in Hispanic communities—Racial and Ethnic Approaches to Community Health Across the US Project, 2009–2012. Preventive medicine, 83, 11-15.
Woo, T. & Wynne, A. (2012). Pharmacotherapeutics for Nurse Practitioner Prescribers. Philadelphia, PA: F.A. Davis Company