I’m working on a nursing case study and need support to help me understand better.
High blood pressure, or hypertension, is a dangerous condition that affects approximately 30 percent of Americans, causing or contributing to a near 360,000 deaths per year in the United Staes alone. High blood pressure typically has no symptoms, but it causes progressive harm to the cardiovascular system. When blood pushes with too much force through the cardiovascular system, it can damage the walls of the arteries as well as the heart muscle. Damage to the arteries that supply the heart muscle with blood can eventually contribute to a heart attack. Similarly, damage to the arteries that supply the brain with blood can contribute to a stroke, and damage to the arteries that provide the kidneys with blood can lead to kidney disease. For this reason high blood pressure is often termed “the silent killer,” (FDA 2021).
My usual days at clinical almost include 3 or even more patients coming in to the practice with issues of uncontrolled high blood pressure. To date all of theses patients had already had the diagnosis of hypertension at some point in time, whether they chose to acknowledge it and follow the treatment plan, or not. This week however a 55 year old Caucasian female came into the office complaining of undiagnosed high blood pressure for the past week. Patient denied symptoms but stated her husband had gotten a blood pressure monitor throw his insurance company and she was just “playing around with it for jokes and giggles.” Upon using the machine she stated blood pressure levels were 180/116, and continued to show similar numbers for a week. Even with that the patient still made no effort to seek care. Her last blood pressure reading before she decided to make an appointment was 203/121. Upon arrival to the office patient’s blood pressure was 220/145, which according to the medical assistant was the best reading he was able to get after multiple attempts. Patient denied symptoms at first, stating she has been “healthy” and has not had any problems. Patient also denied any medical issues but then admits she had not had any wellness exams or medical interaction in “10 years.” Upon examination patient’s face was flushed, which she stated has been happening for a while but she didn’t think much of it. Patient had bilateral lower extremity swelling, however patient attributed that to her sitting more at her desk, and weight increase, working from home over the last year. The patient was give a first dose to catapres 0.1mg which only mildly improved the blood pressure, so the patient was given another 0.1mg which brought blood pressure reading down to 201/116. The patient was then given another o.1mg of catapres and Blood pressure retaken after an appropriate time which showed 185/100. The patient was then give instructions prescriptions for amlodipine 10mg daily, losartan 50 mg daily and hydrochlorothiazide 25mg to be started the same and given a followup appoint for the next 2 days and a cardiology referral. My initial plan was to have the patient go to the emergency room, however the provider stating there practice is to typically give 2 doses of catapres and if still unresolved then send the patient. This patient was treated with 3 doses because of moderate resistance to having to go to the emergency room.
This week I learned that there may be patients that present to the clinic that are, figuratively speaking, knocking on death’s door, and it is up to the practitioner to help the patient make the right decisions for themselves. This patient almost became one of the novel persons who helped define hypertension as the “silent killer,” dying before she even realized she wasn’t really “healthy.” Because of this knowledge, the patient’s presentation and lack of medical care for a decade, as well as the differential diagnoses of heart failure, kidney disease, or stroke, I would have educated the patient and had the patient go to the emergency room, located right across the street. Also, even though catapres is a very potent medication used to reduce blood pressure, it can also cause a rebound hypertensive effect, causing her to have another spike in blood pressure when she got home, especially if she wasn’t able to get her prescriptions picked up in time, (Elliott, 2021).
References
Elliott, William (2021), Withdrawal syndromes with antihypertensive drug therapy. Uptodate Accesses June 9,2020 from https://www.uptodate.com/contents/withdrawal-syndr…
Food and Drug Administration (FDA)(2021), High Blood Pressure–Understanding the Silent Killer: The Who, What, Why, and How of High Blood Pressure. FDA. Accesses June 9,2020 from https://www.fda.gov/drugs/special-features/high-bl…
0 comments