Respond to your peers
- Katia Gedeon
Clinical Experience
- This week I worked in a clinic where I mainly attended to patients who came for medication reviews and follow-ups. The majority of the patients I attended to had issues concerning diabetes and hypertension. I successfully managed to handle most of these patients and ensured I met their expectations. One outstanding success was how I offered patient education to these clients. I exhaustively discussed with them various ways they can keep themselves healthy and even control their blood pressure. I also discussed various foodstuffs that each of them needs to avoid depending on their conditions.
One case that I handled was of 64 years old African-American female who had prediabetes and had come for an annual physical. She did not have any complaints. Her average reading after 2 BP readings in the right arm was BP 143/88. The physical examination was unremarkable, save for the obesity. Moreover, she did not have any history of heart failure, myocardial infarction, kidney disease, or stroke. The patient had measured her blood pressure at home a month before this visit, and her average blood pressure after multiple homes and clinic readings was 138/86.
The patient’s total cholesterol was 260 mg/dl, LDL 165 mg/dl, and HDL 42 mg/dl. The patient did not smoke.
According to the 2017ACC/AHA guideline, this patient had stage 1 hypertension (Greenland & Peterson, 2017). The guideline uses a uniform blood pressure definition for stage 1 hypertension without taking the age of the patient or comorbid illness including chronic kidney disease or diabetes into consideration. Furthermore, it states that stage 1 HTN is present where SBP is between 130-139 or DBP between 80-89.
Care plan
Since the patient had stage one HTN and a ten-year ASCVD of about 10 percent, she needed to get a blood pressure-lowering medication. Calcium channel blockers, thiazide diuretics, angiotensin II receptor blockers (ARBs), and angiotensin-converting enzyme (ACE) inhibitors were the first-line agents because they were capable of reducing clinical events’ risks (Colantonio et al., 2018). Furthermore, calcium channel blockers and thiazide diuretics are more effective in cardiovascular prevention and lowering BP in African-Americans more than ARBs or ACE inhibitors. Besides, patient-specific factors including out-of-pocket cost, age, drug adherence, comorbidities, and concurrent medications were considered. The choice of this HTN medication was driven by shared decision-making.
Some of the nonpharmacological strategies for this patient included physical activities, weight loss, and dietary changes. Furthermore, the patient was advised specific agents such as decongestants, stimulants, oral steroids, and NSAIDs to raise blood pressure. The goal, in this case, was to achieve a BP of 130/80. Therefore, the patient was advised to monitor her blood pressure at home and then return to the clinic after a month.
One important lesson that I learned this week was maintaining healthy feelings despite the issues I was experiencing t work. I learned from colleagues that I take frequent breaks and never skip meals anytime I am at work. Furthermore, I also learned that I should leave behind work issues and focus on my personal life after leaving work. Finally, I learned that take time for myself, get sufficient rest, and eat nutritiously.
References
Colantonio, L. D., Booth, J. N., Bress, A. P., Whelton, P. K., Shimbo, D., Levitan, E. B., … & Muntner, P. (2018). 2017 ACC/AHA blood pressure treatment guideline recommendations and cardiovascular risk. Journal of the American College of Cardiology, 72(11), 1187-1197. https://www.jacc.org/doi/abs/10.1016/j.jacc.2018.05.074 (Links to an external site.)
Greenland, P., & Peterson, E. (2017). The new 2017 ACC/AHA guidelines “up the pressure” on diagnosis and treatment of hypertension. Jama, 318(21), 2083-2084. https://jamanetwork.com/journals/jama/article-abstract/2664349
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