Posted: August 28th, 2023
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DISCUSSION POST #1 Ella
Besides his high blood pressure, the patient’s test results also indicate hypertriglyceridemia and hypercholesterolemia. In this specific case, a comprehensive assessment of the patient’s medication regimen and lifestyle factors is warranted. Despite the patient’s verbal confirmation of medication adherence, a thorough evaluation is necessary to ensure optimal management of his hypertension. Several aspects should be considered, for example: While the patient stated he takes his medication regularly, further exploration is essential. Inquire about the patient’s medication administration routine, including the specific time of day, dosage, and any potential challenges he might face in adhering to the prescribed regimen. Verify the last time the patient refilled his medications to gauge the consistency of his usage.
We need to investigate whether the patient is consuming any herbal supplements or alternative remedies that could potentially interfere with his blood pressure medications.
We need to assess his caffeine consumption, including the sources and amounts of caffeine he ingests. As noted by Sparks (2020), excessive caffeine intake—approximately 200 to 300 milligrams—can lead to a temporary elevation in blood pressure.
We need to ensure that the combination of hydrochlorothiazide and metoprolol is appropriate for his condition.
Hypertriglyceridemia E78.5 – According to (Sweeney, 2021) Hypertriglyceridemia, a condition in which triglyceride levels are elevated, is a common disorder in the United States. It is often caused or exacerbated by uncontrolled diabetes mellitus, obesity, and sedentary habits, all of which are more prevalent in industrialized societies than in developing nations.
Hypercholesterolemia E78.0- According to (Ibrahim et al., 2023), high cholesterol can be defined as an LDL-cholesterol greater than 190 mg/dL, greater than 160 mg/dL with one major risk factor, or greater than 130 mg/dL with two cardiovascular risk factors.
Hypertensive Crisis I16.0: The patient’s medical background involving hypertension and the prevailing blood pressure measurement may contribute to the symptoms he has been encountering over the last four days, such as headaches and blurred vision.
Plan of Care: Given the limited medication dosage information provided, I intend to proceed by adjusting the blood pressure medication in accordance with the previously prescribed dose. Furthermore, the patient will be initiated on a statin medication, specifically simvastatin at a dosage of 20 mg taken orally once daily in the evening. This regimen aligns with the recommended starting dose, as outlined in Pottinger (2022), which suggests 20 mg/day to be taken as a singular evening dose.
Education of the patient is pivotal, encompassing the significance of medication adherence and the adoption of healthy lifestyle modifications to effectively address elevated blood pressure and cholesterol levels. A fundamental element of this educational endeavor is instructing the patient on maintaining medication compliance and incorporating practices conducive to overall well-being.
Part of this educational outreach involves enlightening the patient about the value of maintaining a journal that documents blood pressure readings and any associated symptoms following the commencement of simvastatin. This journaling process will facilitate tracking and awareness of treatment progress and effects.
To ensure a vigilant approach, I will closely monitor the patient’s trajectory. Consequently, I will schedule a follow-up appointment in approximately three weeks, allowing for a comprehensive assessment of blood pressure and lipid panel outcomes. Based on these evaluations, medication adjustments will be implemented if deemed necessary.
The ultimate goal of this multifaceted plan of care is to holistically address the patient’s hypertension and hypercholesterolemia through tailored medication management, patient education, and meticulous monitoring.
To best care for this patient, it is crucial to focus on evaluating his blood pressure and neurological symptoms. Despite his claim of following his prescribed medications, we must examine his complaints of headaches and blurred vision. I would inquire about the nature of his headaches—whether they are persistent or intermittent—and investigate factors that worsen or alleviate both his headaches and blurred vision. Given his blood pressure reading of 190/100 coupled with neurological symptoms, it is likely that he is experiencing a hypertensive emergency, which is characterized by severely high blood pressure and signs of damage to target organs, as seen in his neurological symptoms (Alley & Schick, 2020). It is also important to consider the possibility of reduced kidney function, as this could be another symptom (Sanders & Suneja, 2022). To further diagnose the condition, tests such as a metabolic panel and urinalysis can be requested. Considering his predominant neurological symptoms, a head CT might also be advisable. The primary approach to managing hypertensive emergencies involves rapidly reducing his blood pressure. A decrease of 20-25% in mean arterial pressure within the first 1-2 hours is recommended. Intravenous vasoactive medications like labetalol, esmolol, or nicardipine can be administered (Alley & Schick, 2020). Given the urgency of the situation, the patient should be directed to the emergency room for intravenous treatment, as these medications are not administered in a clinic setting.
Additionally, addressing the patient’s cholesterol levels is a secondary concern. This individual not only presents with elevated blood pressure but also carries a high risk for atherosclerotic cardiovascular disease (ASCVD). Initiating treatment with a daily dose of 40 mg of atorvastatin orally can be considered (Martin & Cardoso, 2021). Furthermore, educating the patient about reducing saturated fats, fried foods, and oily items in his diet is important. If the patient is not engaging in regular physical activity, guidance should be provided to include 30-minute exercise sessions 4-5 times per week.
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