CASE STUDY 1: HYPERTENSION
Objectives for the presentation of the case
1. Review the risk factors and pathophysiology of hypertension that are known and relate to historical information given in case
2. What physical exam would you do in this patient and why? Make sure you integrate for your fellow students what target organ damage are common complications of HTN
3. Review with your classmates what are the JNC VII guidelines for the diagnosis and treatment of hypertension
4. Integrate the major drug classifications for treating hypertension in your teaching of your classmates; make sure you include mechanism of action; adverse effects; and most important nursing implications
5. Integrate all the patient’s medications with reason for taking; how might they impact the HTN; and how do they fit into the JNC VII guidelines
6. Looking at the patient’s social history, what factors may play a role in adherence to a medication regime?
7. If you were the nurse discharging the patient from the hospital what are the most important patient education content that should be included?
8. Find one research article on current hypertension treatment that you think is applicable to this case and share with your fellow students.
REMEMBER IF YOU HAVE THIS CASE YOUR ROLE IS THE TEACHER OF THE CLASS. YOU NEED TO DO MORE THAN JUST ANSWER THE QUESTIONS ABOVE, YOU NEED TO THINK ABOUT HOW THE CONTENT ON HTN NEEDS TO BE PRESENTED SO YOUR CLASSMATES WILL LEAVE THE PRESENTATION WITH KNOWLEDGE OF THE PATHOPHYSIOLOGY OF HTN, THE IMPORTANT HISTORY AND PHYSICAL EXAMINATION THE NURSE SHOULD PERFORM, AND THE ABILITY TO COMPARE AND CONTRAST ALL THE MAJOR CLASSIFICATIONS OF HTN MEDICATIONS AVAILABLE
Case Study HTN
A 76 year old female with essential hypertension that has been difficult to control is admitted to the hospital with a blood pressure of 200/86 and a pulse rate of 64. She was diagnosed with hypertension in 1980. Her past history is positive for hypothyroidism diagnosed in 1975, colon cancer with a colectomy in 1993, and a current history of shoulder pain for two months.
Family History: father died at age 68 from pneumonia, mother had HTN an died at age 77 from a stroke; she has one brother who is alive and well at 66
Social History: she lives alone on a restricted income. She consumes increased amounts of canned soups and vegetables. She has a 50 pack year history of smoking tobacco (1.5packsfor 33 years). She quit smoking one year ago. Consumes two to three alcoholic beverages per day. She enjoys spending time with her great grandchildren and window shopping.
Cardura 12 mg po QD (physician increased dose on last visit from 8mg)
HCTZ 25 mg po qd
K-Dur 20 mEq po QD
Synthroid 0.1 mg per day
Ibuprophen 400 mg po PRN Shoulder pain (Takes five or six per day)
Denies OTC medication use
Vital Signs: BP 150/98, p. 68, r. 16
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