A 56-Year Old Female With Blood Pressure Recheck I Human Case Class 6512, Assignments of Health sciences

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A 56 - Year Old Female With Blood Pressure Recheck

I Human Case Class 6512

Problem Statement

The patient is a 5 6 - year-old overweight Hispanic construction worker who

presents for evaluation of an elevated blood-pressure reading at a recent local

health fair. she reports intermittent mild headaches, and interrupted sleep with

snoring Physical examination is notable BP 172/94 L and 178/98 R; laterally

displaced PM; and, funduscopic findings of A-V nicking. Was told she had

elevated BP in the past, but took no action. FH is positive for hypertension and

related complications

Management Plan

Key elements of the patient’s treatment plan will include the following

1. HTN

• His BP goal is SBP=120 and DBP 80 mm Hg since he is less than 60 y/o
• Medication selection: he is nonblack (Hispanic) so the recommendation by the

JNC 2013 is initiate thiazide-type diuretic or ACEI or ARB or CCB alone or in

combination

- Start HCTZ 25 mg po Q D x 1 week, F/U 2 weeks, if still hypertensive,

consider increasing to BID or adding ACEI (Lisinopril) 10 mg PO Q D to achieve

BP goals stated above.

• Arrange for home BP monitoring
• Obtain lipid panel and HgA1c as baseline measurements
• Nutritional consultation for weight loss

Sleep Apnea

• Refer for CAP assessment and fitting (sleep apnea device)
• Counsel patient regarding lifestyle modification – alcohol, weight reduction,

smoking

Case: Key Findings

 Key Finding

 Elevated BP

 Headaches

 Daytime somnolence and fatigue

 Smoker

 Overweight status

 Hypertensive retinopathy – AV Nicking

 Laterally displaced PMI

 Snoring, awoken by wife for breathing problem

 NSAID use

 Poor eating habits

EHR Documentation - Reason for encounter – High Blood Pressure HPI: PMH: Gastritis Hospitalizations/Surgeries: Right knee ACL repair Medications: Omeprazole, Ibuprofen 200-400 mg Allergies: NKA Preventative Health: Childhood immunizations “none since”, no annual u shot Family History: Father (Death at 62) stroke Mother 78: DM Grandmother: DM, Death at 82 Grandfather heart attack death at 52 Brother HTN Uncle HTN Son living in good health (19 yo). Social History: Works construction doing ooring installation and cabinet work. Drinks alcohol on weekends. Smoke 1 pack per day since age 20s. Denies recreational drug use. Diet consists of cup of co ee in the morning, fast food, texmex style food, chips.

Physical Examination Documentation General: Integumentary/Breast: Nails without clubbing, ridging, peeling, or pitting. HEENT/Neck: Head: normocephalic, atraumatic, no deformities, facial features symmetric with equal eye closure and smile, temporal arteries are non-tender to palpation. Maxillary and frontal sinuses non-tender on bilaterally. Hair thickness and pattern distribution typical for age and gender. Eyes: PERRLA, conjunctiva pink and no discharge. No sclera icterus. No edema, redness, tenderness, or lesions noted. Visual acuity 20/20 right eye, and 20/20 left eye. Prominent arteriovenous nicking bilateral fundi, some narrowing of vessels. Sharp disc margins without ame or dot hemorrhages, or soft or hard exudates. Ears: External ears without deformities, edema, lesions, or erythema. No discharge noted. Canals without erythema or cerumen. Bilateral tympanic membranes non-bulging, translucent, pinkish-gray. No scarring, discharge, or purulence noted. No hearing decits.

Problem Statement: Management Plan – Diagnostic Tests: ECG – Normal ECG, 75 bpm, regular rhythm CBC – Normal with di 昀昀 erential CMP – Normal CMP TSH, blood – Normal TSH UA – Normal UA All tests above with normal results indicated the patient has primary (essential) hypertension (Unger et al., 2020). Medications:

• Hydrochlorothiazide 12.5 mg PO once daily (Puckey, 2024a). - Lisinopril 10 mg PO once daily (Puckey, 2024b). According to the clinical practice guidelines, H.H.’s blood pressure of 170s/90s is Grade 2 and should immediately be treated with pharmacological therapy (Unger et al., 2020). Those with Grade 2 Hypertension and who are non-black should be started on a low-dose ACEI/ARB and a CCB and subsequently titrated to a full dose as applicable (Unger et al., 2020). The additional thiazide diuretic and/or spironolactone may be considered to be added to the client’s medication regimen (Unger et al., 2020). The client’s medication regimen should be simplified with once-daily dosing and single pill combinations as much as possible to promote medication adherence (Unger et al., 20200. Suggested consults/referrals:
• Dietician for education and plan for dietary modications Lifestyle modications should be included asrst-line therapy in a treatment plan for a patient with essential hypertension as healthy lifestyle choices can delay or prevent related cardiovascular complications (Unger et al., 2020). Client Education:
• The client should be instructed to self-monitor their blood pressure before taking any medication at home to prevent excessive hypotension
• The client should be educated on smoking cessation as it can be a major risk factor for hypertension
• The client should be encouraged to increase exercise as regular exercise can prevent the onset of hypertension
• The client should avoid foods containing excess salt and follow a lowsodium, hearthealthy diet
• Caeine and alcohol intake should be limited or avoided altogether as they can contribute to hypertension
• Encourage the client to follow up with their primary care provider when recommended and annually for age-appropriate screenings, immunizations, and general care as well as follow-up on hypertensive status
• Patient lifestyle counselling:
• • General dietary recommendations to reduce fats and salt and

increase foods with potassium. Weight reduction – recommend a loss of 13

Is

• • Avoidance of NSAIDs – to minimize renal injury
• • Smoking cessation – to reduce risk of atherosclerosis
• •BP assessment at 2 weeks, with regular follow-up thereafter