Class 6512: I Human Case Week #7 56 Year Old Female Reason For Encounter: Blood Pressure, Exams of Integrated Case Studies

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Class 6512: I Human Case Week #7 56 Year Old Female Reason For Encounter: Blood Pressure Recheck 2025 Class 6512: I Human Case Week #7 56 Year Old Female Reason For Encounter: Blood Pressure Recheck 2025 Here is a formal case study write-up for your Class 6512 i-Human Case Week #7 , involving the 56 - year-old female patient presenting for a blood pressure recheck : Case Study Write-Up Course: NURS 6512 – Advanced Health Assessment

such as chest pain, dizziness, shortness of breath, headaches, or palpitations, but reports mild fatigue , which she attributes to work- related stress. She is concerned about her high blood pressure and wants to ensure proper management moving forward. Past Medical History (PMH):

• Hypertension (diagnosed 2 years ago)
• Hyperlipidemia
• No history of diabetes , kidney disease, heart disease, or stroke
• No known allergies
• Immunizations up to date Past Surgical History (PSH):
• Appendectomy (uncomplicated, remote) Medications:

• Lisinopril 10 mg PO daily (non-adherent)
• Atorvastatin 20 mg PO at bedtime Family History:
• Mother: Hypertension, deceased from stroke
• Father: Hypertension, alive with type 2 diabetes
• No genetic conditions identified Social History:
• Tobacco Use: Denies smoking
• Alcohol Use: Occasional wine consumption (1–2 glasses/weekend)
• Drug Use: Denies illicit drug use
• Diet: High sodium, low vegetable and fruit intake
• Physical Activity: Sedentary lifestyle with no regular exercise

Physical Examination (PE):

• General: Alert, oriented, no distress
• Vital Signs: o BP: 152/92 mmHg (right arm, seated) o HR: 82 bpm o RR: 16/min o Temp: 98.6°F o BMI: 30.2 (Obese Class I)
• Cardiovascular: Regular rhythm, no murmurs or gallops
• Respiratory: Clear to auscultation bilaterally
• Abdomen: Soft, non-tender, no palpable masses
• Extremities: No edema, pulses 2+ bilaterally
• Neurological: Alert, intact cranial nerves, no focal deficits Assessment: Primary Diagnosis:

• Essential Hypertension (I10): Elevated BP readings during the visit and a history of hypertension with non-adherence to medications. Differential Diagnoses:

1. Medication Non-Adherence (Z91.14): Patient admits to inconsistent medication use.
2. Hyperlipidemia (E78.5): Elevated LDL and triglycerides; contributes to cardiovascular risk.
3. Obesity (E66.9): BMI of 30.2, which contributes to HTN and insulin resistance.
4. White Coat Hypertension (R03.0): Considered based on BP readings in the clinical setting; home monitoring may help rule it out.
5. Pre-diabetes (R73.03): A1C of 5.8% indicates risk for developing type 2 diabetes.
6. Anxiety-related BP Elevation (F41.1): Stress from work could elevate BP.

3. Lipid Management: - Continue Atorvastatin 20 mg nightly; consider increasing to 40 mg if lipid levels remain high after 3 months 4. Pre-Diabetes: - Lifestyle changes (diet, exercise) to delay progression to type 2 diabetes - Recheck A1C in 3–6 months 5. Monitoring: - Home BP monitoring: Instruct patient to track BP at home twice daily for 2 weeks - Labs: Follow-up in 4 weeks for lipid panel , renal panel , electrolytes - Follow-up Visit: Schedule in 4 weeks to assess BP control, review lab results, and adjust treatment if needed Reflection:

This case emphasizes the importance of patient education and adherence to prescribed treatments, especially for conditions like hypertension and hyperlipidemia, which require long-term management. Lifestyle changes such as diet modification, increased physical activity, and stress reduction play a pivotal role in improving cardiovascular health. Regular follow-up and careful monitoring of BP, lipid levels, and renal function are essential for reducing the risk of complications associated with untreated or poorly managed hypertension. For a comprehensive case like the 56-year-old female with hypertension, here are additional differential diagnoses and treatment strategies that could be considered: Additional Differential Diagnoses:

1. Secondary Hypertension Secondary hypertension is caused by an underlying condition such as kidney disease,

of the renin-angiotensin-aldosterone system (RAAS). Additional Treatment Strategies:

1. Review and Address Medication Adherence: o Non-adherence to hypertension medications is common. Using reminders or pill organizers can help the patient take medications consistently. o If the patient is struggling with side effects of the medication, it may be useful to explore alternative drugs or dosing strategies. For instance, ACE inhibitors like Lisinopril could be substituted with Angiotensin II receptor blockers (ARBs) (e.g., Losartan) if the patient experiences a persistent dry cough.
2. Pharmacologic Adjustments: o If blood pressure remains uncontrolled, combination therapy might be necessary. This can include:

▪ Adding a calcium channel blocker (CCB) (e.g., Amlodipine) for additional BP control. ▪ Consider a thiazide diuretic (e.g., Hydrochlorothiazide) if the patient’s hypertension is associated with fluid retention. ▪ Beta-blockers (e.g., Metoprolol) can be used if the patient also has cardiovascular symptoms such as palpitations, or for patients with a history of myocardial infarction.

3. Lifestyle Modifications: o Dietary Changes: Encourage the DASH (Dietary Approaches to Stop Hypertension) diet , which emphasizes low sodium intake, high fruits, vegetables, lean meats, and whole grains. o Physical Activity: A goal of 150 minutes per week of moderate exercise can improve cardiovascular health and assist with weight management.

function (e.g., creatinine, eGFR) and electrolytes (particularly potassium).

5. Addressing Comorbidities: o Hyperlipidemia: If the patient’s lipid levels are not controlled, adjusting the dosage of atorvastatin or adding other lipid-lowering agents (e.g., ezetimibe or PCSK9 inhibitors ) may be necessary. o Obesity: This should be actively addressed as it is a major risk factor for both hypertension and cardiovascular disease. Encourage a weight loss program tailored to the patient’s lifestyle. o Pre-diabetes: Regular glucose monitoring and emphasis on lifestyle changes (diet, exercise) are necessary to prevent progression to type 2 diabetes. ?