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

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Reason For Encounter: Blood Pressure RecheckI Human Case Week #7 56 Year Old Female

Class 6512

  Atorvastatin 20 mg nightlyMultivitamin Aller  gies: No known drug allergies Family History:  Mother: Stroke at age 67, hypertension   Father: Type 2 diabetesBrother: Hypertension Social History:  Lives with husband   Works as a school secretaryOccasional alcohol, no smoking or drug use   Poor diet, recentlyWalking 3x per week making changes ROS:  Negative for all major complaints (neuro, cardiac, respiratory, GI, etc.) 🧑 Vital Signs: ⚕️ 2. Objective Data (Physical Exam)   BP: ~145/88 in officeHR: 78 bpm   RR: 16Temp: 98.6°F  BMI: 32 (Obese)

General:  Well-appearing, no acute distress HEENT:  Normal CV:  Regular rate and rhythm, no murmurs or extra heart sounds Resp:  Clear to auscultation bilaterally Abdomen:  Soft, non-tender, no masses Neuro:  Alert and oriented x3, no deficits

🧑 Labs (if ordered or reviewed): 3. Diagnostic Considerations   Lipid Panel:CMP: Normal renal function (important for Lisinopril monitoring) Elevated LDL, low HDL   A1C:Urinalysis: Normal range or borderline (depending on case specifics) May be normal or trace proteinuria EKG:  Likely normal or shows mild LVH (if longstanding HTN)

 Consider ti weeks tration to 20 mg daily if BP remains above goal in 2– 4  Monitor after any med change electrolytes and renal function (BMP/CMP) 1–2 weeks Lifestyle Modifications:  Continue DASH diet: low sodium, rich in fruits/vegetables   Encourage weight loss (target 5Physical activity: At least 150 minutes of moderate–10% reduction) -intensity  aerobic exercise/weekLimit alcohol (≤1 drink/day for women) Monitoring:  Home BP log: check 2x/day, log readings   Recheck inWatch for cough, dizziness (possible Lisinopril side effects) 2 – 4 weeks Labs/Diagnostics:  Repeat BMP (renal fxn & potassium) in 2–3 weeks   Lipid panel Consider urine microalbumin annually or sooner if uncontrolled if diabetes suspected or CKD

Patient Education:^ concern   Importance of adherence to medicationUnderstanding BP targets (<130/80 mmHg per ACC/AHA)   Educate on potential side effects of ACE inhibitorsEncourage regular follow-up visits

✅ Follow-Up Plan

  Return to clinic in 2Sooner if any side effects or symptoms–4 weeks for BP recheck and med adjustment  Reinforce long-term cardiovascular risk reduction

History of Present Illness (HPI): The patient is a 56-year-old African American female who presents for a follow ago when her BP was elevated at 162/98 mmHg. At that time, she was-up visit to recheck her blood pressure. She was seen two weeks advised to monitor her blood pressure at home, reduce sodium intake, increase physical activity, and follow up for reassessment. She reports feeling well overall and has been checking her blood pressure at home, which has ranged from 138/86 to 148/90 mmHg. She denies any headache, dizziness, chest pain, shortness of breath, or visual changes. Past M  Hypertension (diagnosed 2 weeks ago) edical History (PMH):   Hyperlipidemia (diagnosed 2 years ago)Obesity (BMI ~32)   No history of diabetesNo known cardiovascular disease

Past Surgical History (PSH):  Appendectomy in her 20s  Tubal ligation in her 30s

  Respiratory:Neurological: Denies shortness of breath, cough Denies dizziness, headache, or visual changes   GI:GU: Denies nausea, vomiting, abdominal pain No urinary complaints

Physical Examination^ ^ Musculoskeletal:^ No joint or muscle pain General:  Well-developed, well-nourished, African American female in no

 acAlert and oriented ×3.ute distress. Vital Signs:^ ^ Appears stated age, cooperative throughout the exam.   BP (right arm, seated):Pulse: 78 bpm, regular 145/88 mmHg   Respirations:Temperature: 16 breaths per minute, unlabored 98.6°F (oral)   Height:Weight: 5’5”190 lbs  BMI: 31.6 (obese category) HEENT:  Head: Normocephalic, atraumatic  Eyes: retinopathy PERRLA, EOMI, no funduscopic evidence of hypertensive  Ears/Nose/Throat: abnormalities Mucous membranes moist, no lesions or  Neck: No thyromegaly or lymphadenopathy, no JVD

Cardiovascular:  RRR (regular rate and rhythm)   S1 and S2 audible, no murmurs, rubs, or gallopsNo peripheral edema   No carotid bruitsPeripheral pulses 2+ bilaterally

Respiratory:  Lungs clear to auscultation bilaterally   No wheezes, rales, or rChest expansion symmetricalhonchi

Abdomen:  Soft, non-tender, non-distended   Bowel sounds present in all quadrantsNo hepatosplenomegaly  No masses or bruits Extremities:  No cyanosis, clubbing, or edema   No tenderness to palpationFull range of motion

Neurologic:  Alert and oriented ×

 No evidence of secondary hypertension (normal renal exam, no bruits, normal labs if available).  No end-organ damage on physical exam. Secondary Diagnoses: 1. Hyperlipidemia (E78.5)  History of hyperlipidemia; likely still present based on her comorbidities and risk factors.   Needs updated lipid panel if not recently done.Currently on atorvastatin 20 mg at night.

2. Obesity, Cla  BMI 31.6 ss I (E66.9)  Major risk factor for cardiovascular disease and poor blood pressure control  Lifestyle modifications encouraged (diet, physical activity, weight loss goals)

Risk Factors Identified:  African American ethnicity (higher risk of HTN complications)   Family history of stroke (mother)Hyperlipidemia   ObesitySedentary lifestyle (though improving)  Diet high in sodium (improving) Goals of Care:

  Achieve BP <130/80 mmHgPrevent progression to hypertensive complications (stroke, MI,  CKD)Manage comorbid conditions (lipids, weight)  Educate and support adherence Would you like help formulating the SOAP note format or discussion board post Plan or turning this into a full? 4o You said: Key Findings ChatGPT said: Here are the 56 - year-old female Key Findings presenting for a from the I blood pressure recheck - Human Case Week 7 involving a — perfect for pulling into your SOAP note, discussion post, or case reflection for Class 6512.

⭐️ 🧑 Subjective: Key Findings  Follow 162/98 mmHg)-up for hypertension diagnosed 2 weeks ago (initial BP:  Home BP readings improved but still elevated (ranging 138/86 to 148/90 mmHg)  Denies any symptoms (no headache, dizziness, chest pain, SOB, or visual changes)  Reports adherence to Lisinopril 10 mg daily

 Education and management. lifestyle counseling essential to long-term  Follow progression. - up and lab monitoring required for med effects and Diagnostic Tests These tests help confirm the diagnosis , evaluate for comorbidities , and screen for end guidelines. - organ damage , per JNC-8 and ACC/AHA hypertension

✅ (^)  1. Basic Metabolic Panel (BMP/CMP) Purpose: o o EvaluateCheck renal function electrolytes (esp. potassium with ACE inhibitors) (BUN, creatinine) — critical for  Expected Findings:^ monitoring^ ACE inhibitors like Lisinopril Normal or mildly elevated creatinine; potassium should be within normal range ✅ (^)  2. Lipid Panel Purpose: o o AssessPatient has cardiovascular risk profile hyperlipidemia and is on atorvastatin  Expected Findings: o Likely elevated LDL , low HDL o Reinforces need for lifestyle modification and statin therapy ✅ 3. Hemoglobin A1c

 Purpose: o Screen for diabetes or prediabetes , especially given obesity o and family historyHypertension and diabetes often coexist  Expected Findings: o Possibly normal, but borderline elevations could indicate metabolic syndrome ✅ (^)  4. Urinalysis (UA) Purpose: o Screen for damage due to hypertension proteinuria , which may indicate early renal  Expected Findings: o Normal or trace proteinuria (if hypertension is affecting kidneys) ✅ (^)  5. Urine Albumin Purpose: -to-Creatinine Ratio (UACR) o Detect hypertensive patients microalbuminuria , a marker of kidney damage in  Recommended especially if diabetic, African American, or with high CVD risk

✅ (^)  6. Electrocardiogram (EKG/ECG) Purpose: o Screen for changes left ventricular hypertrophy (LVH) or ischemic

o o African American ethnicity (higher prevalence)Obesity, sedentary lifestyle, and high sodium intake  Dia^ o^ gnosis of exclusion No signs of secondary causes on exam or history but commonly assumed if no red flags ⚠️ Hypertension due to an underlying cause. Less likely in this case, but 2. Secondary Hypertension important to rule out if BP remains uncontrolled despite treatment, or if there are red flags. Subtypes to consider:  Renal Artery Stenosis o Usually presents sudden onset with resistant HTN, abdominal bruit, or  Primary Hyperaldosteronism (Conn's Syndrome)^ o^ No bruit, normal renal function →^ unlikely o o Suspect if HTN + hypokalemiaNo hypokalemia reported → less likely  Obstructive Sleep Apnea (OSA) o Strongly associated with resistant HTN o o Ask about snoring, fatigue, witnessed apneaMay be a consideration based on obesity → possible  Thyroid Dysfunction (Hyper/Hypothyroidism) o Can cause BP changes o No thyroid enlargement, symptoms, or metabolic changes → less likely  Pheochr o Rare, usually causes paroxysmal HTN, palpitations, sweating omocytoma o No episodic symptoms → very unlikely

⚠️ (^3) . White Coat Hypertension Elevated BP in clinical settings but normal at home   Patient’sOffice BP still above goal → may be a home readings are improved contributing factor , but still slightly elevated, not the sole cause ⚠️ (^4) . Medication Non Always a consideration in uncontrolled hypertension - Adherence  However, patient reports changes → less likely compliance with Lisinopril and lifestyle

⚠️ (^5) . Masked Hypertension Normal BP in clinic, elevated at home   Opposite of white coat hypertension Not applicable here since both office and home BPs are elevated

🧑 Summary Table Essential HTN^ Diagnosis^ ⭐️ Likelihood Highly^ Supporting/Refuting Features Secondary HTN^ likelyPossible^ Gradual onset, family history,^ obesityNo red flags but assess if White Coat HTN Possible^ uncontrolledHome readings improved, not fully OSA Possible normalObesity risk factor, no symptoms reported