NR 566 Final Exam Study Guide- comprehensive-2024-2025.docx, Exams of Nursing

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NR 566 Week 3: ANS Case Study - Margaret is a

59-year-old Caucasian female-2024-

Discussion Case Study & Discussion Questions Margaret is a 59-year-old Caucasian female who presents to the clinic for follow-up of her hypertension. She reports that she has a worsening of a tremor in her hand over the last few months. She was seen by a neurologist previously and was diagnosed with an essential tremor but opted to not take medication because it wasn’t particularly bothersome. She reports now that she has difficulty pouring a drink, drinking from a cup, using utensils to eat, and writing or drawing. Margaret also reports that since you started her on Clonidine last month for her blood pressure, she has been having some difficulties with headaches, dizziness, dry mouth and difficulty urinating. You plan to discontinue the clonidine. Past Medical History: Hypertension, essential tremor and seasonal allergies. Surgical History: Tonsillectomy. Family History: Mother HTN & essential tremor, Father Diabetes, Sister Diabetes all deceased. Social History: Denies tobacco use, wine one to two glasses a week, denies recreational drugs, exercises twice a week. Allergies: NKA Current medications: Multivitamin with Iron 1 tab PO daily, Allegra 10mg PO prn for allergies, Clonidine 0.1mg PO BID All vaccines up to date. Vitals: Height 57 inches, Weight 145 pounds, BP 156/85, P 70, R

16. Physical exam is normal.

Dr. Hall and classmates, What are your treatment goals for Margaret today? The treatment plan for Margaret is to discontinue clonidine and replace the hypertension medication. What is your pharmacological plan and rationale? Aplha2 agonists are usually a second- or third-line choice of drugs to treat mild to moderate hypertension. Clonidine should be avoided or used with extreme caution due to its cognitive function effect on geriatric patients. Clonidine decreases sympathetic tone, peripheral resistance, heart rate and renal vascular resistance, while increasing parasympathetic stimulation. The patient (Margaret) presented common adverse effects of clonidine such as dry mouth and urinary retention. Urinary retention is a good reason alone to discontinue clonidine, since it can cause other additional issues. However, Clonidine should not be discontinued abruptly since the lack of alpha2 receptors impair the homoeostatic balance of the sympathetic nervous system and potentially cause a life-threatening hypertension effect. Margaret will be taper gradually over four days. Margaret did compliant about increase tremors and a beta- adrenergic block would be a good choice to decrease tremors. However, clonidine and beta- adrenergic block place the patient at risk for life-threatening hypertension and is best to avoid using these drugs together (Woo. P.174-180., 2016). Margaret stated that she opted out of take medication for the tremors because the tremors were not particularly bothersome before taking clonidine. After discontinuing the clonidine, the tremors should decrease. The Joint National Committee (JNC) 8, hypertension guideline algorithm recommends to begin with one of the following ACE inhibitors, angiotensin receptor blocker (ARB), thiazide diuretic or calcium channel blocker (CCB). For Margarets’ treatment, an angiotensin converting enzyme (ACE) such as lisinopril will be given to treat hypertension (JNC, 2019) Medication name: Lisinopril 10mg tablets Stg: take 1 tablet by mouth daily for 4 weeks If hypertension is not controlled after four weeks adding a combination pill such lisinopril and hydrochlorothiazide 10mg/12.5, depending on the patient outcome. Research has demonstrated that hypertension control can be affective with half the standard dose and second medication such as thiazide-type diuretic can results in fewer adverse effects with a combination of two low dose medication than a high-dose monotherapy (Hansell,2017).

- Pick one medication from your response above and list five patient- centered teaching points for the medication. 1. The adverse effects of lisinopril such as headache, dizziness, dry cough, hacking cough, hypotension and chest pain. 2. Report any allergy symptoms immediately such as changes in urinating, confusion, weakness and dysrhythmias.

3. Before taking any potassium supplements, potassium-containing salt substitutes, over the counter medication, dietary supplements or herbal preparation contact the office.
4. Contact the office if your pregnant or suspect your pregnant immediately.
5. To use effective contraception if still within childbearing potential.
6. Take a baseline blood pressure before taking daily medication take blood pressure daily for hypotension.
7. Monitor weight changes.
8. Monitor for signs of angioedema (flushing or pallor of face), swelling of face, eyes, tongue or lips, difficulty breathing and/or swallowing. Stop taking medication and contact the office immediately or 911.
9. Missed dose should be taken soon as possible, unless it’s almost time for the next dose (Woo. P. 295-308, 2017).

Reference Hansell, M. W., Mann, E. M., & Kirk, J. K. (2017). Hypertension treatment strategies for older adults: This evidence-based review illustrates how to adjust treatment for comorbidities and incorporate frailty and cognitive impairment into the equation. Journal of Family Practice , 66 (9), 546–554B. Retrieved from https://chamberlainuniversity.idm.oclc.org/login? url=https://search.ebscohost.com/login.aspx? direct=true&db=pbh&AN=124918188&site=eds-live&scope=site Joint National Committee (2020). JNC 8 hypertension guideline algorithm. Retrieved from http://thepafp.org/website/wp-content/uploads/2017/05/2014-JNC-8-Hypertension.pdf Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for Advance Practice Nurse prescribers (4th ed.). Philadelphia, PA: F. A. Davis Company. and cognitive impairment into the equation. Journal of Family Practice , 66 (9), 546–554B. Retrieved from https://chamberlainuniversity.idm.oclc.org/login? url=https://search.ebscohost.com/login.aspx? direct=true&db=pbh&AN=124918188&site=eds-live&scope=site