NR 508 Week 3 Case Study Discussion: Case of Mr. Russell
Mr. Russell is a 73-year-old male who presents to your clinic with complaints heart palpitations
... [Show More] and light headedness on and off for the past 3 months. He has a history of hypertension and is currently prescribed HCTZ. He also is complaining of heartburn and belching after a large meal.
Vital Signs: B/P 159/95, Irregular HR 88, Resp. 22, Weight 99 kilograms
Lower extremities with moderate 3+edema noted in left leg, 2 + edema in right leg, ABD + BS, Neuro AOX3,
Labs: NA 143mEq/L, CL 99 mmol/L BUN 18mg/dL, Hbg 15, TC 234 mg/dL, LDL 137 mg/dL, HDL 35 mg/dL, triglycerides 241mg/dL,
1. What are your treatment goals for Mr. Russell today?
2. What is your pharmacologic plan; please state your rationale for your plan?
3. What are five key patient education points based on your plan?
4. How would your plan change if your patient is African American?
What are your treatment goals for Mr. Russell today?
On the basis of the blood pressure of Mr. Russell of 159/95, it can be deduced that his primary treatment goal is to reduce the BP to a normal range. Taking this into account, according to American Heart Association (2018), that normal blood pressure or a normal individual should be less than 120 mm Hg for systolic and less than 80 mm Hg for Diastolic. As such, a normal range of blood pressure for Mr. Russell will play an imperative role when it comes to the reduction of heart palpation and lightheadedness. Another treatment goal of Mr. Russell is to educate him on lifestyle changes such as exercise program and healthy in order to manage his weight. Mr. Russell also needs to lower his cholesterol level from the current 234 to a normal range of around 200.
What is your pharmacologic plan; please state your rationale for your plan?
The pharmacological plan for the case of Mr. Russell is to use Amiloride in combination with HCTZ. Amiloride usually helps the body in the absorption of salts. Additionally, it helps in ensuring that the potassium level in the body is maintained. In the other hand, as explained by Roush and Sica (2016), Hydrochlorothiazide, which is a diuretic works by helping the body get rid of extra salt as well as water. Taking this into consideration, the combination of these drugs will be fundamental in treating Edema and high blood pressure. For the purpose of lowering cholesterol levels, Ezetimibe will be taken into account. This drug usually acts by decreasing cholesterol absorption in the small intestine.
What are five key patient education points based on your plan?
Based on the aforementioned pharmacological plan, the first education point is how to use the drugs. From this point of view, there is considerable need for Mr. Russell to understand that the drugs should be taken on the prescribed time and in the right amount. Besides, the drugs should be taken with food (Roush & Sica, 2016). There is also a need for Mr. Russell to understand the possible side effects associated with the use of the drugs such as headache, stomach upsets, and dizziness(American Heart Association, 2018). Thirdly, a special diet is required when taking these drugs. Precisely, Mr. Russell needs to avoid high alcohol intake as well as a high-salt diet. The fourth educational point is about precautions on using these medications. In this view, Mr. Russell should be made aware that when using these drugs, he needs not to drive or operate machinery due to dizziness. Lastly, there is a substantial need to educated Mr. Russell on the importance of exercise programs alongside a healthy diet for the purpose of ensuring that his weight supports his condition.
How would your plan change if your patient is African American?
Thiazide diuretics are used in the treatment of hypertension. These classes of drugs are considered effective in most patients irrespective of ethnicity or racial backgrounds (Roush & Sica, 2016). Therefore, in case Mr. Russell was African American, the plan would not change.
References
American Heart Association. (2018).Change you can make to Manage High Blood Pressure. Retrieved from: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/PreventionTreatmentofHighBloodPressure/Prevention-Treatment-of-High-Blood-Pressure_UCM_002054_Article.jsp?gclid=EAIaIQobChMIuP7xpIqz3AIVEVuGCh02EQMuEAAYAyAAEgLks_D_BwE#.W1TCZtUzbIW
Roush, G. C., & Sica, D. A. (2016). Diuretics for hypertension: a review and update. American journal of hypertension, 29(10), 1130-1137. https://doi.org/10.1093/ajh/hpw030 [Show Less]