Hypertension: C.D’s Case Study


C.D is an African American patient in his mid-fifties who has visited his primary care provider complaining of headache and chest pressure, which have persisted for the last two days. Upon being interviewed, he says that he has been smoking a pack of cigarettes daily for the last fifteen years and has a habit of drinking many bottles of beer every evening. He neither exercises nor participates in diet programs, and he has gained about thirty pounds in the past 12 months. Moreover, he does not restrict the consumption of salt and carbohydrates.

Upon reviewing the patient’s systems, it is established that C.D has difficulties in breathing while resting or climbing stairs, and he has nocturia as well as hemoptysis. He says that his breathing has been worsening for the last few days. Physical examination has revealed that his blood pressure is 190/120 mmHg. Although other assessments appear normal, lung sounds have demonstrated that mild basilar crackles are present. This essay provides a management plan, diagnostics, education approach, cultural and lifestyle factors critical to consider, information on healthcare maintenance requirements, and a follow-up and referral for the client.

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Management Plan

Based on the information in the case study, it appears like the client has been suffering from hypertension (high blood pressure). A management plan for C.D would incorporate both pharmacological interventions and lifestyle changes to improve his health (Tykarski et al., 2015). He should be put on hypertensive drugs immediately to lower systolic and diastolic pressures. Some of the recommended medications on which C.D should be put include ACE inhibitor, thiazide-type diuretic, as well as angiotensin receptor blocker. For example, he can be offered 25 milligrams of hydrochlorothiazide once daily, but the amount can be increased to 50 milligrams if there is a good response (Tykarski et al., 2015). As part of the management plan, lifestyle and cultural changes are discussed in the next section.

Cultural and Lifestyle Considerations

Since the patient smokes and consumes alcohol, he should quit these habits to manage hypertension and improve health in general. However, the client should be advised to stop smoking and drinking by reducing quantities progressively. If he quits them immediately, withdrawal consequences might be severe. If he limits alcohol consumption to only two beers daily, this could lower blood pressure by about 2 to 4 mmHg (Angell, De Cock, & Frieden, 2015). Research has shown that lifestyle changes should be included in the patient’s management plan to handle elevated blood pressure. Calculation of C.D’s BMI shows that it is at 31.7, and this figure shows that he is obese. To reduce the BMI to a healthy point, he should start to participate in physical activities for a minimum of thirty minutes daily. Diet modifications would also be included in the plan. His daily sodium intake should be less than 2.4 grams (Angell et al., 2015). In addition, his diet should incorporate fruits, lean meat, vegetables, as well as dairy products containing low quantities of fat.

Diagnostics

For the provider to determine the causative factors for D.C’s high blood pressure, he or she would perform diagnostic tests. These would concentrate on the evaluation of the target organs and conditions (Savoia et al., 2017). However, they would not focus on the secondary causes of hypertension. In the context of the case study, an electrocardiogram would help to determine the current condition of the client’s heart. An echocardiogram (ECHO) would go a long way in finding out causative factors for high blood pressure. Moreover, this test can reveal the pumping ability of the heart, working conditions of valves, and any factors that may be affecting the normal physiology of blood vessels. It would also be important to conduct a renal ultrasound to assess whether the patient is suffering from renal artery stenosis that may result in high blood pressure and kidney damage. Research has demonstrated that pheochromocytomas can cause of hypertension (Savoia et al., 2017). Thus, the provider can perform a CT scan of chest/abdomen/pelvis to find out any organ abnormalities.

Education and Health Promotion

Providing patients with appropriate information about conditions or diseases can help them to improve their health outcomes. It is recommended that providers should involve patients to develop plans of care to achieve therapeutic objectives and align them with the needs of clients. The patient in the case study should be made aware of the importance of being put on hypertensive drugs to control both his systolic and diastolic pressures (Angell et al., 2015). D.C should be educated on how to monitor his blood pressure daily using an automatic machine. Moreover, he should be told the significance of adopting lifestyle modifications like ceasing smoking, reducing the amount of alcohol and sodium intake, eating more fruits, vegetables and white meat.

Education Strategies

Appropriate approaches should be applied to teach the client in the case study. For example, the healthcare practitioner should demonstrate to the patient how he would be obtaining accurate pressure readings using an automatic machine. In order to gauge if the client has understood, the provider should ask him to teach him what he has learned. Another strategy to ensure that the patient understands and adheres to the management plan is to adopt written materials that contain pictures. In addition, D.C should be shown how to read and interpret food labels; this would help him to avoid some products that may contain large amounts of salt and fat (Tykarski et al., 2015). He can also be provided with a journal to keep a record of blood pressure readings.

D.C would be advised to visit his provider after three to six months to assess effectiveness and adherence to the management plan geared toward handling hypertension. However, checkups may be shortened to two to three weeks if it would be established that the plan is ineffective. In the event that the patient does not respond well to the medications and lifestyle changes, the provider would initiate a referral process for the client to seek management for hypertension in other facilities. If the approaches to manage hypertension are working well, visits to the provider may be reduced to only once in a year (Tykarski et al., 2015). Notably, these annual follow-ups will continue to evaluate how the medications are working and check for any side effects.

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Conclusions

This essay has shown that the client in the case study is suffering from hypertension, which would be managed by medications as well as modifications of lifestyle. In order to ensure that the strategies for handling the condition are effective, the provider should teach the patient the importance of adopting them. In addition, the best steps to use an automatic machine to obtain pressure readings should be demonstrated. Follow-ups are recommended to assess whether the patient is adhering to the management plan and if it is helping him to improve health.

References

Angell, S. Y., De Cock, K. M., & Frieden, T. R. (2015). A public health approach to global management of hypertension. The Lancet, 385(9970), 825-827.

Savoia, C., Volpe, M., Grassi, G., Borghi, C., Rosei, E. A., & Touyz, R. M. (2017). Personalized medicine — A modern approach for the diagnosis and management of hypertension. Clinical Science, 131(22), 2671-2685.

Tykarski, A., Narkiewicz, K., Gaciong, Z., Januszewicz, A., Litwin, M., & Kostka-Jeziorny, K. (2015). Guidelines for the management of hypertension. Arterial Hypertension, 19(2), 53-83.

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