Question

Case Study, Chapter 26, Drug Therapy for Hypertension

Mark Ilescu is a 44-year-old client who has been diagnosed with primary hypertension. His medical history includes type 1 diabetes mellitus, with early signs of nephropathy. He had a myocardial infarction 2 years ago and has been treated with a beta-blocker, metoprolol, since that time. He has been taking hydrochlorothiazide in addition to the beta-blocker to treat his hypertension. His blood pressure today is 138/92 mm Hg, which is consistent with the readings on his last three visits. His physician has added captopril to his treatment regimen.

1. Mark states that he does not understand why he needs an additional medication considering his blood pressure is below 140 mm Hg systolic. How should the nurse respond?
2. Discuss the rationale for choosing captopril in Mark’s case.
3. What should the nurse include in teaching Mark in order to minimize adverse effects of the captopril and metoprolol?

Answer 1

1. Hello, Mr Mark. Dr has advised you to take Captopril. Actually sir, by reducing blood pressure and fluid retention, captopril helps to prevent heart failure. It also prevents and controls diabetic nephropathy (kidney disease) and help control diabetic retinopathy (eye problems). Though it do not slow the heartbeat or directly lower blood sugar.

Sir, as you are having type 1 diabetes mellitus, with early signs of nephropathy doctor has prescribed this medication.

2.  Captopril improves survival following myocardial infarction in clinically stable patients and reduces the incidence of hospitalization.

Captopril decreases the rate of progression of renal insufficiency, thus given in Treatment of diabetic nephropathy in patients with type I insulin-dependent diabetes mellitus.

By reducing blood pressure and fluid retention,Captopril helps to prevent heart failure.

These are the rationals why Captopril is given to Mr. Mark.

3. a.Instruct patient to take medication as directed, at the same time each day, even if feeling well; do not skip or double up on missed doses. Take missed doses as soon as possible up to 8 hr before next dose. Abrupt withdrawal may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia.

b. Teach patient and family how to check pulse daily and BP biweekly and to report significant changes to health care professional.
c. May cause drowsiness. Caution patient to avoid driving or other activities that require alertness until response to the drug is known.
d. Advise patient to change positions slowly to minimize orthostatic hypotension.
e. Caution patient that this medication may increase sensitivity to cold.
f. Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any Rx, OTC, or herbal products, especially cold preparations, concurrently with this medication. Patients on antihypertensive therapy should avoid excessive amounts of coffee, tea, and cola.
g. Diabetics should closely monitor blood glucose, especially if weakness, malaise, irritability, or fatigue occurs. Medication does not block sweating as a sign of hypoglycemia.
h. Advise patient to notify health care professional if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, light-headedness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs.
i. Instruct patient to inform health care professional of medication regimen before treatment or surgery.

j. Advise patient to carry identification describing disease process and medication regimen at all times.

k. Reinforce the need to continue additional therapies for hypertension (weight loss, sodium restriction, stress reduction, regular exercise, moderation of alcohol consumption, and smoking cessation). Medication controls but does not cure hypertension.

l. advise patient to avoid moderately high or high potassium dietary intake. This can cause high levels of potassium in his blood.

These are the advices that should be given to Mr Mark.