Question

Mr. B, a 70-year-old male client, presented to his primary care physician with complaints of blurred vision and headaches over the last two months. On several visits, Mr. B's blood pressure was found to be elevated, so the physician started him on hydrochlorothiazide 25 mg by mouth daily. One month later, Mr. B began to have chest pains and shortness of breath, so his primary care provider referred Mr. B to a cardiologist for further evaluation. The cardiologist ordered an echocardiogram and stress test which revealed heart enlargement and a reduced ejection fraction (volume of blood pumped out of the heart per minute). As a result, the cardiologist started Mr. B on a beta-blocker (metoprolol 25 mg by mouth daily). A few days after taking the new medication (in addition to the hydrochlorothiazide ordered by the primary physician), Mr. B suffered a fall at home. Upon arrival at the emergency room, Mr. B's blood pressure was 80/50. The emergency room physician suspected the cause of Mr. B's fall was hypotension secondary to the medications he was taking. The ER physician recommended that Mr. B follow up with his primary care physician and cardiologist, but hold the medication until seen by them. As recommended, Mr. B visits his primary care physician for a follow-up. During the visit, Mr. B's blood pressure is found to be elevated (160/90), so his physician tells Mr. B to restart taking his blood pressure medication.

Imagine that you are the nurse attending to Mr. B and that he indicates that he's afraid to restart the medication because of his recent fall.

1. What considerations/actions should the nurse make regarding the client's refusal to restart his blood pressure medication?
2. What considerations/actions would have helped the healthcare team to prevent the client's fall?

Answer 1

1.Nurse as a client advocater inform the condition to the physician and to the cardiologist about afraid of taking drug and also he is taking two antihypertensive.So the nurse has to ask the doctors whether it is necessary take both antihypertensive at a time or reduce the dosage.Inform Doctors to stop anyone of the drug or else give necessary to counseling to the client.

2.The health care team must ensure the proper drug and dosage taken by the client.Here the client taken two antihypertensive.Atleast the physician or cardiologist or the nurse must see all the drugs taken by the client and the primary physician of the client should with hold or stop any of the medications.orelse the cardiologist should inform only his prescribed drug only is enough and don't take other medications along with it. It should not be without checking blood pressure.Thats the reason the client encounter by hypotension.No one take any action that is the reason for hypotension.