Question

Consider the scenario below, then follow the instructions underneath it to complete the discussion. If appropriate, support your position with credible resources/examples/evidence and provide APA references.

Mr. B 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

What considerations/actions should the nurse make regarding the client's refusal to restart his blood pressure medication?

• Sit down and listen to the client's reason for refusal to restart antihypertensive medications.
• Evaluate the client understanding level and make realistic plans to educate the client and family.
• Observe the client willingness to participate in the treatment plan.
• Make a power point guided or video guided explanation to the client on the need for maintaining the blood pressure at desired body levels, explain the ill effects of increased blood pressure on the organs and systems, and also stress on the fatal complications like heart attack or stroke.
• Make live streaming of other patients who have gone through same situations and their self explanation on how they dealt with the same situation successfully.
• Help to make an appointment with a hypertension management specialist.
• Advice on the need for a blood pressure apparatus at home and teach how to check BP at home.
• Explain on the home care and regular intake of medicines on correct time, sit up and get out of the bed slowly, lie down when feel giddiness or tired.
• The family also has to be taught to have a tight check on client's blood pressure until he maintains a regular routine with medicines and diet.

What considerations/actions would have helped the healthcare team to prevent the client's fall?

• The client and family must have been taught to check the blood pressure regularly.
• The client has to be advised NOT to jump out of the bed suddenly. He has to sit up and slowly change to standing position in order to prevent orthostatic hypotension.
• The toilet rails or bath rails should have been installed in wash rooms, in order to support the client when he feels giddiness.
• Contact the primary care physician in case of repeated giddiness feel and he may change the dose of medications.
• The client must have asked for help from a family member if he had felt unwell.