Question

1. How long has the client had the issue(s)? Briefly explain the cardiac issue.

2. Is there a family history of cardiac issues?

3. What medications are being taken to address the issue? (List name, dosage, and frequency of medications related to the cardiac condition ONLY).

4. How is the cardiac condition being managed?

5. Discuss any education you provided to the client regarding his or her treatment plan. (2 key points)

Answer 1

Patient name - James Anderson

Age - 65 year

Sex - male

History - severe headache, nosebleed, fatigue, confusion, chest pain and difficulty in breathing i.e. patient is suffering from high blood pressure(hypertension). He is having such symptoms for last 2 to 3 years.

Definition:-

Elevated BP- 120-129/<80mm hg

Stage-1: 130-139/80-89mm hg

Stage-2: >140/90mm hg

Ambulatory BP recording:-

Avg. Awake bp- >135/85mm hg

Avg. Sleep bp- >120/75 mm hg

Classification:-

Hypertension is divided into primary (essential) and
secondary. Hypertension is classified as "essential" when the causes are generally unknown. Essential hypertension is the most prevalent form of hypertension accounting for 90 per cent of all cases of hypertension. Hypertension is classified as ''secondary" when some other disease process or abnormality is involved in its causation. Prominent among these are diseases of kidney (chronic glomerulo-nephritis
and chronic pyelonephritis), tumours of the adrenal glands, congenital narrowing of the aorta and toxemias of pregnancy. Altogether, these are estimated to account for about 10 per cent or less of the cases of hypertension.

Risk factors:-

1). Non modifiable:-

Age

Sex

Genetic factors

Family history

Ethnicity

2). Modifiable:-

Obesity

Salt intake

Saturated fat

LDL cholesterol

Heart rate

Alcohol

Lack of physical exercise

Environmental stress

Socioeconomic status

Most common cause = idiopathic

Most common secondary cause= renal causes

Congenital cause = coarctation of aorta

Yes, there is family history of hypertension present

James mother was suffering from hypertension for over 10 to 13 years, died due to complication of the same.

TREATMENT OF HYPERTENSION:-
1) DIURETICS:
(a) Thiazides: Hydrochlorothiazide
Chlorthalidone
DOSAGE: 25-100 mg once daily.
(b) High ceiling diuretics: Furosemide
DOSAGE: 20-80 mg once daily in the morning.
(c) K+ sparing: Spironolactone, Amiloride
DOSAGE: 25-50 mg twice daily.
2) ACE INHIBITORS:
Captopril [DOSAGE: 25 mg twice daily]
Enalapril [DOSAGE: 5-20 mg twice daily]
3) ANGIOTENSIN (AT1 RECEPTOR) BLOCKERS:
Losartan [DOSAGE: 50 mg once daily] Candesartan [DOSAGE: 5-10 mg once daily]

4) DIRECT RENIN INHIBITOR:
Aliskiren[DOSAGE: 150-300 mg once daily]
5) CALCIUM CHANNEL BLOCKERS:
Verapamil[DOSAGE: 80-100 mg once daily]
6) BETA- ADRENERGIC BLOCKERS:
Propranolol [DOSAGE: 40-80 mg twice daily]
7) BETA+ALPHA ADRENERGIC BLOCKERS:
Labetalol [DOSAGE: 25-50 mg twice daily] Carvedilol [DOSAGE: 10-25 mg twice daily]
8) ALPHA- ADRENERGIC BLOCKERS:
Prazosin [DOSAGE: 1-4 mg twice daily] Phenoxybenzamine [DOSAGE: 20-60 mg once daily]

9) CENTRAL SYMPATHOLYTICS:
Clonidine [DOSAGE: 100 microgram once/twice daily]
Methyldopa [DOSAGE: 250-500 mg twice daily]
10) VASODILATORS:
Sodium Nitroprusside [DOSAGE: 50 mg once daily]

Education to the patient:-

-Weight reduction
-Adopt DASH
-eating plan modification
-Dietary sodium reduction
-Physical activity
-Moderation of alcohol consumption.
-Maintain normal body weight (BMI :18.5- 24.9)
-Consume a diet rich in fruits. vegetables and low-fat dairy products with a reduced content of saturated fat and total fat
-Reduce dietary sodium intake to no more than 100 mEq d (2.4 g sodium or 6 g sodium chloride)
-Engage in regular aerobic physical activity such as brisk walking (at least 30 minutes per day, most days of the week)
-Limit consumption to no more than two drinks per day.