Question

DIRECTIONS: Pretend that you are a recently diagnosed hypertensive patient who comes to the pharmacy to pick up the diuretic that your doctor just prescribed. The diuretic is hydrochlorothiazide 25 mg and is to be taken every morning. The pharmacist counsels you on the new medication; the consequences of uncontrolled hypertension; the importance of adhering to medication, dietary, and physical activity regimens; and the importance of routine self-monitoring of blood pressure.

To help you achieve your goals, the pharmacist gives you a food, physical activity, and blood pressure diary to fill out every day. Your assignment is to “walk in this patient’s shoes” by taking a Tic Tac every morning for one week; filling out the food and physical activity sections of the attached diary every day for one week; and checking your blood pressure once a week for four weeks at your practicum site. You can use the free-standing blood pressure machine at your practicum site or ask your preceptor to take your blood pressure. Finally, answer the questions below. This assignment must be typed.

1. Complete the food, physical activity, and blood pressure diary. (12 points)

2. How many “pretend doses” did you miss? What factors contributed to your non-adherence? (2 points)

3. What difficulties did you encounter when attempting to complete the food, physical activity, and blood pressure diary? (2 points)

4. Based on the insight and experience you gained as a result of this exercise, what advice can you give patients to improve their chances of following the recommendations of their health care team and attaining health outcomes? Please give at least two pieces of advice. (4 points)

Food, Physical Activity, and Blood Pressure Diary
	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Breakfast
Lunch
Dinner
Snacks
Physical Activity

Blood Pressure

Date and Measurement

Date and Measurement

Date and Measurement

Date and Measurement

Answer 1

Complete the food, physical activity, and blood pressure diary. (12 points)

Answer:The food, physical activity, and blood pressure diary for the newly diagnosed hypertensive patient taking diuretic is hydrochlorothiazide 25 mg is tabulated below:

Food, Physical Activity, and Blood Pressure Diary	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
breakfast	bananas, pancakes,milk	oats and milk with almonds and raisins	toast bread with jam,2 bagels,orange juice	scrambled eggs,bread and apple juice	2 boiled eggs ,waffles, cake	cornflakes,soya milk,peanuts
lunch	chicken salad with dressing,cherry tomatoes,apple juice	tuna salad with cherry tomatoes,yogurt	roasted chicken,cauliflower broccoli tomato salad with balsamic dressing	chicken burger and coke	grilled tuna,avocados,baby carrots	pizzas ,coke
dinner	garlic bread,stuffed tomatoes and chicken breast.	mashed potatoes,celery salad ,red wine	grilled chicken,boiled carrots and peas	,boiled chicken, rice,cranberry juice	sauteed salmon with capsicum,cabbage salad with Italian dressing	chicken burgers,roasted sliced turkey,beer
snacks	30 peanuts with shells,pastry	lemon yogurt,almonds	apple juice,cake	wheat crackers,potato chips	cheese wedges,orange juice	chicken nuggets,chips,popcorn
physical activity	morning walk 20 minutes	climbing up stairs at work 15 minutes	gym treadmill workout 25 minutes	running and cycling 30 minutes	gym treadmill workout 25 minutes	No exercise,dancing with friends for 45 mins (house party)
blood pressure	26/10/2020 130/82mmHg	2710/2020 126/82mmHg	28/10/2020 120/80mmHg(6.00pm) 138/96 mmHg(6.05pm) two varied readings 5 mins apart	29/10/2020 124/82mmHg	3010/2020 134/80mmHg	Missed dose 31/10/2020(actually taken blood pressure after midnight after friends left due to headache) 140/92mmHg

How many “pretend doses” did you miss?

answer:

The pretend dose missed during the week from Monday to Saturday was one dose, that is the dose on Saturday.

What factors contributed to your non-adherence? (2 points)

answer:

The reason for missing the dose was a personal preoccupation with a small house party leading to my forgetting the dose:

My inability to take the dose on Saturday was on account of my personal negligience and forgetfulness  to take the dose due to my preoccupation of having to arrange for a small house lunch party for my close friends,

What difficulties did you encounter when attempting to complete the food, physical activity, and blood pressure diary?

answer:

The difficulties and problems I encountered when attempting to complete the food, physical activity, and blood pressure diary are:

1.The difficulty in maintaining discipline and schedule of writing the dairy and  the tendency to ignore or postpone the writing of the diary.

2. The difficulty in following the health care recommendations for eating and exercises based on my personal eating preferences and routine exercise patterns

3.The problems of recall for the smaller details in case I tried to fill up the diary for two days together.

4.The problem of getting two closely taken varied readings for blood pressure on Wednesday as I was trying to record my blood pressure.

5.The problem of non compliance and forgetfulness to the taking of medication on the day when I had a preoccupation with a small house party and resulting high BP on account of it.

6.The problem to plan menu as per dietary recommendations due to less availability/ nonavailability of raw foods /ingredients in my fridge resulting in dairy food entries incongruent to my dietary recommendations.

7.My lack of discipline in following the dietary recommendations and medication on the day of the house party leading to increase in the blood pressure.(cheat day/party day)

Based on the insight and experience you gained as a result of this exercise, what advice can you give patients to improve their chances of following the recommendations of their health care team and attaining health outcomes? Please give at least two pieces of advice. (4 points)

answer: Based on the insight and experience I gained as a result of this exercise, The advices I would give patients to improve their chances of following the recommendations of their health care team and attaining health outcomes are:

1..I would advise the patient to practice self-discipline in trying to maintain the diary and stick to the recommendations . I would advice the patient to make a chart of the recommendations and dairy and stick the diary in the places which are easily approachable or accessible such as the fridge door  or the closet door Taking the diary entries seriously and keeping it alongside with the recommendations will help in the patient to stick to the recommendations. Keeping the diary entries in the places of access or approach will eliminate the problems of forgetting to enter the diary and facilitate better documentation. The patient should also practice the habit of setting up alarms for reminders for the diary entry and the medication compliance.[ This advice is based on account of my personal difficulty in maintaining the diary documentation on account of lack of discipline/inconsistent access and forgetting to take the medication on my busy day of the party due to not setting reminders for the same}

2. I would advice the patient to purchase a standard blood pressure instrument for blood pressure measurement  which is approved by the medical authorities and get verified /checked from his physician or the practicing nurse practitioner before using it in order to eliminate the errors of instrumentation/recording .[This advice is based on my personal experience of recording two close by readings for my blood pressure on Wednesday which were highly variable making me doubt/suspect the the efficiency of my blood pressure recording instrument]

3 Advance.Meal and menu scheduling: The patient would be advised by me to stick to the diet plan as per the dietary recommendations: The patient would also be advised to take a conscious effort to replan his existing meal and snack practices/ eating habits as per the dietary recommendations based on his medical condition. He should arrange for the food purchase as per the dietary recommendations and make the necessary items available in his kitchen. Proper food planning at the beginning of the week with  the listing of required food items and their purchasing helps to stick to dietary recommendations. [This advice is based on my personal experience of facing difficulty in trying to stick to the recommended diet/ menu because of non availability of food items in my kitchen due to the lack of proper planning and therefore my diary entries of food were not in congruence with the dietary recommendations]

4.Appropriate patient education and patient motivation: The compliance of the patient to the dietary physical exercise and medical recommendation requires appropriate patient education and patient motivation. The patient may find it difficult to adapt to the changes in his existing lifestyle, eating habits, exercise habits and hence the patient must be appropriately motivated.I would give the advice to the patient to stay motivated and disciplined regarding the recommendations .I would educate and warn about complications on noncompliance.[This advice is based on my personal experience of the cheat day /party day where I failed to stick to the dietary recommendations and medications]