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. (Learning Objectives 2, 4, 8, and 9)
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?
Instructions:
Your discussion post should be at least 140 words. Follow APA guidelines for references.
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The nurse should explain to Mark that while his blood pressure is currently below 140/90 mmHg, it is still elevated and puts him at risk for further cardiovascular complications in the long run if not properly managed. As someone with a history of hypertension, diabetes, and a previous heart attack, it is important to get his blood pressure as close to normal (<120/80 mmHg) as possible to reduce strain on his heart and protect his kidneys from further damage. Adding captopril will help lower his blood pressure in combination with the other medications.
Captopril was chosen for Mark because it is an ACE inhibitor like lisinopril. ACE inhibitors work well for patients with hypertension and diabetes or kidney disease by helping relax blood vessels and lower blood pressure. They are also beneficial after a heart attack for their cardioprotective effects. Captopril is a good option given Mark's history of heart disease and early signs of diabetic nephropathy as it can help protect his kidneys.
The nurse should advise Mark about potential side effects of captopril like dizziness or cough and instruct him to notify his doctor right away if they occur. She should also remind him that taking captopril and metoprolol together can sometimes lower his blood pressure too much, so he needs to monitor it regularly and watch for signs of low blood pressure like lightheadedness. Dietary sodium restriction and staying well hydrated can help minimize side effects. The nurse should emphasize the importance of adherence to his full medication regimen and follow up appointments.
