Nursing
Topic: Cardiovascular disease in women
Paper details:
ase Study:
J.S. is a 54-year-old Hispanic woman who presents to her primary-care clinician for follow-up regarding elevated blood pressure. She was last seen 2 weeks prior with a blood pressure of 162/94 mmHg. She has no significant medical history, she is a 1 ppd tobacco user with a history of 25 pack-years, and she has a family history of premature cardiac death.
Assessment:
Her vital signs are as follows: height, 5 ft 4 in.; weight, 188 lb.; pulse, 84 beats/min; blood pressure, 168/98 mmHg; and body mass index, 32.3. As J.S. has been found to be hypertensive (>149/90) on two consecutive office visits, starting an antihypertensive medication is indicated.
Questions:
What is your initial choice for an antihypertensive medication in this patient? (Support your treatment plan with a discussion of the evidence based guideline you utilized)
Which therapeutic lifestyle change is a priority in helping J.S. achieve blood pressure control?
Which of the following diagnostic tests would you order for J.S. to establish a baseline before starting an anti-hypertensive?
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Initial choice for an antihypertensive medication in this patient
The initial choice for an antihypertensive medication in this patient would be a thiazide diuretic. Thiazide diuretics are the first-line treatment for hypertension in most patients, and they are effective in lowering blood pressure and reducing the risk of cardiovascular events. In addition, thiazide diuretics are relatively inexpensive and well-tolerated.
The evidence for the use of thiazide diuretics in hypertension is strong. The Seventh Joint National Committee on Prevention, Detection, Assessment, and Treatment of High Blood Pressure (JNC 7) guidelines recommend thiazide diuretics as the first-line treatment for hypertension in most patients. The guidelines also state that thiazide diuretics are effective in reducing the risk of cardiovascular events, including stroke, heart attack, and death.
Therapeutic lifestyle changes
In addition to medication, lifestyle changes are an important part of the treatment for hypertension. Therapeutic lifestyle changes (TLC) include weight loss, exercise, a healthy diet, and smoking cessation. TLC can help to lower blood pressure and reduce the risk of cardiovascular events.
The JNC 7 guidelines recommend that all patients with hypertension make TLC. The guidelines state that TLC can lower blood pressure by 10-20 mmHg, and that this reduction in blood pressure can reduce the risk of cardiovascular events by 20-30%.
Diagnostic tests
Before starting an antihypertensive medication, it is important to establish a baseline of the patient’s health. This includes a physical exam, blood work, and an electrocardiogram (EKG).
The physical exam should include a check of the patient’s blood pressure, pulse, heart rate, and respiratory rate. The doctor should also check the patient’s weight, height, and body mass index (BMI).
The blood work should include a complete blood count (CBC), a blood chemistry panel, and a lipid profile. The CBC will check for anemia, which can be a side effect of some antihypertensive medications. The blood chemistry panel will check for kidney function, liver function, and electrolytes. The lipid profile will check for cholesterol and triglycerides.
The EKG is a test that checks the electrical activity of the heart. The EKG can be used to check for heart disease, which is a risk factor for hypertension.
Conclusion
J.S. is a 54-year-old Hispanic woman with hypertension. Her initial choice for an antihypertensive medication would be a thiazide diuretic. In addition to medication, she should make lifestyle changes, such as weight loss, exercise, a healthy diet, and smoking cessation. Before starting an antihypertensive medication, it is important to establish a baseline of her health. This includes a physical exam, blood work, and an EKG.
