Hypertension Senami E. AvosehPurdue University NorthwestNur 192 (Foundations) Professor Desiree Lynn Hilborn04/15/2019Identification I took care of a 96 year-old patient with admitted diagnosis of accelerated hypertension, she had a blood pressure of 171/69 at the beginning of my shift classified as stage 2 hypertension. Hypertension also known as elevated blood pressure (BP) can be associated with a variety of structural changes in the blood vessels and heart which can lead to cardiovascular disease, stroke and renal disease (Yimei Li, 2017). It is one of the leading cause of death in the United States and globally, it causes over 7 million deaths each year (Yimei Li, 2017). Primary hypertension is the most common form of hypertension, it means high BP with no identifiable cause, and it occurs around 95% of all cases of hypertension (Yimei Li, 2017). Hypertension is also named the “silent killer” because it has no identifiable signs and symptoms. My patient showed no signs and symptoms but she was brought to the hospital because she was weak and high blood pressure was noticed upon auscultation. Interventions comparisonMy patient was given blood pressure medications by the nurse to treat hypertension. Some medications given to the patient by the nurse as ordered by the physician to treat high blood pressure were Carvedilol (COREG) tablet, lisinopril (PRINIVIL ZESTRIL) tablet, and atorvastatin (LIPITOR) tablet. My patient’s blood pressure reduced to 137/67 on auscultation few hours after taking the medications. She was also placed on a cardiac diet to help improve her blood pressure. According to Vivek Podder, (2018), elevated blood pressure (hypertension) is said to increase with age, which most commonly and rapidly occur in adults over 60 years. Antihypertensive pharmacotherapy is recommended for treating elevated blood pressure and has been shown to be of benefit to middle aged people and older people aged 60-80 years & above with moderate-to-severe systolic and/or diastolic hypertension to reduce all-cause mortality and cardiovascular morbidity and mortality (Vivek Podder, 2018). However, among older people effectiveness of antihypertensive pharmacotherapy have been comparatively more recent and older people aged over 80 years, may be considered, but a low-maximal intensity is recommended (Vivek Podder, 2018). Medication/Drug therapy for elevated blood pressure should normally begin with a low dose thiazide-type diuretic. If necessary, add a beta-blocker unless a patient is at raised risk of new-onset diabetes, in which case add an ACE-inhibitor. Thirdly, add a dihydropyridine calcium-channel blocker (Long Khanh Dao Le, 2017). Most patient will require more than one medication to achieve target blood pressure and different drugs can be added as needed to achieve normal blood pressure range until further treatment is declined or inappropriate (Long Khanh Dao Le, 2017). If there’s need for more lowering of blood pressure, the use of ACE-inhibitors or beta-blocker can be considered if not yet used, another antihypertensive drug, or referring to a specialist (Long Khanh Dao Le, 2017). Patient’s allergies, medical and surgical history should be put into consideration when administering blood pressure medication to promote safety. According to Long Khanh Dao Le, (2017), substituting an angiotensin receptor blocker should be considered in patients who do not tolerate an ACE-inhibitor due to cough. Antihypertensive pharmacotherapy is also recommended for preventing hypertension, vascular dementia in hypertensive older people and treatment thresholds and targets should be predicated on the patient’s global atherosclerotic risk, target organ damage and comorbid conditions, according to Canadian hypertension guidelines in 2010 (Long Khanh Dao Le, 2017).Antihypertensive therapy should be considered with persistent high blood pressure of 160/100 mmHg, patients with raised cardiovascular risk (ten-year risk of CHD greater than or equal to 15% or CVD greater than or equal to 20% or existing CVD or target organ damage) with persistent blood pressure of more than 140/90 mmHg and in all adult patients regardless of age (caution should be exercised in elderly patients who are frail) (Long Khanh Dao Le, 2017).Comparing the nurse intervention with evidence based article, intervention was similar as it both involves implementation of antihypertensive pharmacotherapy which has been proven to be effective in treating elevated blood pressure.Evaluation I would say outcome/goal was met but partially resolved at the end of my shift. Patient’s blood pressure was still 137/67 mmHg at the end of my shift after taking blood pressure medication which got better compared to her blood pressure (which was 171/69 mmHg) at the beginning of my shift. I said goal/outcome was met because patient’s elevated blood pressure was decreased and according to Long Khanh Dao Le, (2017), blood pressure should be decreased to less than 140/90 mmHg in all patients, and to less than 130/80 mmHg in patients with diabetes mellitus or chronic kidney disease. It was partially resolved because her blood pressure was not fully back to normal blood pressure range which is 120/60 mmHg. However, there was a huge difference in her blood pressure after initiation of antihypertensive pharmacotherapy and she was well rested. Patient also verbalized feeling better than she was the previous day.References Long Khanh Dao Le B.Pharm, MPH, MHHSM. Evidence Summary. Hypertension: Pharmacological Interventions. The Joanna Briggs Institute EBP Database, JBI@Ovid. 2017; JBI1547.Vivek Podder, MBBS Student. Evidence Summary. Hypertension (Older People): Pharmacotherapy . The Joanna Briggs Institute EBP Database, JBI@Ovid. 2018; JBI8838.Yimei Li. Evidence Summary. Hypertension, Primary (Adult): Mineral Supplementation. The Joanna Briggs Institute EBP Database, JBI@Ovid. 2017; JBI1295.
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