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Posted: July 7th, 2022
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 and include at least one 100-word response to a classmate. Follow APA guidelines for references. At least one . Discussion 2 Pharm
________________________
The nurse should respond to Mark’s question by explaining that even though his current blood pressure is below 140 mm Hg systolic, it is still considered elevated and requires further management. The goal of hypertension treatment is not just to bring the blood pressure below 140 mm Hg, but also to reduce the risk of complications associated with hypertension, such as heart disease, stroke, and kidney damage. By adding captopril, the healthcare provider aims to further lower Mark’s blood pressure and provide additional protection for his kidneys and cardiovascular system. It is important to emphasize that hypertension is a chronic condition that requires ongoing management and that combination therapy with multiple medications is often necessary to achieve optimal blood pressure control and reduce the risk of complications.
Captopril was chosen in Mark’s case due to his medical history, particularly his type 1 diabetes mellitus and early signs of nephropathy. Captopril is an angiotensin-converting enzyme (ACE) inhibitor, which has shown benefits in reducing blood pressure and protecting kidney function in patients with diabetes-related kidney disease. ACE inhibitors, such as captopril, can help decrease proteinuria and slow down the progression of diabetic nephropathy. Furthermore, ACE inhibitors have been shown to be beneficial in patients with a history of myocardial infarction, as they can improve cardiac function and reduce the risk of future cardiovascular events. Therefore, captopril is a suitable choice in Mark’s case to address his hypertension and provide renal and cardiovascular protection.
In teaching Mark about the medications captopril and metoprolol, the nurse should include the following points to minimize adverse effects:
Captopril: Inform Mark about the possibility of a dry cough as a common side effect of ACE inhibitors. If he experiences this side effect, he should notify his healthcare provider. Also, educate him about the importance of regular blood tests to monitor renal function and potassium levels while taking captopril. Emphasize the need to avoid pregnancy while on captopril due to its potential teratogenic effects.
Metoprolol: Explain to Mark that metoprolol is a beta-blocker that can cause fatigue, dizziness, and low blood pressure. Advise him to rise slowly from a sitting or lying position to minimize dizziness. Instruct him not to abruptly stop taking metoprolol without consulting his healthcare provider, as sudden discontinuation can lead to rebound hypertension or other adverse effects. It is important to emphasize that compliance with the prescribed medication regimen is crucial for the management of his hypertension and overall health.
References:
National Institute for Health and Care Excellence. (2019). Hypertension in adults: diagnosis and management. Retrieved from https://www.nice.org.uk/guidance/ng136
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