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Case Study on a Client with HTN

Ronald Sanford, a 37-year-old diagnosed with essential hypertension, has an average blood pressure of 160/94 mm Hg and a family history of hypertension. He is prescribed lisinopril and hydrochlorothiazide to manage his condition, with instructions on monitoring his blood pressure and avoiding adverse effects. After two years, atenolol is added to his regimen due to increasing blood pressure, but he experiences fatigue and decreased sexual activity, which are common side effects of the medication.

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13 views

Case Study on a Client with HTN

Ronald Sanford, a 37-year-old diagnosed with essential hypertension, has an average blood pressure of 160/94 mm Hg and a family history of hypertension. He is prescribed lisinopril and hydrochlorothiazide to manage his condition, with instructions on monitoring his blood pressure and avoiding adverse effects. After two years, atenolol is added to his regimen due to increasing blood pressure, but he experiences fatigue and decreased sexual activity, which are common side effects of the medication.

Uploaded by

feguy.lindor
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Case Study—The Client With Hypertension

Ronald Sanford, age 37 years, is diagnosed with essential hypertension. His blood
pressure has been ranging between 148- and 176-mm Hg systolic and 90 and 110 mm Hg
diastolic. His average blood pressure is 160/94 mm Hg.
There is a strong family history of hypertension and stroke on both sides of the family.
Mr. Sanford is married, with two school-age children. He works full-time as a loading
dock supervisor for a long-distance trucking company. His elevated blood pressure was
found during a routine physical examination. He reports no other manifestations. At this
time, there is no evidence of renal insufficiency or retinopathy.
Mr. Sanford is to begin taking lisinopril, 10 mg daily, and hydrochlorothiazide, 50 mg
daily.
1. Lisinopril is an angiotensin-converting enzyme inhibitor (ACEI). How will this
type of drug contribute to the control of Mr. Sanford's blood pressure?
Lisinopril, as ACEI, will contribute to controlling Mr. Sanford's blood pressure by:
 blocking the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor.
 Inhibiting angiotensin II production decreases constriction of blood vessels.
 The relaxation of blood vessels leads to vasodilation. These effects will help lower Mr.
Sanford's blood pressure by reducing peripheral resistance and making it easier for the
heart to pump blood. Furthermore, ACEIs like Lisinopril can also reduce the workload on
the heart, which may help manage hypertension and reduce the risk of cardiovascular
complications.
2. Describe the antihypertensive action of hydrochlorothiazide.
A. Hydrochlorothiazide (HCTZ) is a diuretic medication that improves urine production and
removes excess fluid and sodium from the body. As a result, sodium and chloride ions are not
reabsorbed by the kidneys, which leads to a decrease in blood volume and, subsequently, a
decrease in blood pressure. Hypertension can be effectively treated with this antihypertensive
effect because it reduces the workload on the heart and blood vessels.
3. What does Mr. Sanford need to know about taking his medications and avoiding
adverse effects?

Mr. Sanford should know the following to avoid adverse effects and take his medications
effectively:
 Ensure he takes the right medication, at the right dose, at the right time, and for the full
duration recommended.
 Encourage him to monitor his blood pressure at home and report any significant changes
to his healthcare provider.
 Follow up with his provider: Schedule regular check-ups to assess the medication's
effectiveness and monitor for potential side effects.
 Report side effects: Encourage him to report any unusual symptoms or side effects to his
provider immediately.
 Be aware of potential drug interactions: Tell him about over-the-counter medications,
supplements, and herbal products and advise him to consult his doctor before taking new
medications.
 Recommend dosage instructions: Warn him against taking more or less of the medication
than prescribed and caution him against stopping or skipping doses without consulting his
provider.

By understanding these key points, Mr. Sanford can take his medications safely and effectively,
minimizing adverse effects.

4. In addition to drug therapy, what non-pharmacologic measures should you teach


Mr. Sanford to help lower his blood pressure?
Follow the instructions on his medication and take it at the same time each day.
 Inform his healthcare provider of any side effects or concerns.
 Monitor his blood pressure regularly and report any changes.
 Avoid potassium-rich foods and supplements while taking HCTZ.
 Avoid alcohol and NSAIDs while taking Lisinopril.
 Weigh himself daily to monitor his fluid status.
Non-pharmacologic measures for lowering blood pressure:
 Follow a healthy diet such as the DASH diet.
 Increase physical activity levels, aiming for at least 30 minutes of moderate-intensity
exercise per day.
 Maintain a healthy weight.
 Limit sodium intake to less than 2,300 mg per day.
 ◦ Manage stress through relaxation techniques, such as deep breathing or meditation
 Get enough sleep (7-8 hours)
 Quit smoking, if applicable.
5. Over the next 2 years, Mr. Sanford experiences a gradual increase in his blood
pressure. Dosage adjustments in the Lisinopril and hydrochlorothiazide fail to lower his
blood pressure effectively. Atenolol, 25 mg two times daily, is added to his treatment
program. How does atenolol lower blood pressure?
A. As a beta-blocker, atenolol lowers blood pressure by reducing heart rate and force of
contraction, which results in a decrease in cardiac output and blood pressure.

6. What does Mr. Sanford need to know about taking atenolol to achieve maximum
therapeutic benefit?
A. It is important that Mr. Sanford takes atenolol regularly, at the same time each day, and not
skip or stop taking it without consulting his doctor first. In addition, he should inform his
provider if he has any symptoms or side effects.

7. After 6 months of this drug therapy, Mr. Sanford's blood pressure is maintained
at 124 to 138 mm Hg systolic and 78 to 88 mm Hg diastolic. However, he complains that he
doesn't seem to have the energy he used to have and that he is having some decrease in
sexual activity. What should you tell Mr. Sanford about these concerns and their
relationship to the addition of Atenolol to his medication regimen?
A. I would tell Mr. Sanford that fatigue and decreased sexual activity are common side effects of
atenolol and other beta-blockers. I would reassure him that his blood pressure is well-controlled,
but discuss the possibility of adjusting his medication regimen or exploring other causes of his
symptoms with his provider.

Reference

Sinha, S. (2023). Lisinopril uses, dosage, side effects & warnings. Drugs.com.
https://www.drugs.com/lisinopril.html
Smith, D. K., Lennon, R. P., & Carlsgaard, P. B. (2020, March 15). Managing hypertension
using combination therapy. American Family Physician.
https://www.aafp.org/pubs/afp/issues/2020/0315/p341.html

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