Ms Champher is a 50-year-old homemaker of Afro-Caribbean descent who presents at

Question

Ms Champher is a 50-year-old homemaker of Afro-Caribbean descent who presents at your clinic with watery, itchy eyes, runny nose and sneezing. Ms Champher has no significant past medical history except asthma, colds and influenza. However, she does smoke 15 cigarettes per day and drinks alcohol socially.

On examination, and further history taking, you conclude that Ms Champher has hay fever and is allergic to pollen. Apart from the presenting symptoms, she is well but does appear overweight. She states that she feels she has a healthy diet overall. On examination, her vital signs are within the normal limits except her blood pressure, which is 154/94mmHg in her left arm. The second measurement is 150/92 and the final measurement 152/96mmHg. Her chart indicated blood pressure measurements on her previous 2 visits were also elevated. She is 162cm tall and her weight is 75kg.   

1. Diagnosis of hypertension: (check all that apply for diagnosing HTN)

___Take BP in left arm

___Take oral temperature

___Evaluate heart rate

___Take BP in right arm

___Measure respiratory rate

___Check urine for glucose, protein and bacteria

___Height and weight evaluation

___Age

___Multiple visits for evaluation

2, Define the following conditions and indicate expected systolic and diastolic values:

                        (use blood pressure chat attached)

Stage 2 Hypertension:

Boarderline:

Prehypertensive:

Normotensive:

Severe Hypertension:

Hypotension:

Malignant Hypertention:

Stage 1 Hypertension:

3. Indicate the affects of each substance or activity on the BP and its components:

Substance    Blood pressure =        cardiac output         x           peripheral vascular resistance

or Activity                    (BP)                                                                  (CO)                                                                                    (PVR)

nicotine

Alcohol (1serving)

Ibuprophen

Anaphylacic

   Shock

Narcotic

Withdrawl

Sepsis

Meditation

Caffeine

The results from most of the investigations (including renal) are within the normal range except for serum cholesterol, which is 5.9mmol/l. In addition, the 12-lead ECG and echocardiogram results showed evidence of mild LVH (left ventricular hypertrophy) changes, which may be secondary to the hypertension. The results from Ms Champher’s formal assessment of cardiovascular risk were used as a basis to discuss her prognosis as well as her healthcare options. She was placed on the appropriate pharmacological therapy and provided with lifestyle advice that was specific to her needs, i.e. exercise, diet …

4. How does hypertension cause ventricular hypertrophy?

5. List 4 lifestyle changes you recommend for this patient.

6. List the problems this patient has (other than HTN) which you can treat pharmacologically:

A.

B.

C.

7. List the prescriptions you would write for each of these conditions

A

B

C

8. Make a drug card for each medication mentioned in this case.

9. If your patient was prescribed both cimetidine and nifedipine, what type of drug interaction could occur and WHY or HOW?

10. Where are Alpha-1 receptors and What would be the effect of blocking alpha-1 receptors? Name an medication that blocks these receptors.

11. What type of drug interaction could occur with a diuretic and with an ACE-inhibitor? Name a diuretic drug.

12. Describe how an ACE inhibitor works to lower blood pressure. BE Specific!! Name an ace – inhibitor.

13. What stage of Hypertension does your patient suffer from?

14.   Taking into consideration the algorithm and chart below, and your patients other issues and the drugs you have prescribed, what would you prescribe to treat her hypertension? Briefly explain your reasoning.

nicotine

Alcohol (1serving)

Ibuprophen

Anaphylacic

   Shock

Narcotic

Withdrawl

Sepsis

Meditation

Caffeine

Explanation / Answer

1. We will take in to considerstion

-age

-blood pressure of both arms

-multiple visits

-urine for sugar ,protein, bacteria

-height and weight

-heart rate

-oral temperature

2. Stage 2 hypertension:- systolic blood ppressur more than 159mmhg and dystolic more than 99mmhg

Prehypertension:- systolic blood pressure120-139 mmhg and dystolic 80-89 mmhg

Boarderline htn:- 130/85 mmhg

Stage1 htn:- systolic 140-159 mmhg and diastolic 90-99 mmhg

Normotensive:-systolic less than 130 mmhg and diastolic less than 85 mmhg

Severe htn:-systolic more than or equal to 180 mmhg or diastolic more than 110 mmhg

Malignant htn:-htn tha deveolps rapidly and causes some organ damage more than 180/120 mmhg

3. Alcohol ,caffeine, ibuprofen(NSAID), narcotic withdrawl increases blood pressure

Anaphylactic shock,sepsis reduces the blood pressure

4.hypertension causes left ventricular hypertrophy because systemic vascular resistance increases so ventricle will have to contract with more force to pump to supply blood to the body and it will lead to the hypertrophy of left ventricle

Hypertension doesnot have any direct effect on the growth .

5. Reduce weight, quit smoking ,exercise, DASH Diet(eating more fruit and vegetables,less fat diet)

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