NU-664B Week 6 QBank Questions

Value: 100 points

Due: Day 7

Gradebook Category: QBank

Please navigate to your APEA learning portal and complete a 20-question practice quiz related to the body system/topics covered this week. You may choose whichever test mode you like. You may complete as many 20-question quizzes as you like to improve your score. Once you are satisfied with your score, please take a screenshot of the quiz score you would like to count and submit to the Moodle dropbox. Please be sure the following are visible in your screenshot:

1. Your name
2. Date (must be completed in the week it is due)
3. Number of questions completed
4. Topics questions came from
5. Overall score

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Submission status	Submitted for grading
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Last modified	Monday, 6 February 2023, 11:10 PM
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Differential Diagnoses

1.     Hypertension – also called high blood pressure- is a condition where a patient’s blood pressure tends to be higher than normal. High blood pressure is characterized by changes in vision, headaches, fatigue, chest pain, ear pain, buzzing, and confusion (WHO, 2021). The condition relates to the case because the patient complained of having a change in vision, fatigue after medication, headache, and swollen legs. The presented symptoms confirm the diagnosis.

2.     Aortic valve disease – is a health condition affecting the heart valve. The valve between the aorta and the left ventricle fails to function correctly, causing the blood not to flow in the correct direction through the heart (Wenn & Zeltser, 2022). The disease is characterized by fatigue, dizziness, shortness of breath, and chest pain. The condition was ruled out by dizziness, shortness of breath, and chest pain because the patient denied these symptoms.

3.     White coat hypertension. White coat hypertension occurs when blood pressure is consistently elevated in the office but remains normal in out-of-office readings (Basile & Bloch, 2022). This is one example of a patient who has normal blood pressure at home but has elevated blood pressure readings in medical settings or in front of health care providers. However, based on the patient’s response, this patient consistently has elevated blood pressure readings and similar subjective findings. Her most recent blood pressure reading at home was 142/90 mmHg. a month ago

4.      Hyperaldosteronism – is a condition where the adrenal gland releases excess aldosterone that causes high blood pressure and reduces potassium levels in the body. It is characterized by high blood pressure, fatigue, headache, numbness, reduced potassium levels in the blood, and muscle weakness (Penn Medicine, 2021). The condition was ruled out by numbness, reduced potassium levels in the blood, and muscle weakness.

Plan of Care for Hypertension

Pharmacology

Atenolol 50 mg daily due to bradycardia and tapered down to avoid rebound hypertension (Steinman and Reve, 2021).

Lisinopril 10 mg daily.

Non-Pharmacology

      Change in lifestyle – the patient should adopt a healthy lifestyle by taking a healthy diet and engaging in physical exercises (Verma et al., 2021). The patient eats unhealthy meals and is not physically active, leading to weight gain and thus causing health complications such as heart attacks.

     Healthy diets – the patient has no time or finance to afford healthy foods, so she takes food rich in saturated fat that could lead to further health complications (Verma et al., 2021). She should also reduce her intake of salt and alcohol.

     Physical exercises – the patient should create a few hours daily to do physical exercises (Verma et al., 2021).

Labs/Diagnostics

       A complete blood count (Dunphy et al., 2019).

      CMP with GFR (Dunphy et al., 2019).

      EKG (Dunphy et al., 2019).

      Urinalysis (Dunphy et al., 2019).

      Hemoglobin A1C (Dunphy et al., 2019).

     Lipid Panel (Dunphy et al., 2019).

Referrals/Interprofessional Communication

      A patient with hypertension should be referred to a specialist or a cardiologist if the blood pressure is severe, they have difficulties with the prescribed medication, young age hypertension, hypertension during pregnancy, and when the doctor suspects they have secondary hypertension.

Patient Education

    The diagnosis – the patient should understand her current diagnosis, which should be done through education. The doctor should explain to the patient her underlying condition, how to manage it, and how she can prevent further complications.

       Blood pressure readings – the patient should understand the readings after measuring her blood pressure (Elsevier, 2022). If her blood pressure is high and seems to worsen, she should talk to the doctor.

       Possible complications – the possible complications of hypertension, when not managed correctly, include heart attack, aneurysm, vascular dementia, and stroke (Elsevier, 2022).

      Diet – the patient should maintain a healthy diet with less salt and fats. Consume plenty of fruits, vegetables, and water (Elsevier, 2022).

       Alcohol consumption – she should also reduce or stop consuming alcohol because it could worsen her condition (Elsevier, 2022).

      Physical activities – the patient should exercise regularly (Elsevier, 2022). She should create a few hours a day, in the morning or evening, after school to exercise.

      Medication – the patient should adhere to the prescribed medicines and not miss taking them for improved results (Elsevier, 2022). Also, she should talk to the doctor before taking over-the-counter medicines. Patients with hypertension are only advised to use aspirin or acetaminophen as the only over-the-counter medicines.

      Blood pressure monitoring – the patient should monitor their blood pressure at least once or twice daily (Elsevier, 2022). Before monitoring the pressure, they should have rested for about 30 minutes before.

       When to visit the hospital – the patient is advised to visit the hospital immediately if they experience a severe headache that does not go away after taking medications and if the blood pressure does not reduce after taking the prescribed medicines (Elsevier, 2022).

      Support groups and programs – the patient should identify and join the available support groups and programs in the community (Elsevier, 2022). These programs can help patients adopt a healthy lifestyle that promotes managing their health.

     Hypertension is a long-term health condition, so the patient should aim to maintain normal blood pressure by taking the prescribed medicines and maintaining a healthy lifestyle.

Follow Up

       Patients with hypertension should have a follow-up plan at 3-6 months, but those with higher blood pressure should have a follow-up plan at an interval of 1-2 months. Since the blood pressure for the patient has reduced after increasing the dosage, they should have a longer interval. She will be required to return to the hospital after five months for a follow-up check-up to assess the patient’s progress.

Health Maintenance Item

       Lifestyle is a health maintenance item that the patient should consider. The item is important because it will help the patient maintain hypertension. Lifestyle includes reducing or eliminating the intake of alcohol, engaging in regular physical activities, consuming healthy meals with less fat and salt, and getting enough sleep. Also, the patient should adopt a stress management strategy that would help her manage stress so that she can get enough quality sleep.

Social Determinants of Health

      The social determinant of health that the patient may face is the individual socioeconomic status. The management of hypertension can be influenced by an individual’s education, income, and occupation (Nakagomi et al., 2022). In this case, the patient is a school teacher, and she said she had no time to cook because she was too occupied with her work at school. The patient’s occupation forces her to order unhealthy fast foods, given that she has a condition that requires her to eat healthily. Also, she is not physically active because she has no time to engage in physical exercise. Her income also affects how she manages her health condition. She admitted that she ordered fast food because she could not afford healthy food.

References

Basile, J., & Bloch, M. J. (2022). Overview of hypertension in adults. (In Forman, J. P. Ed.) https://www.uptodate.com/contents/overview-of-hypertension-in-adults

Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D. (2019). Primary care: Art and science of advanced practice nursing – An interprofessional approach. (5th ed.). Philadelphia, P.A., F.A. Davis.

Elsevier. (2022). Managing your hypertension. https://elsevier.health/en-US/preview/managing-your-hypertension

Nakagomi, A., Yasufuku, Y., Ueno, T., & Kondo, K. (2022). Social determinants of hypertension in high-income countries: A narrative literature review and future directions. Hypertension Research, 45(10), 1575-1581.

Penn Medicine. (2021). Hyperaldosteronism (Conn Syndrome). https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/hyperaldosteronism

Steinman, M., Reeve, E., (2021). Deprescribing. Up to Date. www.uptodate.com

Verma, N., Rastogi, S., Chia, Y. C., Siddique, S., Turana, Y., Cheng, H. M., … & Kario, K. (2021). Non‐pharmacological management of hypertension. The Journal of Clinical Hypertension, 23(7), 1275-1283.

Wenn, P., & Zeltser, R. (2022). Aortic Valve Disease. In StatPearls [Internet]. StatPearls Publishing.

World Health Organization, WHO. (2021). Hypertension. https://www.who.int/news-room/fact-sheets/detail/hypertension#:~:text=When%20symptoms%20do%20occur%2C%20they,chest%20pain%2C%20and%20muscle%20tremors.