NU-664B Week 6 Discussion 1: Patient with Hypertension

1. Are you compliant with your atenolol 75 mg daily? Are you taking it at the same time each day? Are you missing any dosages? (Dunphy et al.,2019) I cut the tablet in half..I don’t think I need that much medication.

2. Are you having any side effects to the atenolol such as dizziness, fatigue, shortness of breath, vivid dreams, depression, sexual dysfunction, nausea, vomiting, diarrhea, or itching? (Dunphy et al.,2019) Yes, thats why I cut it in half. I mostly get really dizzy and feel off. I don’t like feeling that way. I feel better when I take half a dose.

3. Are you under a lot of stress or having anxiety? If so, are you doing anything to help with coping such as meditation, yoga, exercise, or therapy? (Dunphy et al.,2019) I am a teacher, so I have stress on a daily basis. I am too busy to exercise. When I get home I like to relax.

4. Do you use any recreational drugs? (Basile & Bloch,2023) No, I have never used drugs.

5. Are you checking your blood pressure at home? If so, what are the readings? (Basile & Bloch, 2023) Yes, when I think about it. The readings are usually 130’s over 80’s. They always seem to be higher when I come here.

6. What is your diet like? Do you add salt to food? Do you eat a lot of sodium or processed foods? (Basile & Bloch, 2023) I add salt to everything for flavor. I eat a lot of beans, rice, and meat.

7. Do you drink alcohol? If so, how much? (Basile & Bloch, 2023) I drink socially. When I have a family bbq or something.

8. Do you exercise? (Basile & Bloch, 2023) I don’t have time to exercise.

9. Do you snore at night? If so, have you ever been evaluated for sleep apnea (Dunphy et al.,2019) What is sleep apnea? I am not sure if I snore.

10. How much sleep are you getting each night? (Basile & Bloch, 2023) oh, probably 8 hours. I do not really have any troubles sleeping.

11. Are you taking any other medications or over the counter medications or supplements? Are you taking NSAIDs or decongestants? (Dunphy et al.,2019) I take fish oil, vitamin D, and iron. I prefer supplements over medications.

12. Have you seen an eye doctor in the past year? (Dunphy et al.,2019) No, I can see fine.

13. Are you having any chest pain? (Dunphy et al.,2019) Nope. I feel good.

14. Do you have any history of diabetes? If so, do you check your blood sugar and what are the readings? ((Dunphy et al.,2019) My mom had diabetes, but I don’t. I don’t check, I dont have anything to check it with.

15. Any history of heart disease such as heart attack? (Dunphy et al.,2019) One of my parents had one I think, but not me.

16. Any history of asthma or COPD? (Dunphy et al.,2019). No asthma for me.

17. Do you smoke cigarettes? (Dunphy et al.,2019) I did occasionally when I was young, everyone did. I haven’t touched those since I was 20 though.

18. Do you have a stable place to live and access to food? (Basile & Bloch, 2023) Yes.

19. Have you ever tried any other medications for blood pressure? (Basile & Bloch, 2023) No, I said I don’t like the way those medications make me feel.

20. How long ago were you diagnosed with hypertension? (Basile & Bloch, 2023) Two years ago.

Week 6 Discussion 1: Patient with Hypertension

Done: Make forum posts: 1

Value: 100 points

Due: Create your initial post on Day 3, Initial Response post by Day 5, and Reflective Response by Day 7.

Gradebook Category: Simulated OV Discussions

Instructions

Prior to completing this first discussion forum, please watch the Discussion Board Directions video for more information on how to complete the forums.

Discussion Board Instructions (2:53 Minutes)

Discussion Board Instructions Video Transcript

Initial Post

Imagine that you are a primary care provider in the middle of your busy Thursday. Your 10:30 a.m. office appointment is as follows:

HPI: A 50-y-old Spanish-speaking female who is bilingual returns to your office for a follow-up BP check. She is a schoolteacher and has been your patient for many years. She arrives 45 min late for her appointment. At her previous visit 4 weeks ago, her BP was 160/90 mm Hg on atenolol 50 mg QD (Tenormin, beta-blocker, max dose 100 mg QD), and you increased the atenolol to 75 mg QD at that time.

Today she feels well, and her BP is 140/85 mm Hg on 2 measurements and her HR is 50 bpm.

Labs: CBC (WNL), Creatinine 2.0 mg/dl (normal range 0.5–1.3 mg/dl), potassium 3.8 MEQ/L (nml range 3.5–5 MEQ/L), and a 24 h urine protein of 1.3 g (normal <150 mg/d), similar to her previous lab results 6 month ago.

Allergies: NKDA

Family History: Father (deceased 85 y/o CVA); Mother (deceased 91 y/o MI)

Physical Exam

• Vitals: BP 140/85, HR 50, RR 18, Wt 132 lbs, Ht 5’1”
• HEENT: PERRL, Funduscopic exam notes cotton wool spots present.
• Respiratory: Lungs were clear bilaterally with good aeration.
• Cardiac: RRR, S1/S2 auscultated. 2+ pitting edema bilaterally.
• Abdominal: Unremarkable
• Integumentary: Intact.
• Vascular: Capillary refill +3

Complete the following:

Initial Post by Wednesday (Day 3) at 11:59 p.m.

• List 10–20 questions of subjective information that your patient will need to provide to help you formulate your differential diagnoses and plan. Include two scholarly references for the questions that you ask of your patient. See the Grading Rubric for more detail.
• Initial Post by Wednesday (Day 3) at 11:59 pm

Initial Response Post by Friday (Day 5) 11:59 p.m. Choose a classmate’s questions to answer:

• Every peer post should only have one response post. Please do not reply to a peer if a response is already posted.
• You are answering as the patient. Make it case appropriate but imaginative. Be creative and answer thoroughly. No references are needed.

Reply Posts

Reflective Response Post by Sunday (Day 7). Please respond with the following:

• Four appropriate differential diagnoses and rationales with references. For each differential diagnosis, explain why this is an appropriate differential and how it was/would be ruled in or out. Support your answers with references.
• Pick one differential and create a plan of care for that patient.
  • Plans must include Pharmacology, Non-Pharmacology, Labs/Diagnostics, Referrals/Interprofessional Communications, Patient Education (10–15 individual items minimum) and follow up.
  • Make sure to pick one health maintenance item for this patient (primary or secondary) and explain to the patient why this is important.
  • Address one social determinant of the health this patient may face during your visit. How will you help the patient overcome this obstacle to health care?

Please refer to the Grading Rubric for details on how this activity will be graded.

Posting to the Discussion Forum

1. Select the appropriate Thread.
2. Select Reply.
3. Create your post.
4. Select Post to Forum.