Cardio Case Study Assignment

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Cardio Case Study Assignment

George Lucas, a 68 year old African American man who recently moved to your state from Florida, was referred to your physician’s practice for follow-up.  He has heard great things about your approach as a nurse practitioner from his neighbor, Mrs. Channel. He has a past history remarkable for diet-controlled diabetes mellitus type II.  He also reports previous high blood pressure readings.  His average on his home monitor is 150/85.  He is not currently taking any medications as he has been told that his blood pressure is not unusual for his age.  He denies any history of heart or kidney disease.  He has a 20-pack year history of smoking and denies alcohol or recreational drug use. He is living alone and is functioning independently. Family history is positive for hypertension and stroke.Cardio Case Study Assignment

On physical exam, G.L. is 5’ 10” and weighs 197lbs.  His sitting blood pressure is 162/88 mmHg.  Pulse is 76/min regular and full of volume.  You listen carefully for bruits and looked for signs of target organ damage.  G.L.’s complete examination was otherwise normal.

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Questions:

  1. What is your differential diagnosis with rationale.
  2. What are the general considerations with HTN?
  3. What are the age associated changes related to HTN?
  4. What is the prevalence of HTN in the U.S.?
  5. What would your diagnostic evaluation entail?
  6. Will you start G.L. on an antihypertensive medication at this time?
  7. What will be your follow-up plan?
  8. What would your patient education involve at this point?
  9. Current research on HTN and your present treatment plan. (Summarize in your own words).

Part II:

You choose to bring G.L. back for a repeat blood pressure check and follow-up, rather than start him on any medication.  You put in place a mechanism by which his blood pressure can be measured reliably at home pending his next appointment.  You emphasize the importance of reporting to you if his systolic blood pressure rises above 160 mmHg or his diastolic above 100 mmHg.

You are now seeing Mr. Lucas on follow-up 2 weeks after his initial visit.  He has no symptoms to report and he tells you Mrs. Channel says hello.  The average BP readings from home is 158/89 mmHg. No changes in his weight from previous visit.  His carefully repeated BP is  160/88 mmHg. His other examination findings are unchanged from previous visit.  His CXR was normal.  Fasting BG was 156mg/dL and hemoglobin A1C was 8.2%. Total cholesterol was 185 mg/dL, triglyceride 230mg/dL, HDL 48 mg/dL, and LDL 114 mg/dL. He also has microalbumniuria.  His other serum chemistries, LFTs, and CBC were WNL. You conclude that G.L. does have stage 1 or 2 HTN and type II DM.Cardio Case Study Assignment

Questions:

  1. How do you evaluate for target organ damage secondary from HTN?
  2. What other CV risk factors does G.L. have?
  3. What are your management considerations for this patient?
  4. What non-pharmacologic lifestyle modifications will you initiate?
  5. What will be your goal for weight reduction?
  6. In what risk group is G.L.?
  7. Will you start antihypertensive medications at this time? If so, what are your options?
  8. What steps will you take to ensure/encourage medication adherence?
  9. What will be your goal for BP reduction and when will you follow-up?
  10. What are the consequences of uncontrolled HTN and their possible management strategies?

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Cardio Case Study Assignment