Unit 2 Discussion 1 Treating Hypertensive Urgencies
Instructions:
Scenario
You have a 57-year-old mixed-race male (black and Asian) who comes into your office for a screening to participate in a study to evaluate the effectiveness of a home cervical traction device on neck pain and intervertebral disc space. He has a history of neck pain and was diagnosed six years ago with spinal stenosis at the C5-C6 level.
During the screening, the gentleman is found to have a BP of 217/109. When you question him about this BP measurement he reports to you that he knows that his blood pressure has been in that range for about the last decade. He reports he has not seen a health care professional about his elevated blood pressure and does not have a health care professional that he sees on a routine basis. He is a healthcare professional at the provider level.
Based on the blood pressure measurement he does not meet the inclusion criterion for the cervical traction device research study.
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.
Discussion Prompt
Utilize the information provided in the scenario to create your discussion post.
1. Construct your response as an abbreviated SOAP note (Subjective Objective Assessment Plan).
2. Therapeutics: pharmacologic interventions, if any – new or revisions to existing; include considerations for OTC agents (pharmacologic and non-pharmacologic/alternative); [optional – any other therapies in lieu of pharmacologic intervention]
3. Educational: health information clients need in order to address their presenting problem(s); health information in support of any of the ‘therapeutics’ identified above; information about follow-up care where appropriate; provision of anticipatory guidance and counseling during the context of the office visit
4. Consultation/Collaboration: if appropriate – collaborative ‘Advanced Care Planning’ with the patient/patient’s care giver; if appropriate -placing the patient in a Transitional Care Model for appropriate pharmacologic and non-pharmacologic care; if appropriate – consult with or referral to another provider while the patient is still in the office; Identification of any future referral you would consider making.
Respond to the additional questions below.
5. What role does disease prevalence of hypertension and cardiovascular disease play among minority groups such as the patient in the study?
6. Considering your role as psychiatric mental health nurse practitioner student is there correlation between mental health and physical health?
· Support the interventions outlined in your ‘P’ with scholarly resources.
Please be sure to validate your opinions and ideas with citations and references in APA form
Example
Unit 2 Discussion 1 – Treating Hypertensive Urgencies
Subjective
The patient is a 57-year-old man who visited the hospital for a screening to participate in
an undergoing study to evaluate the effectiveness of a home cervical traction device for neck
pain and intervabal disc space. The screening reports conducted showed he had blood pressure
(BP) of 217/109 and confirmed that it has been in that range for the last two decades.
Surprisingly, the man has never visited a healthcare professional upon finding out about his
elevated blood pressure; neither does he have frequent scheduled clinical visits with a
professional to address the blood pressure. Additionally, the patient has spinal stenosis at the C5-
C6 level, diagnosed six years ago, and has a history of neck pain. He is a healthcare professional
at the provider level.
Objective
The laboratory screening results ascertain that the man has a blood pressure of 217/109.
The elevated blood pressure of the patient indicated that he does not meet the criteria to
participate in the study for evaluating the effectiveness of a home cervical traction device.
Assessment
The information provided from the first two segments indicates that the patient is
suffering from hypertension 2, spinal stenosis at the C5-C6 level, and persistent neck pain.
Notably, the blood pressure of 217/109 falls under (>160/109) systolic readings and (>100)
diastolic readings and is thus a type 2 hypertension (Sharma et al., 2021). Considerably, type 2
hypertension has significantly been associated with organ damage and hypertensive
complications. Immediate pharmacological and physiological interventions are thus needed to
protect the patient from such complications. It is important to note that despite high systolic and diastolic readings in blood pressure,
patients with hypertension do not experience any symptoms. Therefore, it becomes difficult to
diagnose the patient. However, progression to a hypertensive crisis introduces several symptoms
such as headaches, nosebleeds, and shortness of breath (Sharma et al., 2021). Notably, the neck
pain experienced by the patient can be attributed to spinal stenosis, a condition caused by the
narrowing of the protective cover for the spinal cord. This can be caused by disc herniation,
osteophyte formation, hypertrophy of the ligamentum flavum, and degeneration pathologies that
lead to decreased space available for the spinal cord (Hung et al.,2020).
Plan
Therapeutics: Certain factors must be considered to ensure efficient control of BP. It is
essential to consider the frailty of the patient, ability to follow instructions, availability of care
from family members, renal function, electrolytes, and complexity of regimen. Consequently,
loop diuretics and alpha-blockers should be avoided for this patient due to their association with
falls. Therefore, certain medications will be combined for the patient to ensure effectiveness.
Thiazide diuretics, angiotensin-converting-enzyme inhibitor (ACEI), angiotensin II receptor
blockers (ARB), and calcium channel blocker (CCB) combination have proven to be effective
for patients of older age (Oliveros et al.,2019). However, the combinations should be increased
or decreased depending on the tolerance of the patient and the improvement detected in our
frequent assessments. I will also ascertain the side effects of the drugs, inform the patient and
work with the drugs with manageable side effects. I will also administer pain medication to
relieve the patient of neck pain.
Educational: I will inform the patient of other activities to help regulate his blood
pressure even though he is a healthcare professional. Regular physical activity, weight control, smoking cessation, and avoidance of alcohol intake are some interventions to controlling blood
pressure (Oliveros et al., 2019). Additionally, I will advise the patients to take more low
carbohydrate, vegetarian and Mediterranean diets and consider taking six small meals per day
instead of 3 heavy meals. I will also emphasize the importance of water between the diets to
improve digestion and kidney functioning. The patient should take potassium, calcium, and
magnesium supplements while reducing the consumption of sodium. Furthermore, I will advise
the patients to begin with aerobic exercises with at least 90 minutes per day and progress
gradually to achieve weight loss. We will set weight loss and blood pressure goals with the
patient for the next month to help measure progress and ensure that recommended techniques are
working.
Consultation/Collaboration: management of blood pressure and cervical spinal stenosis
will require several healthcare partnerships to be effective. A nutritionist will help the patient
come up with more thoughtful meal plans and exercises to ensure weight loss. This will help to
control blood pressure. Additionally, collaborations with physicians and physiotherapists will be
required. Physicians will help examine the severity of the spinal stenosis using physical
examination, X-ray, MRI assessment of the cervical spine or computed tomography (Hung et al.,
2020). Physiotherapists will help the patient manage pain and recommend exercises to widen the
neck’s protective canal before surgical measures are considered. Collaboration with pharmacists
will help provide pharmaceutical needs for both disorders.
Treating Hypertensive Urgencies
(Subjective) S: A 57-year-old mixed-race male (Black and Asian) is seen in the doctor’s
office for a screening to participated in a study to evaluate the effectiveness of a home
cervical traction device for long term neck pain and intervertebral disc space.
During the screening process, the gentleman was found to have a blood pressure of
217/109.
(Objective) O: BP 217/109
(Assessment) A: Diagnosis of chronic, uncontrolled hypertension: Hypertension urgency
(Plan) P: Hypertension Urgency: Immediately admit the patient to the urgent hospital
treatment and medical management of hypertension crisis
A hypertensive crisis or malignant hypertension is outlined as an exceedingly high systolic
blood pressure and or diastolic pressure as outlined by the Joint National Committee 7.
(Arcangelo, Peterson, Wilbur, & Reinhold, 2017). If a hypertension crisis is not adequately
treated aggressively, organ damage can occur. (Arcangelo et al., 2017).
Therapeutics:
A more cardiac centered assessment will include a physical exam together with blood
pressures individually in each of the arms, listening to heart and lung sounds, listening to
the renal arteries, neurologic exam, and funduscopic assessment. (Arcangelo et al., 2017).
The patient will need a complete workup of labs, including his cardiac enzymes. (Arcangelo
et al., 2017). If the patient has unbalanced pulses in the arms, imaging studies should be
obtained. (Arcangelo et al., 2017). If the patient has heart failure, and electrocardiogram
and echocardiogram are beneficial. (Arcangelo et al., 2017).
The patient will need to have a combination of oral and intravenous medications
administered to decrease and maintain his blood pressures. Blood pressures can typically
be regulated over 24-48 hours, contingent on the insistence of the circumstances.
(Arcangelo, et al., 2017). “Commonly used medications include direct vasodilators
(hydralazine), nitrates (sodium nitroprusside, nitroglycerin), CCBs (nicardipine,
clevidipine), sympatholytic agents (labetalol, esmolol), alpha-I blockers (phentolamine),
ACEIs (enalaprilat)” (Arcangelo et al., 2017, p. 270).
Education:
Patient education is a necessity for the management of hypertension. (Arcangelo et al.,
2017). Patients must be educated about medication management, the significance of being
compliant, and the outcomes of unrestrained hypertension. (Arcangelo et al., 2017). The
patient will need education on the medications that have been prescribed as well as
adverse drug effects, what events need to be reported, and what needs to be done for lifethreatening
circumstances. (Arcangelo et al., 2017). The patient with hypertension needs
to monitor their blood pressure at home and report to the primary care doctor if blood pressure measures out of specific parameters. Medication management needs to be
assessed at all doctors’ office appointments and adjustments of medication therapy if
required. (Arcangelo et al., 2017).
Lifestyle adjustments will need to be addressed, such as the consumption of healthy foods,
decreasing salt intake, smoking cessation, and no alcoholic beverages. (Arcangelo, et al.,
2017). The patient also needs to be encouraged to keep their weight at a healthy level and
exercise for better health. (Arcangelo et al., 2017).
Consultation/Collaboration:
This patient should be referred to have an assessment completed by a cardiologist to
monitor blood pressure and medication efficacy, serum creatinine and potassium levels
should be checked one or two times a year once blood pressure medication is effective.
Reference:
Arcangelo, V. P., Peterson, A. M., Wilbur, V., Reinhold, J. A. (20161108).
Pharmacotherapeutics for Advanced Practice, 4th Edition [VitalSource Bookshelf version].
Retrieved from vbk://9781496374066
S – reports of elevated BP for the last decade; haven’t seek medical consult of his condition; history of neck pain
O – BP 217/109 mmHg
A – Ineffective tissue perfusion related to increased peripheral resistance as evidenced by increased BP;
Acute Pain related to narrowing of the spaces between C5 and C6
Knowledge deficit related to present disease condition;
Noncompliance to therapeutic regimen related to lack of knowledge of disease condition;
P – 1. Pain Management, 2. BP control management 3. Give health teachings regarding therapeutic regimen – need seek consult for Internal medicine, Pain Medicine, Neurologist; rehabilitation therapy
