Damawand-Aquifer Essay FM8-09182023
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Aquifer Case Summary Week 3
Family Medicine 8: Elevated Blood Pressure
Zohra Damawand
FNP-591- Common Illnesses Across the Lifespan
Dr. Ashley Rousell
United States University
September 18, 2023
Introduction:
Mr.
Jose Martin is a 54-year-old Hispanic male presenting for blood pressure check. Today, his
BP is 150/85, (second reading 151/82), and pulse 80. He is otherwise asymptomatic. He hasn’t
received primary care services in 10 years and denies past medical history for any chronic
illnesses. His family history includes myocardial infarction, diabetes, and hyperlipidemia. He has
a sedentary lifestyle, consumes fast food daily, denies smoking and drinking and endorses
financial stressors. He gained 20 lbs. in the last 5 years and is now considered overweight. His
elevated blood pressure readings, recent weight gain, dietary and activity levels, and his family
history of cardiovascular and diabetes diseases puts him at intermediate risk for cardiovascular
diseases and events (ASCVD Risk Estimator, n.d.). We need to formulate a care plan to address
the risk factors (Whelton et al., 2017).
Leading Diagnosis:
Hypertension:
According to the 2020 International Society of Hypertension global hypertension practice
guidelines, blood pressure readings ≥140mmHg/ 90mm Hg are categorized as stage 1
hypertension. Mr. Martin had two blood pressure readings ≥140 mmHg systolic in the clinic. His
uncontrolled blood pressure, in combination with his sedentary lifestyle, diet, overweight status,
and family history puts him at high risk for cardiovascular diseases (Whelton et al., 2017).
Differential Diagnoses:
Diabetes/Pre-diabetes:
There are no recent laboratory tests to establish a baseline or rule out diabetes for Mr. Martin. He
has a family history of diabetes, and his overweight status, low activity level, and high fast-food
consumption put him at great risk for developing diabetes if he already doesn’t have diabetes
(Know Your Risk for Heart Disease, 2023).
Hyperlipidemia:
The family history of hyperlipidemia combined with Mr. Martin’s current lifestyle predisposes
him to hyperlipidemia. Hyperlipidemia is a major risk factor for ASCVD and non-alcoholic fatty
liver disease, and it is often asymptomatic for a prolonged period of the disease (Caussy, Aubin,
& Loomba, 2021).
Diagnostic Plan:
Labs (Essential Hypertension, n.d.) to establish baseline and:
CBC with differential: assess for inflammation,
Basic metabolic with eGFR panel: assess kidney function, electrolyte levels,
Lipid profile: assess for hyperlipidemia,
A1C: assess for diabetes,
LFTs: assess for liver dysfunctions,
TSH: rule out metabolic disorder,
Urinalysis: to assess for presence or glucose or protein that will indicate organ damage.
Imaging:
no imaging is needed at this time.
Additional Tests:
ECG will be obtained in the clinic to assess any cardiac abnormality. A
fundoscopic eye exam at PCP office can assess optic complications of uncontrolled hypertension.
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Treatment Plan:
Pharmacological:
There are missing components of clinical data like baseline renal function for Mr. Martin.
Following the recommendations of AHA, he is started on 25mg chlorthalidone once a day
(Epocrates, 2019). The efficacy of the medication will be evaluated in the follow up visit after
baseline lab values and continued blood pressure readings are available.
Non-pharmacological:
Lifestyle modifications are the first line of therapy for stage 1 hypertension and must be
presented as such to the patients.
DASH diet and Mediterranean diet have proven effective in
ASCVD risk management,
lowering clinical markers of diabetes and hyperlipidemia while offering a wide range of
food options for the patient thus increasing the chance of adherence to the
recommendations (Toi et al., 2020).
Regular physical activity, e.g., 150 minutes/week of moderate-intense activity like brisk
walking can significantly lower the risk of CVD and DM in patients (Toi et al., 2020).
Patient Education:
Dietary and physical activity are important parts of the treatment plan. The patient must
receive clear instructions, and printed material to utilize. He will be instructed to keep a
log of his activity level for personal reference.
He will be instructed to keep a log of his blood pressure for the next two weeks and
provide that information to the provider on his follow up visit.
This patient denies smoking and drinking alcohol and caffeine. The importance of these
practices will be reiterated to maintenance of such behaviors.
Medication information leaflets will be provided to the patient and his questions will be
answered. Adherence to the prescribed medication plan will be emphasized.
Regular follow up with PCP is important to the success of disease management and the
patient will receive verbal information as well as scheduled follow up appointments.
Referrals:
The patient will be instructed to obtain an eye exam. If a patient, like Mr. Martin, has challenges
accessing healthcare services, the PCP can work with the available clinic staff like social workers
or a care coordinator to ensure the patient utilizes the available community resources. Depending
on the results of the ECG and labs, the patient might need referral to cardiologist and/or
endocrinologist for any related illnesses. Nutritional support, if available, enhances the success
of dietary modification needed for the patient. Online resources and printed material are also of
great help.
Follow Up Plan:
This patient will have a follow up appointment with the PCP in 2 weeks. In the follow up
appointments, his lab results will be discussed, and a follow up plan of care will be formulated
based on that. He will be instructed to bring his blood pressure log for review by the provider as
well.
References:
ASCVD Risk Estimator +
. (n.d.).
https://tools.acc.org/ASCVD-Risk-Estimator-
Plus/#!/calculate/estimate/
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C.
D., DePalma, S. M., Gidding, S. S., Jamerson, K., Jones, D. W., MacLaughlin, E. J., Muntner, P.,
Ovbiagele, B., Smith, S. C., Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams,
K. A., . . . Wright, J. T. (2018). 2017
ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the
Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report
of the American College of Cardiology/American Heart Association Task Force on Clinical
Practice Guidelines.
Hypertension
,
71
(6).
https://doi.org/10.1161/hyp.0000000000000065
Unger, T., Borghi, C., Charchar, F. J., Khan, N., Poulter, N., Prabhakaran, D., Ramirez, A.
J., Schlaich, M. P., Stergiou, G. S., Tomaszewski, M., Wainford, R. D., Williams, B., & Schutte,
A. E. (2020). 2020 International Society of Hypertension global hypertension practice
guidelines.
Journal of Hypertension
,
38
(6), 982–
1004.
https://doi.org/10.1097/hjh.0000000000002453
Know your risk for heart disease | cdc.gov
. (2023, March 21). Centers for Disease
Control and Prevention.
https://www.cdc.gov/heartdisease/risk_factors.htm
Caussy, C., Aubin, A., & Loomba, R. (2021). The Relationship Between Type 2 Diabetes,
NAFLD, and Cardiovascular Risk.
Current diabetes reports
,
21
(5), 15.
https://doi.org/10.1007/s11892-021-01383-7
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Essential hypertension - Symptoms, Causes, Images, and Treatment Options
. (n.d.).
Copyright 2006-2023, Epocrates Inc. For Further Info See Our Trademarks
Page.
https://www.epocrates.com/online/diseases/26/essential-hypertension#treatment-approach
chlorthalidone: Dosing, contraindications, side effects, and pill pictures - epocrates
online
. (n.d.). Copyright 2006-2023, Epocrates Inc. For Further Info See Our Trademarks
Page.
https://www.epocrates.com/online/drugs/179/chlorthalidone#adult-dosing
Toi, P. L., Anothaisintawee, T., Chaikledkaew, U., Briones, J. R., Reutrakul, S., &
Thakkinstian, A. (2020). Preventive Role of Diet Interventions and Dietary Factors in Type 2
Diabetes Mellitus: An Umbrella Review.
Nutrients
,
12
(9), 2722.
https://doi.org/10.3390/nu12092722