CASE STUDY: You (NURSE) have just accepted

CASE STUDY: You (NURSE) have just accepted a new position as an office LVN for a busy internal medicine physician. During your interviews with her, she told you that patient education was very important to her but she has found that she never has enough time to give adequate teaching. Part of your new job is to help her with patient management and education in her already established hypertension clinic. On your first day at the hypertension clinic, you meet Mrs. Mary Peters, a lively 78-year-old African-American woman who tells you she was told she had “hypertension” two months ago. She is 5 feet 4 inches tall and weighs 110 pounds. You take her blood pressure (BP) according to approved standards and get 160/102. Her other vital signs (VS) are 78-16-98.2° F. She also tells you that the doctor told her she has to take a pill every day. As you talk with her, you notice she seems confused by her diagnosis and isn’t clear about taking her medication. Mrs. M.P. takes a prescription pill bottle out of her purse. The label tells you it is hydrochlorothiazide (HCTZ) 12.5 mg and that 1 tablet should be taken daily. The medication label indicates that 30 pills were dispensed. You notice there are a lot of pills left in the bottle and it was filled over two months ago. The obvious assumption is that she has not been taking her pills as prescribed. Some professionals would label this “noncompliance” in a way that implies that the patient is deliberately uncooperative with the treatment. That is a big assumption that may not have a basis in reality. Mrs. M.P. tells you her mother died of a stroke at the same age she is now. She says she is “scared to death” the same thing will happen to her. You share with Mrs. Peters that federal guidelines recommend a BP goal of less than 140/90 (for non-diabetic patients). You tell her that you will be glad to work together with her to achieve the recommended level. She thanks you for explaining everything to her and reports she will get her prescription filled today on the way home from the doctor’s office. You see Mrs. M.P. 1 month later. She tells you she is feeling fine and does not have any side effects from her new medication. She shows you her calendar where she has been marking her medication record and her BP. Her BP, checked twice at the senior center, measured 136/78 and 134/82. Focus Questions: 1. You take Mrs. M.P.’s BP and get 132/82. She asks whether these BP readings are OK. On what do you base your response? 2. List at least three important things you might help her with in maintaining her success. Case Study (continued): Mrs. M.P. comes in for a routine follow-up 3 months later. She continues to do well on her daily BP drug regimen with average BP readings of 130/78. She participates in a group walking program at the senior center. She admits she hasn’t done so well with decreasing her salt intake. She tells you she recently was at a luncheon with her garden club and that most of those ladies take different BP pills than she does. She asks why their pills are different shapes and colors. Focus : 3. How can you explain the difference to Mrs. M.P.? 4. You remind Mrs. Peters that she should continue with her prescribed medications and not make any alterations. You emphasize the need to talk with you or the physician before she starts taking any “natural” or herbal remedies, over-the-counter remedies for cold or flu, or nutritional supplements. Name one herbal remedy or natural product that could elevate her BP. PLEASE ANSWER ALL QUESTIONS (4 QUESTIONS). THANK YOU

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