Hypertension Medication Management

Mark Ilescu is a 44-year-old client who has been diagnosed with primary hypertension. His medical history includes type 1 diabetes mellitus, with early signs of nephropathy. He had a myocardial infarction 2 years ago and has been treated with a beta-blocker, metoprolol, since that time. He has been taking hydrochlorothiazide in addition to the beta-blocker to treat his hypertension. His blood pressure today is 138/92 mm Hg, which is consistent with the readings on his last three visits. His physician has added captopril to his treatment regimen. (Learning Objectives 2, 4, 8, and 9)

1. Mark states that he does not understand why he needs an additional medication considering his blood pressure is below 140 mm Hg systolic. How should the nurse respond?

2. Discuss the rationale for choosing captopril in Mark’s case.

3. What should the nurse include in teaching Mark in order to minimize adverse effects of the captopril and metoprolol?

Instructions:

1. Your discussion post should be at least 140 words. Follow APA guidelines for references.

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APA

Answer

Hypertension Medication Management

Nurse’s Response to Additional Medication
Mark’s current blood pressure, though below 140 mm Hg systolic, is still slightly elevated at 138/92 mm Hg. The nurse can explain that the addition of captopril, an ACE inhibitor, aims to provide further protection for his cardiovascular and renal health. Given his history of diabetes and nephropathy, his blood pressure target might be more stringent. Keeping blood pressure as low as possible within a safe range helps slow the progression of kidney damage associated with diabetes and reduces the risk of future cardiovascular events. This preventive approach is vital due to his existing conditions. Hypertension Medication Management

Rationale for Choosing Captopril
Captopril is an ACE inhibitor, which helps relax blood vessels, making it easier for the heart to pump blood. In patients with diabetes and early nephropathy, ACE inhibitors are beneficial because they reduce pressure within the kidneys’ filtration system, thereby slowing the progression of kidney damage. Additionally, captopril has protective effects on the cardiovascular system, which is particularly important for Mark due to his past myocardial infarction.

Teaching to Minimize Adverse Effects
The nurse should instruct Mark on how to minimize adverse effects of captopril and metoprolol. Mark should take captopril at the same time each day, avoid high-salt diets, and stay hydrated. Since ACE inhibitors can cause dizziness from low blood pressure, particularly at the start of treatment, Mark should change positions slowly to prevent falls. With metoprolol, he should monitor for signs of fatigue or low heart rate and avoid abrupt discontinuation, as it can worsen hypertension. Regular blood pressure monitoring and reporting any unusual symptoms are essential. Also, avoiding potassium supplements or high-potassium foods is advised due to the risk of hyperkalemia with ACE inhibitors.

References
McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children. Elsevier Health Sciences