Cardiac Case Study
Primary (Essential) Hypertension
Case Studies in Pharmacology, pg 71-73
Mr. J is a 65 year-old male who has been visiting his primary health care provider yearly for annual examinations specifically related to history of mild congestive heart failure. Over the past year, Mr. J has noticed that he gets infrequent headaches even though he is not stressed. Mr. j is 5’5” and weighs 240 pounds.
Mr. J reports a family history of hypertension and was diagnosed with primary hypertension at the age of 64. He reveals he likes foods that are high in sodium content. His father is alive and well, but his mother died at age 70 from a cerebral vascular accident related to hypertension. His social history reveals alcohol consumption of beer during the day and a glass or wine at dinner. Mr. J is seen by a nurse practitioner at the community clinic for complaints of headache and dizziness. Upon admission his vital signs are:
Blood pressure:190/110
Pulse: 104 and regular
Respirations: 18
Temperature: 98.4 F
He is transferred to the local hospital’s emergency department for further evaluation. On arrival at the emergency department, he is seen by a nurse practitioner who initiates a systems assessment and finds his blood pressure reading to be 180/110 x two readings with the use of appropriate blood pressure cuff size. Mr. J reports current medications of captopril and metoprolol tartrate. He is kept in the emergency department for three hours on continous telemetry while awaiting a bed on the medical unit. He is later transferred to a medical unit with the following orders:
§ Furosemide (lasix) 40 mg IV stat
§ Captopril (Capoten) 25mg po three times per day
§ Hydrochlorothiazide (Hydrodiuril) 12.5 mg po daily
§ Spironolactone (Aldactone) 50 mg po two times per day
§ Ezetimibe (Zetia) 10mg po daily
§ 2 gm sodium diet
Questions:
1. What are the purposes for the prescribed medications?
2. What are the most common adverse reactions of the prescribed medications?
3. Discuss drug-to-drug and drug-to-herbal interactions of the prescribed medications.
4. Discuss the effects of angiotensin converting enzyme (ACE) on hypertension and
nursing priority of care when caring for clients taking ACE inhibitor agents.
5. Discuss client education for a captopril (Capoten) prescription upon discharge to home.