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PATIENT PRESENTATION

Chief Complaint

“Will I inherit my mother’s health conditions?”

History of Present Illness

Yichu Lee is a 59-year-old woman who presents to your office for a health physical. She has a family history of cardiovascular disease. Her mother died from a hemorrhage stroke at age 58. She expresses her concerns that she may develop the same condition as her mother did. Mrs. Lee is a high-level manager at an IT company and is often stressed with work and has little time to exercise. She lives with her husband whom she describes as a great cook. She smokes cigarettes and enjoys having two glasses of wine after dinner regularly. Mrs. Lee was diagnosed with hypertension (HTN) 3 months ago and type 2 diabetes (T2DM) 6 months ago. These diagnoses have caused her distress because she thinks she is experiencing what her mother had. Furthermore, she is trying, with limited success, to cut down on her use of salt and sugar as well as dining out at her favorite Chinese restaurant. She also does not check her blood sugar during the day per her physician’s instructions due to her busy schedule. She also admits that she has gone for days without taking her diabetes medication without apparent problems; she comments she wants to avoid using insulin because she does not like the thought of injecting herself. She decided to try dietary changes rather than take the antihypertensive (chlorthalidone) she was prescribed 3 months ago.

Student Work-Up

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Missing Information?

Evaluate:

Patient Database

Drug Therapy Problems

Care Plan (by Problem)

TARGETED QUESTIONS

  1. What is the patient’s target blood pressure according to the 2017 ACC/AHA guidelines?

    Hint: See Table 6-2

  2. Which antihypertensive(s) would you consider initiating based on this patient’s characteristics and lab values?

    Hint: See Table 6-3 and Table 6-7

  3. What nonpharmacologic recommendations would you offer this patient to optimize her antihypertensive therapy?

    Hint: See Nonpharmacologic Treatment Section in Chapter 6 and Table 6-6

  4. How would you educate this patient about the medication(s) selected?

    Hint: See Outcome Evaluation Section in Chapter 6 and Patient Care Process

  5. When and what would you monitor after initiating therapy?

    Hint: See Outcome Evaluation Section in Chapter 6 and Patient Care Process

FOLLOW-UP

Three weeks later, the patient presents to the clinic for a BP checkup. After reviewing the patient’s home blood pressure readings and comparing them to the clinic’s readings, you notice that the home blood pressure readings are lower than the clinic’s readings. What do you think can be causing this discrepancy and what course of action should you take to resolve the discrepancy?

Hint: See Measurement of Blood Pressure Section in ...

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