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Client's high blood pressure

Consider the scenario below, then follow the instructions underneath it to complete the discussion. If appropriate, support your position with credible resources/examples/evidence and provide APA references.
Mr. B
Mr. B, a 70-year-old male client, presented to his primary care physician with complaints of blurred vision and headaches over the last two months. On several visits, Mr. B's blood pressure was found to be elevated, so the physician started him on hydrochlorothiazide 25 mg by mouth daily. One month later, Mr. B began to have chest pains and shortness of breath, so his primary care provider referred Mr. B to a cardiologist for further evaluation.

The cardiologist ordered an echocardiogram and stress test which revealed heart enlargement and a reduced ejection fraction (volume of blood pumped out of the heart per minute). As a result, the cardiologist started Mr. B on a beta-blocker (metoprolol 25 mg by mouth daily).

A few days after taking the new medication (in addition to the hydrochlorothiazide ordered by the primary physician), Mr. B suffered a fall at home. Upon arrival at the emergency room, Mr. B's blood pressure was 80/50. The emergency room physician suspected the cause of Mr. B's fall was hypotension secondary to the medications he was taking. The ER physician recommended that Mr. B follow up with his primary care physician and cardiologist but hold the medication until seen by them.

As recommended, Mr. B visits his primary care physician for a follow-up. During the visit, Mr. B's blood pressure is found to be elevated (160/90), so his physician tells Mr. B to restart taking his blood pressure medication.

Imagine that you are the nurse attending to Mr. B and that he indicates that he's afraid to restart the medication because of his recent fall.

What considerations/actions should the nurse make regarding the client's refusal to restart his blood pressure medication?
What considerations/actions would have helped the healthcare team to prevent the client's fall?

Review the posts made by your classmates and reply to someone expanding on their idea or offering an alternative for consideration.

Please make your initial post by midweek and respond to at least one other student's post by the end of the week. Please check the Course Calendar for specific due dates.

Full Answer Section

Develop a Medication Plan: Collaborate with the healthcare team to develop a medication plan that minimizes the risk of hypotension while effectively managing Mr. B's blood pressure. Consider alternative medications or lower dosages if appropriate.
Involve Support Systems: Encourage Mr. B to involve family or caregivers in his care to provide additional support and supervision.
Monitor Vital Signs: Closely monitor Mr. B's blood pressure and other vital signs to detect any changes early.
Fall Prevention: Implement fall prevention measures, such as removing hazards from the home, using assistive devices, and educating Mr. B about fall risks.
Document Thoroughly: Document all interactions, assessments, and interventions related to Mr. B's medication refusal and fall risk.

Preventing the Fall

Several factors contributed to Mr. B's fall:

Polypharmacy: The combination of hydrochlorothiazide and metoprolol increased the risk of hypotension.
Inadequate medication education: Mr. B may not have fully understood the potential side effects of his medications.
Fall risk assessment: A comprehensive fall risk assessment could have identified Mr. B as being at increased risk.

To prevent future falls, the healthcare team should:

Conduct thorough medication reconciliation to identify potential drug interactions.
Provide clear and concise medication education to patients.
Implement fall prevention protocols in all care settings.
Conduct regular fall risk assessments for at-risk patients.

By addressing these factors, healthcare providers can significantly reduce the risk of falls and improve patient safety.

It is essential to approach this situation with empathy and understanding, recognizing that Mr. B's decision is influenced by his personal experience and concerns. By building a strong therapeutic relationship and providing comprehensive education, the nurse can empower Mr. B to make informed decisions about his healthcare.

Sample Answer

Mr. B's Case: A Complex Balancing Act

Nurse's Considerations and Actions

Mr. B's refusal to restart his blood pressure medication presents a complex situation that requires a multifaceted approach. The nurse must prioritize patient safety while respecting Mr. B's autonomy.

Key Considerations:

Patient Education: Thoroughly educate Mr. B about the risks of uncontrolled hypertension, including stroke, heart attack, and kidney disease. Explain the importance of medication adherence in managing his conditions.
Address Fear and Concerns: Create a safe and supportive environment for Mr. B to express his fears about the medication. Explore his concerns about potential side effects and address them with accurate information.