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Primary care physician with complaints of blurred vision and headaches

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.

Full Answer Section

Dose Adjustment: Consider the possibility that the initial dose of metoprolol might have been too high for Mr. B. The physician might need to adjust the dosage to achieve blood pressure control without causing dizziness or lightheadedness.
Shared Decision-making: Involve Mr. B in the decision-making process. Explain the rationale behind medication choices and encourage him to ask questions and voice his concerns.
Develop a Monitoring Plan: Work with Mr. B to establish a plan for monitoring his blood pressure at home, along with monitoring for side effects like dizziness. This can empower him and increase his confidence in medication use.

Preventing Falls:

Here are some actions that could have helped the healthcare team prevent Mr. B's fall:

Medication Review: During initial consultations, assess potential medication side effects that could increase fall risk, such as dizziness or lightheadedness.
Patient Education: Educate Mr. B about fall prevention strategies like using assistive devices (canes, grab bars), maintaining good lighting, and wearing proper footwear.
Home Safety Assessment: Consider referring Mr. B for a home safety assessment to identify and address potential hazards like loose rugs, cluttered walkways, and inadequate lighting.
Communication: Ensure clear communication between healthcare providers about medications and potential side effects. Encourage Mr. B to report any dizziness or lightheadedness to both his primary care physician and cardiologist.

Responding to Classmates' Posts:

By reading your classmates' posts, I can learn about different approaches to managing medication concerns and fall prevention strategies. I can then offer additional thoughts or alternative suggestions based on their ideas. For instance, if someone mentions medication adherence programs, I could contribute by mentioning the potential benefits of using mobile apps or pill organizers to support Mr. B in taking his medications as prescribed.

By working together and sharing knowledge, we can ensure Mr. B receives the best possible care and support to manage his health and prevent future falls.

Sample Answer

Considering Mr. B's Medication Concerns and Fall Prevention

Addressing Medication Refusal:

As the nurse, here are some considerations and actions regarding Mr. B's medication refusal:

Empathy and Education: Acknowledge Mr. B's fear and explain the importance of blood pressure control for his overall health. Discuss the potential consequences of uncontrolled hypertension, including stroke, heart attack, and kidney disease.
Medication Review: Collaborate with the physician to review Mr. B's medications and ensure there are no interactions causing hypotension. Explore alternative medications if a side effect is suspected.