Diagnoses and Plan of Care

/ Blogs / By

A 61-year-old Black male with a history of hypertension presents to your clinic for complaints of headaches and blurred vision x 4 days. He denies any weakness, numbness, chest pain, shortness of breath, palpitations, or recent, illicit drug use. He states he has been compliant with his medications (hydrochlorothiazide and metoprolol), and he took his meds this morning.

His V/S include: B/P 190/100, P- 90, T- 98.9, R- 22. Recent labs show that Total Cholesterol- 260, LDL-190, HDL- 35, Triglycerides- 320. He did not return for these results and did not start any new meds.

What are your diagnoses and plan of care (include for this patient? Remember to include your rationales with references including the treatment with medications doses for each diagnosis given:

Hypertensive emergency:

Stage 2 hypertension:

Hypercholesterolemia:

Hypertriglyceridemia:

Expectations:

APA format with intext citations

Word count minimum of 250, not including references.

References: 4 high-level scholarly references within the last 5 years in APA format.

Plagiarism free.

Turnitin receipt.

Diagnoses and Plan of Care

Diagnoses and Plan of Care:

  1. Hypertensive Emergency: The patient’s severely elevated blood pressure (190/100 mmHg) along with symptoms of headaches and blurred vision indicate a hypertensive emergency. This requires immediate intervention to prevent target organ damage. The patient should be started on an intravenous antihypertensive medication, such as nicardipine or labetalol, to gradually lower blood pressure over the next 24 hours. Close monitoring of blood pressure and vital signs is essential.

    Reference: Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206-1252.

  2. Stage 2 Hypertension: The patient’s elevated blood pressure reading classifies him as having stage 2 hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg). In addition to immediate management of the hypertensive emergency, the patient should be transitioned to oral antihypertensive medications for long-term control. Adjustment of current medications (hydrochlorothiazide and metoprolol) or addition of other agents, such as an ACE inhibitor or angiotensin receptor blocker (ARB), may be considered.

    Reference: Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension. 2018;71(6):e13-e115.

  3. Hypercholesterolemia: The patient’s lipid profile reveals elevated total cholesterol (260 mg/dL) and LDL cholesterol (190 mg/dL) levels, indicating uncontrolled hypercholesterolemia. Lifestyle modifications, including dietary changes and exercise, should be emphasized. Additionally, statin therapy should be initiated, such as atorvastatin or rosuvastatin, to lower LDL cholesterol levels and reduce cardiovascular risk.

    Reference: Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. J Am Coll Cardiol. 2019;73(24):e285-e350.

  4. Hypertriglyceridemia: The patient’s elevated triglyceride level (320 mg/dL) indicates hypertriglyceridemia. Lifestyle modifications, including dietary changes, weight loss, and increased physical activity, are essential. Omega-3 fatty acid supplementation (e.g., prescription-strength omega-3 ethyl esters) can be considered to help lower triglyceride levels.

    Reference: Jacobson TA, Armani A, McKenney JM, Guyton JR. Safety considerations with omega-3 fatty acid therapy. Am J Cardiol. 2007;99(6A):S35-S43.

In summary, the patient’s diagnoses include hypertensive emergency, stage 2 hypertension, hypercholesterolemia, and hypertriglyceridemia. The plan of care involves immediate management of the hypertensive emergency, initiation of appropriate antihypertensive and lipid-lowering medications, lifestyle modifications, and ongoing monitoring. This comprehensive approach aims to address the patient’s acute symptoms and reduce long-term cardiovascular risks.

Scroll to Top