Case study of hypertension in an African American.
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Develop an evidence-based management plan.
Include any pertinent diagnostics.
Describe the patient education plan.
Include cultural and lifespan considerations.
Provide information on health promotion or health care maintenance needs.
Describe the follow-up and referral for this patient.
Introduction:
Hypertension (HTN) is a progressive metabolic disorder with a high mortality rate and economic burden worldwide. Studies show a high prevalence of HTN is high in African Americans ethnic groups. It is a preventable lifestyle disease with a high risk of developing co-morbidities such as cardiovascular disease, renal disease, peripheral vascular disease and retinopathy etc., Prevention and regulation of HTN is significant in reducing the mortality.
Clinical history:
C.D is a 55-year-old African American obese male with a BMI of 31.5. His family history reveals occurrence of hypertension, Acute myocardial infacrction, and diabetes mellitus along with cystic fibrosis. He suffered from Hypothyroidism and rhinitis in the childhood. He is a heavy smoker; His salt intake is higher than recommended quantity. His allergies have been treated with antihistamine medication Zyrtec 10mg.Overall his health was reported as good without any symptoms.
Diagnosis:
Chief complaints of patient are chest pressure that increases with exertion in association with a recurring headache since 2days. Vitals of the individual such as Heart rate 73, respiratory rate 18, and body temperature 98.8 F are normal. Observation of blood pressure of a 120/90 mm Hg is indicative of hypertension.
Nose bleeding alongwith haemoptysis is present.Patient reported nocturia and dyspnoea.Examination of eye indicated arteriolar narrowing needing further analysis of hypertensive retinopathy. A thorough HEENT i.e.,head, ear , nose and throat and upper respiratory examination revealed no erythema, or tissue damage in the upper respiratory tract directing the diagnosis towardsinvestigating lower respiratory tract.
Haemoptysis is associated with diverse pathological conditions such as infectious, vascular, neoplastic etc., Presence ofsymptoms such as cough, dyspnoea, fatigue with physical activity, consistent pain in the chest cavity along with crackles, but no wheezing sounds are noted. Weight loss along haemoptysis indicates tuberculosis. Whereas in this case the individual gained weight over a 12 pounds in the previous year. To rule out the gastrointestinal involvement, presence of nausea, vomiting, abdomen is examined for any pain or sounds. In this case, no abdominal pain was observed and a further endoscopy analysis is suggested (Corey, 1990).
In the current case, there is no recorded history of any pulmonary infections, trauma, but the family has a history of cystic fibrosis and smoking habits. Auscultation of lung revealed mild basilar crackles from lungs without lymphadenopathy representing the block of airflow due to the accumulation of fluid in the lungs, yet lack of lymphadenopathy reveals non-infectious nature of the disease. Checked for prolonged inspiratory and expiratory sounds in the lungs as is in the case of chronic bronchitis to evaluate the type of crackles(Sarkar et al., 2015).Radiological examination reveals no anatomical abnormalities of abdominal region, normal thyroid without any masses, Papilledema observed could be a manifestation of increased fluid deposition in the cranium with an increase in intracranial pressure.
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Treatment and management:
Early detection and treatment of HTN is crucial in preventing the complications associated with it. Primaryobjective of the HTN treatment methods is to decrease the blood pressure below a value of 130/90 mm Hg. Early detection of HTN improved the prognosis of the disease and is easily managed with lifestyle modifications. Sodium is essential for the homeostasis and is crucial for the maintenance of electrolyte balance and sensory functions. Excess of sodium affects the urinary system negatively increasing the blood pressure (Ha, 2014).
According to World health organisation ideal quantity of salt consumption should not exceed 5gm per day. Studies have shown immediate effect between the reductions in the salt intake in effective management of HTN.
Advanced stage of the disease complicates the treatment and a diverse approach in addition to drug therapy is recommended. HTN in other words is increased pressure on the walls of arteries due to higher volume and hence an approach to control the volume of body fluid is first step in its regulation. Medications such as diuretics, Angiotensin converting enzyme are prescribed to regulate the volume. (Nguyen et al., 2010)
In the current case, chest radiography, cranial examination, along with endoscopic examination, with a tissue biopsy of lung is recommended for further analysis. Retinopathy associated with HTN needs further observation to avoid ophthalmological complications.
Cultural determinants of health:
Ethnicity of the individuals play a significant role in determining the susceptibility towards a disease. Research shows that African Americans areprone todeveloping HTN with an increased salt intake which is referred to as salt sensitivity (Farquhar et al., 2015).In comparison to genetic factors, cultural factors and lifestyle play a predominant role in determining the prevalence of HTN in African Americans. High risk health behaviours such as smoking, alcohol consumption in them predispose these ethnic groups to HTN (Peters et al., 2006).
Patient education plan:
Success of any treatment plan is possible only with the patient compliance. This is achieved through the education of patient with the parameters to manage their disease and to seek care in the case of any notedabnormalities.
A report on blood pressure values on a daily basis along with the scheduled administration of medication is necessary. Avoiding self-treatment ofcommon ailments, such as headache or muscle pain with the over-the counter medications is ideal to prevent drug-drug interactions. Lifestyle changes include reduction of salt intake, alcohol quantity, processed foods with high salt concentration. Weight management is recommended through age appropriate exercises and diet control is also crucial in preventing the HTN associated complications such as peripheral vascular disease. Smoking is highly restricted in the case of hypertensive adults as these habits results in further narrowing of arteries and thereby worsening the condition.
Alternative therapies such as stress management techniques can be used to reduce the anxiety due to work and other social factors.
Along with the lifestyle modifications, a regular follow-up is highly recommended for a better health outcome.
Immediate medical care is advised in the event of sudden chest pain, severe headaches, muscular fatigue, paralytic symptoms, dizziness with confusion and blurred vision, nose bleeding and high blood pressure.
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