Treatment Goals Research Paper

What are your treatment goals for Margaret today?

Margaret has been diagnosed with an essential tumor, and although she may not have initially planned to take medicine, her manifestations are impacting her life quality and her capacity to conduct everyday tasks. At this juncture, it is important to administer medication to alleviate her complications. It is usual for the implications of an essential tremor to impair an individual’s capacity to eat and write and is sometimes the cause of individuals seeking treatment (Elias & Shah 2014). The patient also has a history of high blood pressure and complains of recent indications including urinating difficulty, dry mouth, dizziness, and headaches. Margaret’s blood pressure stands high at 156/85, in addition to her symptoms. It is essential to address the side-effects of the patient and to address the modification of anti-hypertensive medicine along with an alternate medication to manage Margaret’s blood pressure effectively. The first thing I would plan to as an FPN is to discontinue clonidine and substitute it with a medication that will address hypertension.Treatment Goals Research Paper

 What is your pharmacological plan and rationale? (cite with appropriate clinical practice guidelines or scholarly peer-reviewed articles and always include medication name, strength, dosage form, route, frequency and duration when making recommendations)

Clonidine is an alpha-agonist that is usually chosen in treating moderate and mild hypertension and is a second or third-line medication option. Clonidine should be not be used by elderly individuals or can be used with great care because of an increase in parasympathetic stimulation while reducing renal vascular resistance, heart rate, peripheral resistance, and sympathetic tone (Woo & Robinson, 2016). As demonstrated in the case study, Margaret has a few of Clonidine’s typical side effects, which include urination difficulty, dry mouth, and headaches. Urination difficulty is a more serious side effect as it is associated with the risk of getting subsequent complications. It is therefore a fundamental reason for discontinuing this drug individually. Clonidine, however, is not a drug that can be abruptly stopped because the absence of alpha2 receptors adversely affects the sympathetic nervous system’s homoeostatic stability and can result in a detrimental impact of hypertension (Woo & Robinson, 2016). As a care family nurse practitioner, the action that follows could be to slowly decrease the clonidine over a four-day duration. Margaret spoke of rising tremors, and it would be a great idea to minimize tremors with a beta-adrenergic block. Beta-adrenergic and Clonidine medications, however, render the patient at risk of severe hypertension and are better avoided (Woo & Robinson, 2016). Margaret claimed that she initially decided not to use the tremor drug because prior to using clonidine, the tremors were not especially problematic. The tremors should decline after clonidine is discontinued.

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The recommendation algorithm for hypertension specifies that treatment be commenced with either calcium channel blocker, thiamine diuretic, or angiotensin receptor blocker (ARB) (James & Oparil, 2014). ACE, like lisinopril, will be administered for Margaret’s condition to manage her hypertension and potentially reduce the risk of complications from past drugs.

Medication Name: Lisinopril 10mg tablets Treatment Goals Research Paper

Sig: Take 1 tablet orally daily for four weeks

In four weeks, it is necessary for the patient to follow up to determine whether Lisinopril is efficient. Introducing another drug, like a diuretic thiazide in addition to Lisinopril, could be more beneficial if her hypertension is not managed after around four weeks. Studies have shown that with half the usual dosage, hypertension management can be efficient and additional medicines like thiazide-type diuretic can lead to fewer side effects combined with two low-dose drugs in comparison to a single drug taken in high doses (Hansell, 2017). Lisinopril can be very effective when combined with a thiazine diuretic like hydrochlorothiazide, and, based on the outcome of the patient; dosages might begin at 12.5 mg or 10 mg (Sukalo et al., 2018). The ultimate purpose of Margaret’s hypertension treatment is to achieve this by promoting the desired outcome and by lowering the potential of complications.

 Pick one medication from your response above and list five patient-centered teaching points for the medication.

Education is a vital aspect of being a competent FNP. Patients get a deeper understanding of their medications and a constructive approach to compliance with medication through proper education. A list of concerns to address before a new drug like Lisinopril is prescribed includes the following:

  • Inform the patient that Lisinopril can cause side effects such as headaches, chest pain, hypotension, dry cough, and dizziness (Woo & Robinson, 2016).
  • Teach the patient to watch for indications of breathing and swallowing difficulties, swelling of the face, lips, eyes, or tongue, and angioedema. Inform the patient to quit taking drugs and instantly call 911 or the clinic (Woo & Robinson, 2016). Notify the patient to report any indications of allergic reactions instantly, including as urination changes, palpitations that could be consistent with dysrhythmia, fatigue, and confusion (Woo & Robinson, 2016).
  • Advise the patient to track changes in weight, including a weight increase in a week exceeding 5 lbs.
  • To minimize the chance of experiencing low blood pressure, instruct the patient to at all times to take baseline blood pressure before taking her prescribed medicine. Educate the client what natural blood pressure is and when the drug is safe or unsafe to use (Woo & Robinson, 2016).
  • Just like any other medicine, prior to taking other prescription drugs, any over-the-counter drugs, or herbal supplements, it is essential for the FNP to inform the patient to check with healthcare professionals. The use of Lisinopril combined with certain other drugs can cause severe effects and on certain occasions, fatal.Treatment Goals Research Paper Inform the patient that unless it is nearly time for the next dose, the skipped dose has to be taken as soon as it is recalled (Woo & Robinson, 2016).
  • It is highly vital to advise Margaret about the significance of regular follow-up appointments. The original prescription dosage may not be appropriate for the treatment of hypertension in the patient and might have to be reduced or increased, and the maintenance dose may need to be taken into account (Sukalo et al., 2018).

Reference

Elias, W. J., & Shah, B. B. (2014). Tremor. Jama, 311(9), 948-954.

Hansell, M. W., Mann, E. M., & Kirk, J. K. (2017). Hypertension treatment strategies for older adults: This evidence-based review illustrates how to adjust treatment for comorbidities and incorporate frailty and cognitive impairment into the equation. Journal of Family Practice, 66(9), 546–554B.

James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., … & Smith, S. C. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Jama, 311(5), 507-520.

Sukalo, A., Deljo, D., Krupalija, A., Zjajo, N., Kos, S., Curic, A., … & Marjanovic, D. (2016). Treatment of hypertension with combination of lisinopril/hydrochlorothiazide. Medical Archives, 70(4), 299.

Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for Advance Practice Nurse prescribers (4th ed.). Philadelphia, PA: F. A. Treatment Goals Research Paper