Case study of Mr. Zane’s medical assessment

Mr. Zane is a 65 –year-old African Canadian male from Brampton, Ontario, Canada. He came to the Emergency Department with his wife of 30 years. Mr. Zane was sent to the Emergency Department by his primary healthcare provider because “he has not been feeling well” for the past few days. He describes a fullness in his head and chest without any associated symptoms. His medical history is pertinent only for primary hypertension, and he states that he ran out of his medication two weeks before he started experiencing symptoms.

Physical examination reveals an anxious man with a BP of 230/130 mm Hg and a heart rate of 108 beats per minute. Respirations are elevated at 22 breaths per minute. No papilledema is seen on funduscopic examination. Lungs have bilateral crackles, one quarter up from the bases. Cardiac examination reveals a regular tachycardic rhythm with normal S1 and S2. Jugular venous pressure is normal but demonstrates sustained fullness with abdominal pressure. The apical pulse is prominent. No pedal edema or abdominal bruits detectable. Peripheral pulses are equal.

Laboratory test results reveal normal CBCs, electrolytes, and renal functions. Several erythrocytes are present in his urine. Oxygen saturation is 89% on room air. A 12-lead ECG shows sinus tachycardia, left axis deviation, 4-6mm ST-segment depression across the pericardium. A chest X-ray is significant for moderate pulmonary venous congestion and cardiomegaly.

The findings indicate that patient is in a hypertensive crisis and needs immediate medical attention. Mr. Zane is 5 feet 9 inches tall and weighs 210 pounds. He reports no form of regular exercise or a special diet. Mr. Zane’s diet entails carbohydrate-dense foods, salted codfish, bacon, goat meat, and high glycemic index beverages. Mr. Zane has been smoking half a pack of cigarettes for the past five years and drinks a case of beer on weekends. Mr. Zane’s father died of a heart attack at 64-years-old, and his brother had a stroke at the age of 51.

PART 1: Questions

After being stabilized and monitored in the hospital, Mr. Zane is discharged home. Mr. Zane’s primary care physician prescribes him a long-acting calcium channel blocker as first-line monotherapy. Why are calcium channel blockers recommended as first-line therapy for African American people with hypertension? Explain.
Mr. Zane’s blood pressure remains elevated after being started on the calcium channel blocker. Mr. Zane is started on 50 mg of the thiazide diuretic, hydrochlorothiazide daily. Discuss the antihypertensive effects of hydrochlorothiazide.
What information must you share with Mr. Zane to increase adherence and decrease the adverse effects of hydrochlorothiazide? What should Mr. Zane be educated about concerning his disease process and the impact of adherence to the drug therapy regimen?
Mr. Zane’s physician is trying to establish a medication regime to best control Mr. Zane’s primary hypertension, and the β-blocker, carvedilol (Coreg), has been prescribed. Before initiating therapy, what past medical conditions should the nurse inquire about during the nursing assessment?
What should Mr. Zane know about the expected therapeutic and adverse effects of the β-blocker, carvedilol (Coreg)?

Sample Solution