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1)   
What are specific cultural considerations in the
United States for hypertension?

Specific criteria in cultural
considerations for hypertension include medication adherence, patient
education, eating practices, and finances. “Ethnic variations account for some
differences in the prevalence of hypertension and blood pressure control rates
among Hispanics, including the need for culturally appropriate management
models” (Patel, 2011). It has been noted, that in the United States,
socioeconomic and racial factors detrimentally influence ones’ health.
Education, modernization, and structural assimilation directly relate to favorable
blood pressure profiles. Being proficient linguistically significantly impacts one’s
ability to fully comprehend and execute a medical professionals’ explanation
and orders related to hypertension (Patel, 2001). When language is no longer a
barrier, the patient education process is smoother and medication adherence is
more likely to occur since the patient more fully understands what they are
taking and why they are taking a certain medication. Eating practices greatly
impact hypertension as well. African-Americans have what is referred to as “soul
food”; while it may contain healthy foods such as collard greens, legumes, and
potatoes, other parts of their diet are often not healthy. Low fiber, calcium
and potassium deficient, and foods high in fat, contribute directly to
hypertension (Ewing, 2016). Economically disadvantaged families may not have
the ability to afford healthier foods, they may rely more heavily on low
nutrient prepackaged foods, raising their likelihood of hypertension based on
poor health.

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2)   
What are some common nursing diagnoses for
clients with hypertension?

Nursing diagnoses for hypertension
could include decreased cardiac output. An inadequate amount of blood pumped by
the heart would not meet the metabolic needs of the body. Activity intolerance
would produce insufficient energy, both physiological and psychological, to sustain
daily activities. Acute pain ranging from moderate to severe. Imbalanced
nutrition because ones’ nutrient intake is not sufficient for their metabolic
needs. And Deficient knowledge, the patients level of knowledge and understanding
to the topic is insufficient (Hypertension, 2013).

3)   
After the diagnosis of essential hypertension is
confirmed with initial studies, what further evaluations are necessary?

After the initial
diagnosis of hypertension, further evaluations include careful

measurements and recordings of
blood pressure are important. Ambulatory blood pressure monitoring should be
conducted in addition to what the doctor conducts in the office because it
gives a larger picture and more correct view of one’s blood pressure. It
establishes a pattern that can be reviewed and activities to be revised.
Laboratory tests could also include an electrocardiogram, urinalysis, blood glucose
and hematocrit. Serum potassium, creatinine, or corresponding estimated
glomerular filtration rate, calcium would also be measured. Lipid profiles
following a nine to 12 hour fast that included high and low density lipoprotein
cholesterol and triglycerides and a measurement of urinary albumin excretion or
albumin/creatinine ratio would most likely also be conducted (Rafey, 2013).

4)   
What is the purpose of the registered dietitian
in the multidisciplinary team conference with the client who is diagnosed with
essential hypertension?

The registered dietitian
will help the patient to recognize healthy and unhealthy

decisions about food. Their role is
to provide Medical Nutrition Therapy to patients and to help educate their
support system such as family members, who will be involved in the patient’s
care. They advocate for and educate about adequate resources that are available
to the patient. They will complete a nutritional evaluation on the entire diet.
This would include foods, drinks, supplements, and medications. Eating patterns
may be evaluated, allergies and other dietary adjustments possibly related to
religious practices will be taken into account. The Dietitian would then create
a care plan as part of the guided treatment of hypertension (The Role, 2018).
It is important that they meet the patient and be present so the patient has
ample opportunity to ask questions and fully understand the new dietary requirements.

5)   
What are the purposes for the prescribed
medications?

The purpose of prescribed
medications for hypertension are to help the body get rid of

excess sodium and water and to help
control blood pressure. Diuretics such as chlorthalidone, chlorothazide, and
hydrochlorothiazide are often used. Potassium-sparing diuretics including
amiloride hydrochloride and spironolactone are common. Loop diuretics such as
Lasix (furosemide), and Bumex are common hypertension drugs as well. Sometimes
a combination of these drugs is required to be most efficient (Types of, 2017).
Other medications would also include beta blockers, ACE inhibitors, Angiotensin
II receptor blockers, calcium channel blockers, Alpha blockers, Alpha-2
receptor agonist, central agonists, peripheral adrenergic inhibitors, and vasodilators.
This is not an exhaustive list of medications.

6)   
What are the most common adverse reactions of
the prescribed medications?

Adverse reactions
to hypertension medications vary depending on the drug. Diuretics can

lead to an increase in potassium
loss (hypokalemia) that affects muscular function, including cardiac muscle.
Gout, dehydration, and blood glucose levels can also present a problem. Beta
blockers can cause the heart to slow, shortness of breath, and chest pain. ACE
inhibitors can produce a dry cough and possibly lower the blood pressure too
much. Other side effects reported are hyperkalemia, edema, heartburn, dry
mouth, and dizziness (Morelli, 2016).

7)   
Discuss drug-to-drug and drug-to-herbal interactions
of the prescribed medications.

Drug-to-drug and
drug-to-herbal interactions can occur, causing one or both to be

ineffectual or even harmful. Interactions
occur when several drugs are administered at the same time and result in a
change in the effect or concentration of the medications. Pharmacokinetic
interactions change the drug’s effect the absorption, distribution, metabolism,
or excretion. When one or any of these processes are altered, the drug’s
effectiveness is altered. If the drug is not being properly absorbed, it also
will not be properly distributed to the correct place in the body, thus reducing
its effectiveness. Drug-to-herbal interactions are essentially the same as
drug-to-drug interactions, and the risks need to be fully explained to patients.
Often people mistake the ability of herbal supplements to significantly impact
the effectiveness of prescription drugs (Wood, 1988).

8)   
What is the ultimate goal of antihypertensive
therapy?

The ultimate goal
of antihypertensive therapy is reducing cardiovascular risks. It reduces

the risk for myocardial infarction
by 20%-25%. Hypertension is a progressive disorder that affects not only the
heart, but also the kidneys, brain, and other organs that lead to premature
death. Eliminating hypertension through drug therapy potentially extends one’s
life (Antonakoudis, 2007).

9)   
Discuss the effects of angiotensin converting
enzyme (ACE) on hypertension and nursing priority of care when caring for
clients taking ACE inhibitor agents.

Angiotensin Converting
Enzyme “inhibits the conversion of angiotensin I to angiotensin

P, which is a vasoconstrictor,
therefore relaxing blood vessels and reducing blood pressure” (ACE Inhibitors,
2005). Patients who are taking diuretics require close supervision when taking
ACE. The initial dose carries with it the risk of first-dose hypotension but
the effects can be mitigated by lying down 2-4 hours after taking the
medication. Nurses should also teach to avoid excessive alcohol as this can augment
the hypotensive effect. The patient should learn to sit or stand slowly to
lower the possibility of postural hypotension. Because of these possible side
effects, the patient should be closely monitored initially (ACE Inhibitors,
2005).

10)  What are some complementary modalities clients
with hypertension may use to decrease blood pressure?

Hypertension may
be reduced through complementary modalities such as consuming

Coenzyme Q-10, polyphenol-rich dark
chocolate, Qigong, slow breathing, and transcendental meditation. Raising
vitamin D intake and melatonin are also being explored. Dark chocolate and
foods derived from the cacao bean contain high amounts of flavonoid polyphenols
such as procyanidins. Supplemental CoQ10 is known to reduce lipid peroxidation.
Consumption has shown to decrease blood pressure. Melatonin is produced naturally
in the brain and can be consumed in over the counter drugs. When the body gets
adequate sleep, BP can be naturally reduced. Short-term vitamin D treatment has
also shown to reduce BP and reducing hypertension in part because of the other
positive physiological effects it has on other body systems. Mind-body
approaches can reduce mental stress thus reducing hypertension (Nahas, 2008).

11)  Discuss client education for a captopril
(Capoten) prescription upon discharge to home.

Client education
for captopril prescription upon discharge is extensive. Instructing the

patient to take the medication at
the same time every day even if they are feeling better is vitally important.
Do not double doses, but if one is missed, take it as soon as possible. Do not
discontinue ACE inhibitor therapy without being directed to do so by a
healthcare professional. Caution the patient to avoid salt substitutes with
potassium or foods with high levels of sodium and potassium. Changing positions
slowly, from lying to sitting to standing, minimizes orthostatic hypotension.
Using alcohol, extended times of standing, and hot weather my increase
orthostatic hypotension. Notify the health care professional before beginning
any new prescription or over the counter medications including herbal
supplements and cough medicines as this can cause drug-to-drug or
drug-to-herbal interactions. Dizziness may occur and driving vehicles or
operating big machinery should be avoided until it is known how their body will
react to the ACE. Impairment of taste is common and usually resolves within 8-12
weeks. Notify the healthcare professional immediately if a rash, mouth sores,
sore throat, fever, swelling of hands or feet, irregular heartbeat, chest pain,
dry cough, hoarseness, facial swelling, or difficulty with swallowing occur.
Diabetic patients need to monitor their blood glucose levels closely as ACE can
cause hypoglycemia. Contraception is advisable for women of childbearing age.
Follow up examinations are vitally important to evaluate the effectiveness of
the medication. Weight reduction, low sodium diet, stopping smoking and limiting
alcohol consumption along with an approved exercise regime can help control
hypertension (Captopril, 2018).

References
ACE Inhibitors. (2005, April
22). Retrieved January 29, 2018, from
https://www.nursingtimes.net/clinical-archive/medicine-management/ace-inhibitors/203551.article
Antonakoudis, G., &
Poulimenos, K. (2007, Autumn). Blood Pressure Control and
Cardiovascular Risk Reduction. Retrieved January 29, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658793/
Captopril. (n.d.). Retrieved
January 29, 2018, from
https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/109012/all/captopril
Ewing, J. (2016, February
26). Cultural Diversity: Eating in America-African American.
Retrieved January 29,
2018, from https://ohioline.osu.edu/factsheet/HYG-5250

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