Nu636peerresponseU2#2

You have a 57-year-old mixed-race male (black and Asian) who comes into your office for a screening to participate in a study to evaluate the effectiveness of a home cervical traction device on neck pain and intervertebral disc space. He has a history of neck pain and was diagnosed six years ago with spinal stenosis at the C5-C6 level.

During the screening, the gentleman is found to have a BP of 217/109. When you question him about this BP measurement, he reports to you that he knows that his blood pressure has been in that range for about the last decade. He reports he has not seen a health care professional about his elevated blood pressure and does not have a health care professional that he sees on a routine basis. He is a healthcare professional at the provider level.

Based on the blood pressure measurement he does not meet the inclusion criterion for the cervical traction device research study.

Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.

Subjective:

A mixed race Black and Asian came to the doctor’s office for a screening to participate in a study to evaluate the effectiveness of a home cervical traction device for long-term neck pain and intervertebral disc space. Patient with hypertensive urgency may be completely asymptomatic or may present with symptoms such as headache, epistaxis, psychomotor agitation, faintness, malaise, nausea or vomiting (Apra et al., 2020).

Objective:

BP of 217/109

57-year-old male

Assessment: When the blood pressure readings are 180/110 or higher and no damage to the body’s organs, this is what we called hypertensive urgency (Ali et al., 2018).

Plan: First thing to do is to rule out target organ damage using metabolic panels, urinalysis, electrocardiogram, chest X-ray and brain computed tomography (Alley & Copelin, 2021). The goal of treatment of hypertensive urgency is to slowly reduce the blood pressure of a period of 24 to 48 hours and to ensure better long-term blood pressure control (Axon & Breu, 2018). Rapidly bringing down blood pressure in a patient without end-organ damage may result in relative hypoperfusion and harm the patient rather than help (Axon & Breu, 2018).

Therapeutic: Commonly used medications are nitrates, direct vasodilators, CCBs, sympatholytic agents, alpha-1 blockers, ACEIs (Alley & Copelin, 2021). The most common is sodium nitroprusside which is a short-acting agent that the BP response can be titrated from minute to minute (Gauer, 2017).

Education: It is best important to educate patient on medication compliance, healthy lifestyle such as discontinuing smoking, maintaining body weight, regular exercise reduce salt intake, avoid alcohol, and take plenty of fiber in the form of vegetables and fruits (Alley & Copelin,2021).

Consultation/Collaboration: Interprofessional team should include internist, nephrologist, specialty cardiac nurse, and ophthalmologist (Alley & Copelin, 2021). Cardiologist is needed to monitor the blood pressure that it is well controlled. Nephrologist can thoroughly assess the renal function for acute kidney injury that may be due to fluid overload or elevated activity of the renin-angiotensin pathway causing systemic vasoconstriction (Alshami et al., 2018).

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