Management Plan by Enija Shrestha Shiwakoti on case Felipe
Garcia
Management Plan:
Diagnostic tests: ECG, CBC, CMP, TSH and UA. All diagnostic tests result are
normal. Diagnosis: Primary (essential) Hypertension
Medication plan:
The main target of the management plan is to reduce the risk of myocardial infraction and stroke
by lowering the blood pressure target of <130/80 mm Hg within 3 months. According to clinical
practice guidelines,any BP above or equal to 160/100 mmg Hg is categorised as grade- 2 and
should immediately treated with drug therapy and lifestyle intevention (Unger et al., 2020). Felipe
Garcia BP is 170/93 mm Hg (grade 2) and should be treated with drugs and lifestyle
modifications. According to clnical practice guidlines, Patient with stage 2 hypertension and non-
black should be started with low dose ACEI/ARB + DHP-CCB, increase to full dose as applicable,
and add thiazide/thiazide like diuretics (Unger et al., 2020).
Hydrochlorothiazide 12.5 mg daily PO. quantity 30 tablets, no refills. Take 1 tablet in the morning
with food. Lisinopril 10 mg PO once daily.
Hydrochlorothiazide are FDA approved for clinical use in the managment of primary hypertension
and heat failure. This drug is used in outpatient to manage chronic edema states. This drug helps
to remove excess sodium and water from body reducing blood pressure (Unger et al., 2020).
Lisinopril helps to relax blood vessels and helps to flow blood more easily and reduce blood
pressure.
Omeprazole 20 mg, 1 tablet PO daily in am (30 minutes before food) for GERD.
Nicotine transdermal patch. 12 mg patch, apply 1 patch in the morning. 14 counts. No refill.
Apply patch to upper arm, upper chest, or inner shoulder for 24 hours. Skin should be dry. Do not
apply on irritated or damaged skin.
Tylenol 500 mg tablet PO every 4-6 hours as needed for knee pain. Do not exceed more than 4000
mg in 24 hours.
Labs:
Check Lipid Profile (cholesterol, tryglycerides, low density lipoprotein, total cholesterol) to idenify
the risk for heart disease and stroke. Indications: patient is overweight and BMI 28.8, HTN, and
less physical exercise.
Fasting blood glucose, A1C level, due to family history of DM and HTN.
Suggested referral and consult:
Consult with dietician for dietary modifications.
Smoking cessation program such as CDC 1-800-QUIT-NOW. This statelines offers counsellings,
referrals and free medication to help individual quit tobacco use (CDC, 2019). Or, connect with
Texas state local smoking cessation program.
Client Education:
Dietary modification: adopt heart healthy diet such as DASH (Dietary Approach to Stop
Hypertension) diet. This diet emphasize increase intake of vegetables, fruits, whole grains and
low-fat daily products. Limit sodium intake to 1500 mg or about o.5 teaspoons of salt per day.
Avoid consuming fast foods and processed food because it contains high level of salt (Grillo et al.,
2019). Avoid alcohol, caffiene, spicy, and deep fried foods for GERD. Eat smaller meals more
frequently.
, Lifestyle modification: Perform regular physical exercise, moderate-intensity excercise, 150
minutes a week. Perform brisk walk 22-30 minutes with dog, 5 days a week. This helps to reduce
weight and blood pressure.
Garcia
Management Plan:
Diagnostic tests: ECG, CBC, CMP, TSH and UA. All diagnostic tests result are
normal. Diagnosis: Primary (essential) Hypertension
Medication plan:
The main target of the management plan is to reduce the risk of myocardial infraction and stroke
by lowering the blood pressure target of <130/80 mm Hg within 3 months. According to clinical
practice guidelines,any BP above or equal to 160/100 mmg Hg is categorised as grade- 2 and
should immediately treated with drug therapy and lifestyle intevention (Unger et al., 2020). Felipe
Garcia BP is 170/93 mm Hg (grade 2) and should be treated with drugs and lifestyle
modifications. According to clnical practice guidlines, Patient with stage 2 hypertension and non-
black should be started with low dose ACEI/ARB + DHP-CCB, increase to full dose as applicable,
and add thiazide/thiazide like diuretics (Unger et al., 2020).
Hydrochlorothiazide 12.5 mg daily PO. quantity 30 tablets, no refills. Take 1 tablet in the morning
with food. Lisinopril 10 mg PO once daily.
Hydrochlorothiazide are FDA approved for clinical use in the managment of primary hypertension
and heat failure. This drug is used in outpatient to manage chronic edema states. This drug helps
to remove excess sodium and water from body reducing blood pressure (Unger et al., 2020).
Lisinopril helps to relax blood vessels and helps to flow blood more easily and reduce blood
pressure.
Omeprazole 20 mg, 1 tablet PO daily in am (30 minutes before food) for GERD.
Nicotine transdermal patch. 12 mg patch, apply 1 patch in the morning. 14 counts. No refill.
Apply patch to upper arm, upper chest, or inner shoulder for 24 hours. Skin should be dry. Do not
apply on irritated or damaged skin.
Tylenol 500 mg tablet PO every 4-6 hours as needed for knee pain. Do not exceed more than 4000
mg in 24 hours.
Labs:
Check Lipid Profile (cholesterol, tryglycerides, low density lipoprotein, total cholesterol) to idenify
the risk for heart disease and stroke. Indications: patient is overweight and BMI 28.8, HTN, and
less physical exercise.
Fasting blood glucose, A1C level, due to family history of DM and HTN.
Suggested referral and consult:
Consult with dietician for dietary modifications.
Smoking cessation program such as CDC 1-800-QUIT-NOW. This statelines offers counsellings,
referrals and free medication to help individual quit tobacco use (CDC, 2019). Or, connect with
Texas state local smoking cessation program.
Client Education:
Dietary modification: adopt heart healthy diet such as DASH (Dietary Approach to Stop
Hypertension) diet. This diet emphasize increase intake of vegetables, fruits, whole grains and
low-fat daily products. Limit sodium intake to 1500 mg or about o.5 teaspoons of salt per day.
Avoid consuming fast foods and processed food because it contains high level of salt (Grillo et al.,
2019). Avoid alcohol, caffiene, spicy, and deep fried foods for GERD. Eat smaller meals more
frequently.
, Lifestyle modification: Perform regular physical exercise, moderate-intensity excercise, 150
minutes a week. Perform brisk walk 22-30 minutes with dog, 5 days a week. This helps to reduce
weight and blood pressure.
