Question

Mr. B, a 70-year-old male client, presented to his primary care physician with complaints of blurred vision and headaches over the last two months. On several visits, Mr. B's blood pressure was found to be elevated, so the physician started him on hydrochlorothiazide 25 mg by mouth daily. One month later, Mr. B began to have chest pains and shortness of breath, so his primary care provider referred Mr. B to a cardiologist for further evaluation.

The cardiologist ordered an echocardiogram and stress test which revealed heart enlargement and a reduced ejection fraction (volume of blood pumped out of the heart per minute). As a result, the cardiologist started Mr. B on a beta-blocker (metoprolol 25 mg by mouth daily).

A few days after taking the new medication (in addition to the hydrochlorothiazide ordered by the primary physician), Mr. B suffered a fall at home. Upon arrival at the emergency room, Mr. B's blood pressure was 80/50. The emergency room physician suspected the cause of Mr. B's fall was hypotension secondary to the medications he was taking. The ER physician recommended that Mr. B follow up with his primary care physician and cardiologist, but hold the medication until seen by them.

As recommended, Mr. B visits his primary care physician for a follow-up. During the visit, Mr. B's blood pressure is found to be elevated (160/90), so his physician tells Mr. B to restart taking his blood pressure medication.

Imagine that you are the nurse attending to Mr. B and that he indicates that he's afraid to restart the medication because of his recent fall.

1. What considerations/actions should the nurse make regarding the client's refusal to restart his blood pressure medication?
2. What considerations/actions would have helped the healthcare team to prevent the client's fall?

Answer 1

NURSING CONSIDERATIONS / ACTIONS :

• Providing comfortable position.
• Explaining in detail about the disease condition which will help him reduce the anxiety he is having.
• Explaining the need to take the medications.
• Explaining about the medications mechanism of action, benefits and its side effects.
• Encourage to make some lifestyle changes such as diet, quitting smoking if he is a smoker.
  
• Encourage for moderate physical exercise.
  
• Providing psychological support.   
  

ACTIONS / CONSIDERATIONS THAT COULD'VE PREVENTED FALL :

• Proper explanation of the medications should've been given.
• Patient should've been informed to inform the healthcare facility if he experience any dizziness or weakness after taking the medications.
• Proper follow ups should've been done.
• Routine blood pressure assessment should've been done.