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

Being diagnosed with any disease or disorders is very stressful specially if it involves taking medications which are high alert.

NURSING ACTIONS :

• Assess patients knowledge regarding the disease condition to better understand and plan health education accordingly.
  
• Provide comfortable position.
• Explain about the disease condition, it's causes, signs and symptoms, treatment and diet.
• Explain the medications which the patient is advised, it's mechanism of action, benefits, and side effects.
• Explain the lifestyle changes the patient has to do such as the diet, quitting smoke if the patient is a smoker.
  
• Evaluate if the patient understood.
  
• Clear patients doubt.

ACTIONS WHICH COULD HAVE PREVENT FALL :

• Patient should've informed if he experienced any dizziness or weakness after starting the medications.
• Proper follow ups should've been done.
• Routine blood pressure assessment could've been done in the nearby healthcare clinics.