R. S., a 65-year-old African-American man, was referred to the APRN-NP in the hypertension clinic for evaluation of high BP noted on an initial screening. He reports having headaches and nocturia. He states that he has gained 8 pounds over the last year. Past medical history: Appendectomy 30 years ago, Peptic ulcer disease 10 years ago, Type 2 diabetes mellitus for 10 years; Family history: Father had hypertension; died of myocardial infarction at age 55, Mother had diabetes mellitus and hypertension; died of cerebrovascular accident at age 60; Physical examination: Height 69 in, weight 108 kg; BP: 140/89 mm Hg (left arm), 138/82 mm Hg (right arm); Pulse: 84 beats/min, regular; Funduscopic examination: mild arterial narrowing, sharp discs, no exudates or hemorrhages; Laboratory findings: Blood urea nitrogen: 24 mg/dL, Serum creatinine: 1.5 mg/dL, Glucose: 95 mg/dL, Potassium: 4.0 mEq/L, Total cholesterol: 201 mg/dL, High-density lipoprotein cholesterol: 30 mg/dL, Triglycerides: 167 mg/dL, Urinalysis: 1+ proteinuria; Electrocardiogram and chest radiograph: mild left ventricular hypertrophy; Social history: Tobacco: 35 pack years, Alcohol: pint of vodka/week, Coffee: 2 cups/day.
In this discussion forum:
1. Discuss the patient’s diagnosis of hypertension, including the stage, comorbidities, and family history.
2. Discuss specific goals for pharmacotherapy for treating R. S.’s hypertension and cholesterol
3. Discuss what you would consider to be first-line pharmacotherapy for R. S., and why.
4. Discuss the parameters for monitoring the success of the therapy.
5. Discuss health promotion recommendations you would consider for R. S.
6. Does the presence of Diabetes Mellitus impact your treatment selection?
Provide two very full paragraphs supported with evidence from the literature. Use journal articles as key sources of citation only. Avoid use of direct quotes. Paraphrase and provide end of text line citation. This patient has HTN so look at national clinical guidelines such as JNC. Integrate those guidelines in your management plan. 75% of your posts must be original work. Synthesizing the literature and paraphrasing is acceptable, but more than 25% use of quotes is unacceptable. Plagiarism is not acceptable. Use original work only. APA 6th edition only. Answer each question thoroughly.
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