Posted: June 11th, 2024

Effective Management of Hypertension, Dyslipidemia, Asthma, and Chronic Obstructive Pulmonary Disease: A Clinical Approach

Effective Management of Hypertension, Dyslipidemia, Asthma, and Chronic Obstructive Pulmonary Disease: A Clinical Approach
Abstract
This paper explores the management of four common medical conditions encountered in clinical practice: hypertension, dyslipidemia, asthma, and chronic obstructive pulmonary disease (COPD). Drawing from current clinical practice guidelines and scholarly literature, this paper provides evidence-based recommendations for the evaluation, treatment, and monitoring of these conditions. The management strategies discussed aim to optimize patient outcomes, minimize complications, and promote adherence to prescribed therapies.
Scenario 1: Hypertension Management
Sara, a 45-year-old female patient, presents with elevated blood pressure readings of 160/90 mmHg and a history of suboptimal control. The goal for blood pressure management in patients with hypertension is to achieve readings below 130/80 mmHg, as recommended by the 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults (Whelton et al., 2018). Given Sara’s elevated blood pressure and risk factors (age and obesity), initiating pharmacological treatment is warranted.
Recommended Treatment:

Hydrochlorothiazide 25 mg once daily
Prescribe as: “Hydrochlorothiazide 25 mg oral tablet, take one tablet by mouth once daily.”

Patient Education:

Explain the importance of blood pressure control in reducing the risk of cardiovascular complications.
Encourage lifestyle modifications, including dietary changes (reducing sodium intake, increasing potassium-rich foods), regular exercise, and weight management.
Emphasize medication adherence and the need for regular blood pressure monitoring.
Discuss potential side effects of the prescribed medication and when to seek medical attention.

Scenario 2: Dyslipidemia Management
Monty, a 52-year-old male smoker with dyslipidemia, presents with an elevated total cholesterol of 266 mg/dL, LDL cholesterol of 180 mg/dL, and triglycerides of 185 mg/dL. According to the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol (Grundy et al., 2019), the target LDL-C level for high-risk patients like Monty is <70 mg/dL. Recommended Treatment Plan: Atorvastatin 40 mg once daily Prescribe as: "Atorvastatin 40 mg oral tablet, take one tablet by mouth once daily." Encourage smoking cessation and lifestyle modifications, including a heart-healthy diet and regular exercise. Monitoring: Repeat lipid profile in 4-12 weeks after initiating statin therapy. Assess for potential side effects, such as muscle pain or liver enzyme elevations. Monitor adherence to the prescribed regimen. Monty has at least three risk factors for coronary artery disease: male gender, smoking, and dyslipidemia. Scenario 3: Asthma Management Beatrice, a 17-year-old female with mild persistent asthma, reports increased symptom frequency, nocturnal awakenings, and exercise-induced shortness of breath despite using her current inhaled corticosteroid (ICS) and short-acting bronchodilator. =============== Effective Management of Hypertension, Dyslipidemia, Asthma, and Chronic Obstructive Pulmonary Disease: A Clinical Approach Directions: For each of the scenarios below, answer the questions below using clinical practice guideline where applicable. Explain the problem and explain how you would address the problem. If prescribing a new drug, write out a complete medication order just as you would if you were completing a prescription. Use at least 3 sources for each scenario and cite sources using APA format. 1. Sara is a 45-year-old female presenting for her annual exam. Her blood pressure today is 160/90 HR 84 RR 16. Her height is 64 inches and her weight is 195. Her last visit to the clinic 3 months ago shows a BP of 156/92. She is currently taking ibuprofen 600 mg tid for back pain. She has no known allergies. What is the goal for her blood pressure? What medication would you prescribe to treat her blood pressure? What education would you prescribe? 2. Monty is a 52-year-old male following up on his labs that were drawn last week. He smokes 1 pack per day. He is currently on Lisinopril 20 mg po daily. He is allergic to penicillin. Fasting lipid profile shows total cholesterol 266, LDL cholesterol 180, HDL cholesterol 40, and Triglycerides 185. What treatment plan would you implement for Monty’s lipid profile? What is the goal Total Cholesterol (TC), HDL-C, and LDL-C level for Monty? How would you monitor the effectiveness of your treatment plan? How many risk factors for coronary artery disease does this patient have? Identify them specifically. 3. Beatrice is a 17-year-old female diagnosed with mild persistent asthma since age 7. During her visit today, she reports having to use her albuterol MDI 3 to 4 days per week over the past 2 months. Over the past week she has been using albuterol at least once per day. She reports being awakened by a cough three nights during the last month. She is becoming more short of breath with exercise. She also has a fluticasone MDI, which she uses “most days of the week.” Her current medications include: Flovent HFA 44 mcg, two puffs BID, Proventil HFA two puffs Q 4–6 H PRN shortness of breath, Yaz one PO daily, Propranolol 80 mg PO BID. What treatment plan would you implement for this patient? What medication changes would you make? How would you monitor the effectiveness of this plan? 4. Daute is a 56-year-old man seeking evaluation for increasing shortness of breath. He noticed difficulty catching his breath about 3 years ago. Physical activity increases his symptoms. He avoids activity as much as possible to prevent any SOB. His previous physician had placed him on salmeterol/fluticasone (Advair Diskus) one inhalation twice daily 2 years ago. He thinks his physician initiated the medication for the shortness of breath, but he is not entirely sure. He did not refill the prescription and has not been taking it. Pertinent history – Chronic bronchitis X 8 years with one exacerbation in last 12 months of treatment with oral antibiotics. He has a 40-pack-year smoking history. What treatment plan would you implement for this patient? What medication(s) would you prescribe? How would you monitor the effectiveness of this plan?

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