Is Daniels treatment plan a typical treatment plan for hypertension? Support your answer. 2.

Discuss the drugs ordered for Daniel. 3. What should Daniel know about methyldopa? 4. If you were the nurse in whom Daniel confined that he did not understand his illness and the treatment, what would you have done?
1.

Daniels treatment plan is not a typical treatment for him because he experienced side effects of the drugs such as dizziness, and extreme tiredness

A THIAZIDE Diuretics Mechanism of Action:

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inhibits reabsorption of Na and Cl in the distal renal tubule, increasing the excretion of Na, Cl, and water by the kidney.

Indications: Hypertension as sole therapy Or in combination with other antihypertensive drugs Adverse effect: CNS: Dizziness, Paresthesias Cardiovascular: Orthostatic Hypotension Dermatologic: Rash, hives Gastrointestinal: Nausea and Vomiting, Diarrhea Genitourinary: Polyuria, Nocturia

Nursing Considerations: Give with food or milk if GI upset occurs Reduce dosage of other hypertensive by at least 50% if given with thiazides, readjust dosage gradually as BP respond. Administer in the morning so that it will not cause sleep disturbance Instruct patient about the side effects:

Increase urination Dizziness Feeling of fainting upon arising Drowsiness Sensitive to light

An ANTI-HYPERTENSIVE Drug Mechanism of Action: Lowers arterial blood pressure by stimulating Central Nervous System alpha2adrenergic receptors which in turn decreases sympathetic outflow from the CNS
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Indication: - Hypertension *IV methyldopa- acute hypertensive crisis not a drug of choice because of slow onset action Contraindication: Hypersensitivity to methyldopa Active hepatic diseases previous methyldopa therapy associated with liver disorders.

Adverse effect: Headache Dizziness Light headedness Orthostatic hypotension Nausea and vomiting Weakness Drug Interaction: Increase hypotension with levodopa Risk of hypotension during surgery with central anesthetics, monitor it carefully

Nursing Considerations:

Monitor hepatic function, especially in the first 6-12week of therapy or if unexplained fever appears Add a thiazide to drug regimen or increase dosage if methyldopa tolerance occurs. Instruct patient that the drug must be taken exactly as prescribed. It is important that miss doses should be avoided or prevented. Monitor Blood pressure carefully when discontinuing methyldopa. Drug has a short duration of action and hypertension usually returns within 40hours Instruct patient to report unexplained, prolonged general tiredness, yellowing of the skin or eyes, fever, brushing rash.

Is used to treat high blood pressure A class of medications called anti-hypertensives. Action: It works by relaxing the blood vessels so that blood can flow more easily through the body. taken by mouth and 3-4 times a day. Take methyldopa exactly as directed. Do not stop taking methyldopa without talking to your doctor. If you suddenly stop taking methyldopa, your blood pressure may increase and you may experience side effects. Your doctor will decrease your dose gradually. Before taking methyldopa, do not take with iron supplements or vitamins containing iron. tell you doctor if you have or have ever had kidney or liver disease, including hepatitis or cirrhosis.

You should know that this medication may make you drowsy. Do not drive a car or operate machinery for 48-72 hours after you begin to take methyldopa or after your dose is increased. Diet is low salt-low sodium Take the missed dose immediately if forgotten. Do not double the dose

Methyldopa may cause side effects. Tell your doctor

if any of these symptoms are severe or do not go away:

Drowsiness Headache Muscle weakness Swollen ankles or feet Upset stomach Vomiting Diarrhea Gas Dry mouth Rash Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately: Unexplained fever Extreme tiredness Yellowing of the skin or eyes

If I were the nurse to whom Daniel confided that he did not understand his illness and its treatment, I would provide him a health teaching. I will explain that HPN is the elevation of blood pressure greater than 130/90 mmHg for three consecutive readings. I would tell him that hypertension has two types its either essential or secondary. Essential hypertension is the term for high blood pressure with unknown cause. Secondary hypertension is the term for high blood pressure with a known direct cause, such as kidney disease, tumor, etc.

In the case of Daniel he has an essential hypertension. The most common cause of developing Hypertension: Smoking sedentary lifestyle or inactivity high sodium intake Obesity Stress Alcoholism Great contributory factor is the family history.

Medications that can be taken: ACE inhibitors ARB drugs Beta-blockers calcium channel blockers alpha-blockers peripheral vasodilator Diuretics These drugs are effective in lowering Blood Pressure

Health teachings: I will advise him to consult doctor if side effects of hypertensive drugs are experienced. And always had a routine check-up of blood pressure to prevent relapse of hypertension. In his case I will explain that tiredness and extreme fatigue are the side effects of hydrochlorothiazide and methyldopa. And that It is usually is taken two or three times a day. And must follow the directions on your prescription label carefully and hydrochlorothiazide exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Continuation: Continue to take methyldopa and hydrochlorothiazide even if you feel well. Do not stop taking methyldopa and hydrochlorothiazide without talking to your doctor. I will also explain the possible complications of Hypertension if he didnt comply to treatment regimen. He may develop stroke, heart attack, heart failure, problems with his vision, chronic kidney disease, and poor circulation to the legs.

Dizziness, light-headedness, or fainting can occur when rising from a seated or lying position. If this occurs, avoid sudden changes in posture. Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using methyldopa/hydrochlorothiazide; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness. Methyldopa/hydrochlorothiazide may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to methyldopa/hydrochlorothiazide. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.

Your doctor may have prescribed a potassium supplement for you. If so, follow the dosing carefully. Do not start taking additional potassium on your own or change your diet to include more potassium without first checking with your doctor. Patients who take medicine for high blood pressure often feel tired or run down for a few weeks after starting treatment. Be sure to take your medicine even if you may not feel "normal". Tell your doctor if you develop any new symptoms.

Additional Health Teachings: Encourage him to do lifestyle changes which include losing weight if he is obese Quit smoking Limit alcohol consumption. Eat a healthful diet Reduce sodium intake Exercise regularly