Hypertension management plan

A 55-year-old man with a history of hypertension comes to the clinic to establish care. The patient has a history of hypertension and hyperlipidemia. He is currently taking hydrochlorothiazide 25mg PO daily and amlodipine 5mg PO daily for hypertension. He has been working on lifestyle modifications to help normalize his cholesterol level. The current lipid panel shows that this patient’s total cholesterol is 200 mg/dL and HDL is 40 mg/dL. The patient does not drink alcohol but smokes a pack of cigarettes per day. His vital signs today are as follows: BP 134/88mmHg; HR 74bpm; RR 18/min; T98.2F; BMI 31/kg/m2. QUESTIONS:

1. Calculate the patient’s ASCVD risk?

2. What does the NP prescribe for this patient’s hyperlipidemia? Provide a rationale.

3. What does the NP include in the medication (question #2) education plan?

4. What laboratory studies does the NP order? Provide a rationale. The Patient returns for follow up and the home BP readings average 140’s/88-92mmHg. The NP considers modifying the patient’s BP medications. The patient is adherent with the above prescribed medications.

5. List the patient’s pharmacological regimen for the treatment of this patient’s hypertension? Provide a rationale for your choices.

6. What are the side effects of the medications listed above?

7. What is the hypertension management plan for the patient? List patient education, monitoring (what & when) and follow-up?

8. The patient now has a diagnosis of type 2 diabetes and is started on metformin 500mg PO QD and semaglutide (Ozempic)? Does this change the patient’s hypertension management? Provide a rationale.

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