Canadian Healthcare Practice

This document discusses a case study of a patient with hypertension and hypothyroidism, and the prescribed medications Levothyroxine and Captopril. It explores the disease process, diagnosis, rationale behind the medications, dosage calculation, and nursing interventions.

Running head: CANADIAN HEALTHCARE PRACTICE
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1CANADIAN HEALTHCARE PRACTICE
The disease process in the following case study includes the following.
 Mrs Walker who is 88 years old , has the following symptoms:
o Difficulty in sleeping
o Mrs Walker’s current weight is 65 kg and height is 160 cm, therefore
her Body Mass Index (BMI) is 25.4 which falls under the category of
overweight.
 The patient has been diagnosed with Hypertension and it is in relation with
coronary artery disease or CAD. To control the high blood pressure the patient
is currently using salt substitute. The high blood pressure in patient’s
diagnosis has resulted in elevated risk factor for the coronary artery disease, as
the there is a constant pressure on the arteries creates high chances for
formation of plaques in the artery that has led to coronary artery disease
(Rosendroff et al., 2015).
 In a secondary diagnosis it revealed that the patient has hypothyroidism, may
also lead to the elevation of blood pressure, which is a secondary cause of
hypertension and subclinical risk factors for cardiovascular diseases (Kim et
al., 2014).
The physician has prescribe two drugs; Levothyroxine and Captopril (Mechanism of Action
and Pharmacological class)
 Levothyroxine, is used in the treatment of lower thyroid production from
the thyroid gland and the drug is a synthetic hormone replacement of
thyroxin (T 4) and which is converted in to an active metabolite (T 3)
which is L-triiodothyronine. The drug metabolic effect is initiated by the
DNA transcription as well as synthesise of protein.

2CANADIAN HEALTHCARE PRACTICE
 Captopril is used for renal vascular hypertension as well as congestive
heart failure. This a ACE inhibitor or an angiotensin converting enzyme
which is somatic in nature to regulate the high blood pressure and blocks
enzyme proteolysis in AT I and AT II.
The rationale behind the physicians order is that since the patient is overweight and
has hypertension and that is related with the coronary heart disease the medication of
captopril will ensure the decrease of hypertension as well keep in check myocardial infraction
as well as prevent from retinopathy and neuropathy. In case of Levothyroxine, it is due to the
reason that patient has hypothyroidism and hence the patient supplement of synthetic
hormone thyroxin T 4, the drug also reduces the hypertension in patients.
 The dosage calculation of each medicine for Levothyroxine: It is 125 mcg in AM
before meals, which per day in take of that medicine according to body weight is:
8.13 mg daily. Whereas for Captopril is 25 mg BID, that is 1625 mg daily.
The NANDA diagnosis includes:
 Assessment: Here it can be understood that the patient is already overweight and she is
88-year old which means that she is at high risk of getting cardiovascular disorder, the
patient has mentioned difficulty in sleeping.
 Diagnosis: The clinical diagnosis includes: she has hypertension, CHD as well as
hypothyroidism. Planning includes: The doctor has prescribed the captopril which can reduce renal
hypertension and levothyroxine can reduce hypothyroidism.
 Implementation: The patient can be asked to use a supplement of table salt by there
can be many salt substitute like tea tree oil which can relieve heart dysfunctions
(Liley, Collins & Snyder, 2019). The potassium choride can also be used as a
supplement for salt (Cepanac, 2017).

3CANADIAN HEALTHCARE PRACTICE
References:
Cepanec, K., Vugrinec, S., Cvetković, T., & Ranilović, J. (2017). Potassium chloride‐based
salt substitutes: A critical review with a focus on the patent literature. Comprehensive
Reviews in Food Science and Food Safety, 16(5), 881-894.
Kim, E. J., Lyass, A., Wang, N., Massaro, J. M., Fox, C. S., Benjamin, E. J., & Magnani, J.
W. (2014). Relation of hypothyroidism and incident atrial fibrillation (from the
Framingham Heart Study). American heart journal, 167(1), 123-126.
Lilley, L. L., Shelly Rainforth Collins, P., & Snyder, J. S. (2019). Pharmacology and the
nursing process. Mosby.
Rosendorff, C., Lackland, D. T., Allison, M., Aronow, W. S., Black, H. R., Blumenthal, R.
S., ... & Gersh, B. J. (2015). Treatment of hypertension in patients with coronary
artery disease: a scientific statement from the American Heart Association, American
College of Cardiology, and American Society of Hypertension. Journal of the
American College of cardiology, 65(18), 1998-2038.