Nursing Assignment: Treating Hypertension in Diabetic Patients

This nursing assignment addresses the comprehensive management of hypertension in a 65-year-old patient, R.S., who is overweight, has type 2 diabetes, and is a smoker and alcohol consumer. The solution outlines specific nursing goals, emphasizing lifestyle modifications such as weight management, blood glucose control, increased physical activity, and reduced alcohol and tobacco consumption. The assignment recommends angiotensin-converting enzyme inhibitors (ACEIs) as the initial drug therapy, providing a rationale for their use in diabetic hypertensives and detailing parameters for monitoring the therapy's success, including renal function and cardiovascular parameters. It further discusses essential patient education regarding the prescribed therapy, including potential adverse reactions and the choice of second-line therapy (angiotensin II receptor blockers) if ACEIs are not tolerated. The assignment also explores appropriate over-the-counter and alternative medications (mineral supplements), recommends necessary lifestyle changes, and addresses potential drug-food interactions, such as alcohol's impact on mineral absorption. References from key pharmacology and nursing texts are included to support the recommendations.

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Nursing
Name of student:
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List specific goals for treating R.S.’s hypertension.
Management of hypertension is a comprehensive process in which several factors are
to be addressed for achieving desired patient outcomes. For treating R.S’s hypertension, a set
of nursing goals would be crucial considering the clinical conditions the patient is presenting.
According to Siu (2015), high pressure is mainly caused due to obesity, lack of regular
physical exercise, increased consumption of tobacco and alcohol and chronic diseases such as
diabetes. With increased weight, the body requires more supply of nutrients and oxygen to
the tissues. This increases the pressure on the artery walls. Lack of regular physical activity
increases the chances of becoming overweight and thus increased blood pressure. Excessive
consumption of alcohol and tobacco raises the blood pressure on a temporary basis and
damages the artery wall lining. Further, diabetes has been directly linked to elevated blood
pressure across the literature. In the present context, the primary goal of the patient’ treatment
would be the maintenance of appropriate body weight, management of blood glucose level,
increased physical activity and reduced consumption of alcohol and tobacco. The patient is
overweight with 90 kgs at the age of 65 years. His mobility is restricted due to gout which is
a form of arthritis. Further, he is suffering from type 2 diabetes for the past one decade. In
addition, he is a regular smoker and alcohol consumer.
What drug therapy would you prescribe? Why?
A number of therapeutic agents aid in the pharmacological management of
hypertension. The patient in the present case would be prescribed drug therapy of angiotensin
converting enzyme inhibitors (ACEIs). According to Ganesh and Viswanathan (2011) in
diabetic hypertensives, angiotensin converting enzyme inhibitors (ACEIs) are the first line in
the management of hypertension. Angiotensin converting enzyme inhibitors are effective in
reducing morbidity and mortality rates in the patient. The inhibitors fundamentally act by
suppressing the rennin-angiotensinaldosterone system. The drugs cause prevention of the

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conversion of angiotensin I to angiotensin II and block the major pathway of bradykinin
degradation by inhibition of ACE. The drug, therefore, reduces the activity of the rennin-
angiotensin-aldosterone system (RAAS) as the main causal event in the development of
hypertension in patients suffering from diabetes. Some of the commonly used ACEI drug in
the US are Fosinopril, Captopril, Ramipril and Enalapril (Karch & Karch, 2016).
What are the parameters for monitoring success of the therapy?
According to Lehne and Rosenthal (2014) before commencing on the drug therapy
with ACEI, patients must be monitored for renal function, urea, serum creatinine and serum
potassium level. These measurements are to be repeated on week after the commencement of
the therapy and after one week after each increase in dosage. The lowest recommended dose
of ACEI is to be used at the initial level, aiming for the target dose. ACE inhibitors lower
arterial resistance and increase venous capacity. As a result, there is a decrease in cardiac
index, cardiac output, stroke work and volume. These aspects are to be monitored adequately
to for understanding the success of the therapy.
Discuss specific patient education based on the prescribed therapy.
Patient education is of prime importance when the ACEI drug therapy is in practice.
The patient is to be advised to avoid engaging in strenuous physical activity until there are no
signs of dizziness. In addition, the patient is also to be educated that the therapy must not be
stopped without medical consultation. Further, he is to be advised to rise slowly for avoiding
postural hypotension (Adams & Urban, 2015).
List one or two adverse reactions for the selected agent that would cause you to change
therapy.
While ACEI drug therapy is effective in addressing hypertension in diabetic patients,
there is a risk of adverse effects. For patients who do not tolerate ACEI drugs well, adverse

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events might include persistent dry cough and severe dizziness. A dry cough makes the
patient uncomfortable and in need of additional help. Further, dizziness and fatigue are
experienced by a considerable section of the patient population (Lehne & Rosenthal, 2014).
What would be the choice for second-line therapy?
The second line therapy would be angiotensin II receptor blockers. As pointed by
Karch and Karch (2016) ACEIs can be replaced by angiotensin II receptor blockers in case
the patient is intolerant of them. A rich pool of research highlight that ARBs are on par with
ACEI to reduce risks of hypertension. Angiotensin II is responsible for causing muscle
contraction near blood vessels, thereby causing narrowed vessels. This results in an increase
of pressure within the vessels, leading to high blood pressure. Angiotensin II receptor
blockers (ARBs) block the action of angiotensin II through prevention of binding of
angiotensin II on angiotensin II receptors found on blood vessels. Blood vessels are dilated.
As a result, leading to reduced blood pressure. Some common drugs of this class are
Azilsartan and Candesartan.
What over-the-counter and/or alternative medications would be appropriate for R.S.?
The alternative medications that would be appropriate for R.S are mineral
supplements. Though exercise and medications have been the most valuable tactics for
lowering blood pressure, supplements also aid in this regard (Adams & Urban, 2015).
What lifestyle changes would you recommend to R.S.?
Lifestyle changes would be mandatory for R.S in order to reduce the risk of
hypertension in future. Firstly, the patient is to be encouraged and motivated to reduce his
body weight by adhering to a nutritional diet. A balanced diet outlined by a dietician would
be helpful in this regard. In addition, the patient needs to engage in some form of physical
activity on a regular basis that aids in controlling body weight and diabetes (Sun, 2015).

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Describe one or two drug–drug or drug–food interaction for the selected agent.
One drug-food interaction for mineral supplements is that between such supplements
and alcohol. Alcohol has been known to inhibit absorption of folate and other essential
vitamins through the destruction of the cells lining the intestine and stomach mediating
absorption of nutrients (Adams & Urban, 2015).

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References
Adams, M. P., & Urban, C. (2015). Pharmacology: Connection to Nursing. Pearson
Education.
Ganesh, J., & Viswanathan, V. (2011). Management of diabetic hypertensives. Indian journal
of endocrinology and metabolism, 15(Suppl4), S374.
Karch, A. M., & Karch. (2016). Focus on nursing pharmacology. Lippincott Williams &
Wilkins.
Lehne, R. A., & Rosenthal, L. (2014). Pharmacology for Nursing Care-E-Book. Elsevier
Health Sciences.
Siu, A. L. (2015). Screening for high blood pressure in adults: US Preventive Services Task
Force recommendation statement. Annals of internal medicine, 163(10), 778-786.
Sun, Z. (2015). Aging, arterial stiffness, and hypertension. Hypertension, 65(2), 252-256.