Author Question: What could M.P. be doing that is causing her nocturia? What will be an ideal ... (Read 43 times)

geoffrey · **on:** Jun 25, 2018

What could M.P. be doing that is causing her nocturia?

What will be an ideal response?

Question 2

M.P. is a 65-year-old African American woman who comes to your clinic for a follow-up visit. She was diagnosed with hypertension (HTN) 2 months ago and was given a prescription for a thiazide diuretic but stopped taking it 2 weeks ago because

it made me dizzy and I kept getting up during the night to empty my bladder. During today's clinic visit, she expresses fear because her mother died of a cerebrovascular
accident (CVA, stroke) at M.P.'s age, and M.P. is afraid she will suffer the same fate. She states, I've never
smoked and I don't drink, but I am so afraid of this high blood pressure. You review the data from her past
clinic visits.

Family History
Mother, died at age 65 years of CVA
Father, died at age 67 years of myocardial infarction (MI)
Sister, alive and well, age 62 years
Brother, alive, age 70 years, has coronary artery disease (CAD), HTN, type II diabetes
mellitus (DM)
Patient Past History
Married for 45 years, two children, alive and well, six grandchildren
Cholecystectomy, age 42 years
Hysterectomy, age 48 years
Blood Pressure Assessments
January 2: 150/92
January 31: 156/94 (Given prescription for hydrochlorothiazide HCTZ 25 mg PO every
morning)
February 28: 140/90

According to the most recent guidelines from the Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure, M.P.'s blood pressure (BP)
falls under which classification?

Eazy416 · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

She could be taking the HCTZ in the late afternoon or evening, instead of in the morning. Diuretics,
such as HCTZ, should be taken in the morning so that the diuretic effects do not disturb sleep.

Answer to Question 2

Stage 1 hypertension (defined as systolic BP from 140 to 159 mm Hg or diastolic BP from 90 to 99 mm
Hg) on each of two or more office visits. Instructors may refer to the guidelines, the most recent
information from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment
of High Blood Pressure (JNC 9).