FNP 591 Week 3 Aquifer Case Study: Family Medicine 8: 54-year-old male

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Family Medicine 8: 54-year-old male with elevated blood pressure

Ali Junayed

United States University

FNP-591

Prof. Tamika Dowling

January 2025

54-year-old male with elevated blood pressure

Mr. Jose Martin, a 54-year-old male taxi driver, sought care at a student-staffed free clinic due to a lapse of over 10 years without medical attention. His challenging circumstances included financial constraints, lack of insurance, and the demands of a 12-hour, six-day-a-week work schedule as a taxi driver. Despite not experiencing any significant health issues, Mr. Martin’s wife encouraged him to seek a medical evaluation. The interdisciplinary healthcare team, comprising students from various disciplines, delved into Mr. Martin’s health history, lifestyle, and familial influences. 

Main Diagnosis with Supporting Rationale 

The primary diagnosis for Mr. Jose Martin is hypertension, supported by elevated blood pressure readings of 150/85 mmHg and 151/82 mmHg on separate occasions. Mr. Jose Martin has some factors that make him more likely to have hypertension, such as being overweight, having a family history of heart problems (his father had a heart attack at 64), and having a job where he sits a lot as a taxi driver. Even though he does not have any symptoms, the healthcare team thinks it is crucial to manage his blood pressure. It is essential to focus on lifestyle changes and think about which anti-hypertensive medicines would be best for him based on the latest guidelines and his specific situation (Khalil & Zeltser, 2023).

Two Additional Differential Diagnoses 

Two additional differential diagnoses considered for Mr. Jose Martin include hypercholesterolemia and stress-related elevated blood pressure. 

Hypercholesterolemia

Hypercholesterolemia was initially considered due to his family history of high cholesterol and his sedentary lifestyle as a taxi driver. However, his lipid profile, including total cholesterol of 189 mg/dL, HDL of 45 mg/dL, and LDL of 118 mg/dL, falls within the normal or borderline range, making hypercholesterolemia less likely (Vrablik et al., 2020). 

Stress-Related Elevated Blood Pressure

Stress-related elevated blood pressure was also contemplated given Mr. Martin’s acknowledgment of stress, but the consistent blood pressure elevation and the presence of other risk factors for hypertension led the team to prioritize hypertension as the primary diagnosis. These considerations underscore the importance of a comprehensive differential diagnosis approach to tailor effective management strategies (Nwanaji-Enwerem et al., 2022).

Diagnostic Plan with Supporting Rationale

Blood Pressure Monitoring

Continue regular blood pressure monitoring, both in the clinic and at home, to assess the effectiveness of lifestyle modifications and medication adherence. Ongoing blood pressure monitoring is crucial to track the response to interventions and adjust treatment accordingly (Price, 2020).

Lipid Profile Monitoring

Given Mr. Martin’s risk factors and borderline lipid levels, repeat lipid profile testing in six months to assess any changes with ongoing lifestyle modifications. Repeating the lipid profile allows assessment of the impact of lifestyle changes on cholesterol levels (Price, 2020).

Renal Function Assessment

Monitor renal function regularly, considering using antihypertensive medications, such as lisinopril, which may affect kidney function. Renal function assessments are crucial due to the effects, antihypertensive medications have on kidney function (Price, 2020).

Assessment of Lifestyle Modifications

Collaboration with nutrition and social work students to help Mr. Martin with his new diet, get more active, and manage stress that could be affecting his blood pressure is crucial. This includes looking at his lifestyle and any financial stresses he might have. Involving these students is a way to cover all the aspects that could be impacting Mr. Martin’s health (Price, 2020).

Follow-Up Visit

It is important to plan another visit in four weeks to see how well the increased lisinopril dosage is working and to remind Mr. Martin about taking his medications and keeping up with the lifestyle changes. This follow-up is important to check if the medication is doing well and to make sure he is staying on track with his lifestyle adjustments (Price, 2020).

Treatment Plan 

Lifestyle Modifications 

Mr. Martin needs to make some important lifestyle changes to help with his high blood pressure. One big change is in his diet, he needs to follow a DASH diet, which means eating less salt and more fruits, vegetables, and lean proteins. Also, getting some exercise is crucial. He needs to aim for about 150 minutes of moderate exercise each week, like brisk walking, and he can choose what works best for him (Verdecchia et al., 2022).

Medication Management

Mr. Martin is taking 25 mg/day of chlorthalidone to help control his blood pressure. Along with that, the dosage of lisinopril will be increased to 10 mg/day. Increasing it to 10 mg/day aligns with the guidelines set by the American College of Cardiology (ACC) and the American Heart Association (AHA). It will help in more effective blood pressure management (Verdecchia et al., 2022).

Blood Pressure Monitoring 

Mr. Martin needs to check his blood pressure at home regularly and also keep a record. This will help the healthcare professionals to see how his blood pressure changes over time and guide his care better (Verdecchia et al., 2022).

Conclusion

Mr. Jose Martin’s case shows how financial stress and not seeing a doctor for many years can affect health. Student volunteers from different areas worked together to help with his lifestyle, medicines, and other issues. The goal is to help Mr. Martin control his blood pressure and overall health by considering his specific needs. This case highlights the importance of caring for the whole person and how healthcare providers can help with different factors that affect a person’s health.

References for FNP 591 Week 3

Khalil, H., & Zeltser, R. (2023, May 8). Antihypertensive Medications. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554579/

Price, J. D. (2020). Evidence-Based interventions for high blood pressure and glycemic control among Illinois health systems. Preventing Chronic Disease, 17. https://doi.org/10.5888/pcd17.190058

Verdecchia, P., Cavallini, C., & Angeli, F. (2022). Advances in the treatment strategies in hypertension: Present and future. Journal of Cardiovascular Development and Disease, 9(3), 72. https://doi.org/10.3390/jcdd9030072

Vrablik, M., Tichý, L., Freiberger, T., Blaha, V., Satny, M., & Hubacek, J. A. (2020). Genetics of familial hypercholesterolemia: New insights. Frontiers in Genetics, 11. https://doi.org/10.3389/fgene.2020.574474

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