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Reply To My Peers Reply to my peers please see attachments Discussion Question 1 For these questions, please read the following case study and then re

Reply To My Peers Reply to my peers

please see attachments Discussion Question 1

For these questions, please read the following case study and then re

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Reply To My Peers Reply to my peers

please see attachments Discussion Question 1

For these questions, please read the following case study and then respond to the questions noted below.

Ms. BD is a 33-year-old G2P1 African-American female who presents to your clinic today complaining of unusual fatigue, nausea, and vomiting for the last five days. She has a medical history of chronic hypertension (HTN) that was diagnosed shortly after her first pregnancy two years ago and GERD. MS. BD’s blood pressure is controlled on Lisinopril-Hydrochlorothiazide 20/12.5mg by mouth twice a day, and GERD controlled on Bismuth Subsalicylate 262mg by mouth every 6 hours as needed. During the interview, you learn that she is single, sexually active, has one partner, and that her menses is ten days late. She performed a home pregnancy the three days after missing her menstrual cycle, and the results were inconclusive. She states she feels terrible and needs relief. She has no other medical problems, symptoms, or concerns.

Assessment: Physical examination is unremarkable. BP128/68, HR is 74, Urine human chorionic gonadotropin (HCG) positive, beta HCG sent, potassium 4.2, blood urea nitrogen (BUN) 14, creatinine is 0.6, Alanine aminotransferase (ALT) 29, White blood cells (WBCs) 6.5, hemoglobin (Hgb) 12.8, hematocrit (Hct) 39, and platelets 330,000.

1. List the additional questions you would need to ask this patient. Explain.

In the above case study, despite the fact that the patient noted that there were no other medical problems, I would ask questions relating to a past problem, whether related to hypertension or not. Also, I would ask the patient pertaining to the nature of the diet and whether she is involved in physical exercises. These questions are critical because they can help in assessing whether the patient has had an issue in the past that probably triggers high BP. Also, the questions on diets and physical activities are to or confirm the two as possible measures of alleviating the problem. 

2. What is the safety profile of Lisinopril-hydrochlorothiazide and bismuth subsalicylate in pregnant women? What are the possible complications to the pregnant woman and her fetus?

Taking Lisinopril and bismuth can be a risk for pregnant women. According to Woo and Robinson (2015), possible complications related can be problematic during the second and third trimester of pregnancy. 

3. What is the importance of assessing laboratory values when prescribing medications? How might the laboratory values, in this case, impact your treatment plan?

Laboratory monitoring ensure effective and safe medication therapy. This is more so for medication with increased risks of drug-induced toxicity (Woo & Robinson, 2015).

4. Would you make any changes to Ms. BD’s blood pressure and GERD medications? Explain. If yes, what would you prescribe? Discuss the medications safety in pregnancy, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings.

Yes, I would make changes to the BP medication to either nifedipine or labetalol. These are highly recommended for pregnant mothers. However, as argued by Ainuddin et al. (2019), labetalol cannot be used together with nifedipine because of possible additive effects, including dizziness, headache, and fainting. 

5. How does ethnopharmacology apply to this patient if she were NOT pregnant? Explain.

In the case study, the patient was diagnosed with GERD and Hypertension and she has been compliant with medication. Thus, it is not necessary to have ethnopharmacology applied for the patient. 

6. What health maintenance or preventive education do you provide in this client case based on your choice of medications/treatment?

To lower BP or to maintain a healthy BP level for a pregnant woman, it is critical to have her diet low in salt, consume food with potassium and whole grain, watch her weight, avoid drugs, and constant dehydration in case of diarrhea. 

7. Would you treat this patient or refer her? Explain. If you prefer, where would you refer this patient?

Chronic hypertension in pregnant women can be treated. However, this would require constant monitoring, especially concerning her body intake. In case there are more complications, the patient can be referred to an obstetrician. 

References

Ainuddin, J., Javed, F. & Kazi, S. (2019). Oral labetalol versus oral nifedipine for the management of postpartum hypertension: A randomized control trial. Pakistan Journal of Medical Sciences, 35(5), 1428-1433. 

Woo, T. M., Robinson, M. V., & Woo, T. M. (2016). Pharmacotherapeutics for advanced practice nurse prescribers. F.A Davis Company

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