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4 Hypertension case and all soft and hard skills that will be needed to manage this patient Nurse practitioners (NPs) are advanced practice RNs

December 11, 2024

Hypertension case and all soft and hard skills that will be needed to manage this patient

Nurse practitioners (NPs) are advanced practice RNs (APRNs) who blend clinical expertise in diagnosing and treating health conditions, including hypertension, with an emphasis on disease prevention and providing health education, health coaching, and counseling to their patients.

Case:

Ms. C is a 42-year-old Black American woman with a 7-year history of hypertension first diagnosed during her last pregnancy. Her family history is positive for hypertension, with her mother dying at 56 years of age from hypertension-related cardiovascular disease (CVD). In addition, both her maternal and paternal grandparents had CVD.

At NP visit 1, Ms. C presented with complaints of headache and general weakness. She reported that she had taken many medications for her hypertension in the past but stopped taking them because of the side effects. She could not recall the names of the medications. Currently she is taking 100 mg/day atenolol and 12.5 mg/day hydrochlorothiazide (HCTZ), which she admits to taking irregularly because “they bother me, and I forget to renew my prescription.” Despite this antihypertensive regimen, her blood pressure remains elevated, ranging from 150 to 155/110 to 114 mm Hg.

In addition, Ms. C admits that she has found it difficult to exercise, stop smoking, and change her eating habits. Findings from a complete history and physical assessment are unremarkable except for the presence of moderate obesity (5 ft 6 in., 150 lb), minimal retinopathy, and a 25-year history of smoking approximately one pack of cigarettes per day. Initial laboratory data revealed serum sodium 138 mEq/L (135 to 147 mEq/L); potassium 3.4 mEq/L (3.5 to 5 mEq/L); blood urea nitrogen (BUN) 19 mg/dL (10 to 20 mg/dL); creatinine 0.9 mg/dL (0.35 to 0.93 mg/dL); calcium 9.8 mg/dL (8.8 to 10 mg/dL); total cholesterol 268 mg/dL (< 245 mg/dL); triglycerides 230 mg/dL (< 160 mg/dL); and fasting glucose 105 mg/dL (70 to 110 mg/dL). The patient refused a 24-h urine test.

Journal Question:

What soft and hard skills are needed for an NP to manage this patient? Include your rationale

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