Hypertensive emergency is defined as a severely elevated diastolic  blood pressure (>120mmHg) in the presence of target-organ damage.   Please read the attached article for an overview of target-organ  damage.

Scenario

You are seeing a 62 year old white female for her annual visit.   Presented below are some pertinent subjective and objective data that  you elicited during your comprehensive assessment session with the  patient (note – this is not the entire subjective and objective data set  for this office visit).

PMH:  HTN, Hyperlipidemia

Social History:  divorced, employed full time as a graduate nursing  program professor, no smoking history, reports on a rare occasion she  may have a 2 – 3 ounces of wine when dining out [less than 6 times a  year]

Health Maintenance Activities: 1 ½ to 2 hours of exercise every  morning [45 – 60 minutes of yoga, 45 – 60 minutes of step aerobics]; low  glycemic Pescatarian; has not engaged with recommended colonoscopy,  does not have screening mammograms, does not get a flu shot and has not  had any other recommended adult immunizations

Review of Systems

Cardiovascular: reports hypertension diagnosed at 27 years of age,  controlled on 5mg Lisinopril daily; reports elevated total cholesterol  level for the last decade or so with no pharmacologic treatment; denies  chest pains, palpitations, lower extremity edema

Physical Exam

Constitutional – Ht. 64 inches, Wt. 127 pounds [BMI 21.8], BP 112/60, P 68, T 97.9 temporal, R 16, SpO2 99%

Integument – pink, warm and dry to touch

Eyes – no arcus senilis

Cardiovascular – heart regular rate and rhythm, S1 and S2; no S3 or  S4, murmur or gallop; no carotid bruits; radial pulses palpable and  pedal pulses 2+; no lower extremity edema; capillary refill < 3  seconds bilateral

Lipid panel – Total cholesterol 302, HDL 117, Triglycerides 45

Please develop a discussion that responds to each of the following  prompts.  Where appropriate your discussion needs to be supported by  scholarly literature.  Be sure to include in-text citations in the  context of the discussion and provide a full reference citation at the  end of the discussion.

Discussion Prompt

Utilize the information provided in the scenario to create your discussion post.

Construct your response as an abbreviated SOAP note (Subjective Objective Assessment Plan).

Structure your ‘P’ in the following format:  [NOTE:  if any of the 3  categories is not applicable to your plan please use the ‘heading’ and  after the ‘:’ input N/A]

Therapeutics: pharmacologic interventions, if any – new or  revisions to existing; include considerations for OTC agents  (pharmacologic and non-pharmacologic/alternative); [optional – any other  therapies in lieu of pharmacologic intervention]

Educational: health information clients need in order to  address their presenting problem(s); health information in support of  any of the ‘therapeutics’ identified above; information about follow-up  care where appropriate; provision of anticipatory guidance and  counseling during the context of the office visit

Consultation/Collaboration: if appropriate – collaborative  ‘Advanced Care Planning’ with the patient/patient’s care giver; if  appropriate -placing the patient in a Transitional Care Model for  appropriate pharmacologic and non-pharmacologic care; if appropriate –  consult with or referral to another provider while the patient is still  in the office; Identification of any future referral you would consider  making