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Summary Of Jonathon's Hypertension

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Looking at Jonathon’s basic information, his weight indicates that he is obese. His vital signs indicate hypertension due to the blood pressure of 197/112. His lab work shows hyperlipidemia. The physical assessment demonstrates swelling and inflammation of his knee. This seems to be his chief complaint. While his hypertension, obesity, and hyperlipidemia do need to be addressed, the cause of his knee pain will need to be diagnosed.
Differential Diagnoses:
Osteoarthritis (OA): Knee OA and obesity are chronic conditions that are extremely common in individuals between the ages of 50 and 84 (Losina et al., 2011). OA affects joint lining, cartilage, ligament, and bone (Alshami, 2014). Knee OA occurs due to the destruction of joint function, …show more content…

Nonsteroidal anti-inflammatory drugs, both topical and oral, are another treatment consideration for OA (Alshami, 2014). More aggressive treatment includes the use of opioids or corticosteroid injections (Alshami, 2014). Acetaminophen has a maximum daily dose of 4g/day (Mazaleuskaya et al., 2015a). The mechanism of action in acetaminophen remains unclear (Mazaleuskaya et al., 2015a). However, what is known is that the primary mechanism of action is to inhibit the synthesis of prostaglandins (Mazaleuskaya et al., 2015a). Prostaglandins originate from the arachidonic acid pathway (Mazaleuskaya et al., 2015a). This pathway promotes inflammation, fever, and pain (Mazaleuskaya et al., 2015a). I would recommend the patient take the maximum dosage of 4g/day. This would allow the patient to take 1,000 mg every 6 hours. I would also recommend that the patient alternate with ibuprofen. Ibuprofen can be taken over-the-counter (OTC) with a dosage of 800-1200mg/day or as a prescription with a dosage of 1800-2400mg/day (Mazaleuskaya et al., 2015b). Prescription dosages are typically used for long term management of OA (Mazaleuskaya et al., 2015b). Adults on a prescription dosage are recommended to take 200-800 mg every six to eight hours (Mazaleuskaya et al., 2015b). Ibuprofen acts to inhibit two cyclooxygenase enzymes, COX-1 and COX-2 (Mazaleuskaya et al., 2015b). For Jonathon, I would prescribe 800 mg of ibuprofen to be taken alternatively with acetaminophen every 6 hours. In order to maximize therapy, I would suggest that if Jonathon takes acetaminophen at 9 am then at noon he should take ibuprofen. This way he is able to take medication every three hours and stay within safe dose

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