Polymorphism Adversely Responding to ACE †MyAssignmenthelp.com

Question: Discuss about the Polymorphism Adversely Responding to ACE. Answer: Introducrion: Mr. Tim Hewson is a 61 yr. old male patient who stays in Mawson. He is suffering from Hypertension, ischemic Heart Disease and Gastro esophageal Reflux (GERD). He has a history of ischemic stroke that happened 6 months ago, is a widow with no children and lives alone. Hypertension is characterized by chronic elevated BP. GERD is a condition where the esophageal sphincter is abnormal leading to presentation of heartburn and regurgitation. Ischemic heart disease presents with basically angina due to coronary insufficiency (Marie Visvikis-Siest, 2018). He is under the following treatment; Lisinopril 20mg, Frusemide 40mg, Aspirin 150mg, Cymbalta 60mg nocte, panadol 1g PRN, Ibuprofen 400mg TDS, Nexlum 40mg, Coloxyl and Senna 2 tablets. Lisinopril is an ACE inhibitor and is used to manage hypertension (Wu, Yang, Chang Wei, 2016). Frusemide is a diuretic and is used to treat hypertension and heart disease. Aspirin is used in the treatment of pain and inflammation that may result due to th e ischemic heart disease. Nexlum (esomeprazole) is used in treatment of reflux and heartburn by reducing acid production. Ibuprofen is an NSAID and work to relieve pain and inflammation, symptoms of heart disease (Packer, Anker, Butler, Filippatos Zannad, 2017). Cymbacta is an antidepressant that can be used to treat chronic pain. Panadol is used to relieve mild pains such as headaches that may result due to high blood pressure (Maumus, 2018)Coloxyl and senna are laxatives that softens stool hence facilitating gastric emptying hence relieving symptoms of reflux. Mr. Tims symptoms are persisting and he is also suffering adverse reaction due to treatment. It seems Jim has not been completely compliant to the medication and the general measures advised in regards to his condition. As a community health nurse, I would request Tim to explain to me his eating habits and drug taking frequency. In regards to GERD, Tim ought to be aware that he should use a big pillow while sleeping and he should not sleep immediately after eating (Scarpellini, Ang, Pauwels, Santis, Vanuytsel Tack, 2016). He should also avoid acidic meals. Failure to comply to the measure leads to worsening symptoms. During assessment of the conditions, the cues expected; pain on the chest, headaches, edema, complaints of heartburn and reflux. The information required is having prior knowledge about the conditions, precipitating factors, management and general measures of prevention in the community. As a community health nurse, I will be planned to carry out a physical exam and come out with priority nursing care plan. The next focus will be on the health education (Sacks, Alva, Magalona Vesel, 2015). I will educate Tim on the measures in attaining comfort and pain free and how to minimize complications. Due to the continued use of NSAIDs, the symptoms of GERD are persistent. Tim is also thought to be taking meals just before bed time and high acidic meals. This is the reason for persistent symptoms. Due to the chronic use of Ibuprofen, this has increased the hypertension symptoms and heart disease. Asprin increases of the risk of gastrointestinal bleeding in cases where GERD has led to ulceration. Esomeprazole acts after a long period of time up to 4 days. During this period, the symptoms of reflux and heartburn are persistent. Lisinopril in its action it can worsen the symptoms of heart disease such as chest pain and cough. It also worsens the headache that may be present sin ce the patient is suffering from hypertension. The main reason for taking a community visit is to be able to reach patients who are unable to visit a facility. In the community, one I able to diagnose it as one, identify the common problem hence making a community diagnosis. The goal of the visit is to evaluate the nursing interventions for Tim and assess the need for re planning. Prior to this visit one has to be aware of the history of Tim, the treatment regime and the patient centered management. In the assessment, I would assess the vital signs to ensure whether they are within normal ranges. I would monitor the symptoms and check if they are resolving or fluctuating and consult the subjective concept of the patient. I will also assess the occupational adjustments and adaptation as far as his condition is concerned. Tims symptoms are worsening and this may led to complications. I would recommend him to visit a physician for a checkup and reconsider more tests, hospitalization and change of medications. References Marie, P. Y., Visvikis-Siest, S. (2018). Do we need diagnostic strategies enhanced with genetic information for ischemic heart disease?. Maumus, M. (2018). Solving Americas Prescription Epidemic: Pathophysiology, Ethics, Chronic Pain, and Addiction. In Clinical Approaches to Hospital Medicine (pp. 181-200). Packer, M., Anker, S. D., Butler, J., Filippatos, G., Zannad, F. (2017). Effects of sodium-glucose cotransporter 2 inhibitors for the treatment of patients with heart failure: proposal of a novel mechanism of action. JAMA cardiology, 2(9), 1025-1029. Sacks, E., Alva, S., Magalona, S., Vesel, L. (2015). Examining domains of community health nurse satisfaction and motivation: results from a mixed-methods baseline evaluation in rural Ghana. Human resources for health, 13(1), 81. Scarpellini, E., Ang, D., Pauwels, A., De Santis, A., Vanuytsel, T., Tack, J. (2016). Management of refractory typical GERD symptoms. Nature Reviews Gastroenterology and Hepatology, 13(5), 281.Springer, Cham. Wu, S. J., Yang, Y. H., Chang, H. W., Wei, C. C. (2016). Pharmarcogenetic Mechanism of ACE I/D Polymorphism Adversely Responding to ACE Inhibitors in Regulating the ACE Promoter Activity in Neurons. Alzheimer's Dementia: The Journal of the Alzheimer's Association, 12(7), P856.