Elmer Foley is a 72-year-old Caucasian male with a 10-month history of uncontrolled HTN. Initially, Elmer was prescribed the thiazide diuretic HCTZ (Microzide). However, after 1 week of therapy his...

Elmer Foley is a 72-year-old Caucasian male with a 10-month history of uncontrolled HTN. Initially, Elmer was prescribed the thiazide diuretic HCTZ (Microzide). However, after 1 week of therapy his blood pressure has remained at 168/102 mmHg. Next, Elmer’s health care provider added an angiotensin-converting enzyme inhibitor, captopril (Capoten), to the regimen. Still, Elmer’s blood pressure remained above normal limits. Lastly, the health care provider discontinued the captopril and started Elmer on hydralazine (Apresoline). With this visit, his blood pressure is 146/90 mmHg. When Elmer was first told he had HTN, he began many of the suggested lifestyle changes encouraged by his health care provider. He has lost a total of 15 kg (33 lb) since starting his diet 10 months ago. Elmer started walking daily for exercise and can now walk up to 1 mile without fatigue. He avoids all salty foods and diligently checks food labels for fat and salt content. Elmer occasionally drinks a glass of wine, although never more than 1 to 2 glasses per month. Although it was difficult for Elmer to stop smoking totally, he proudly claims he has been smokeless for 8 months.

1. How would you respond to Elmer’s question, “What else can I do?” Is there anything else he can do to reduce his blood pressure?

2. Elmer wants to know why the previous therapies were unsuccessful. What would you say as his nurse?

3. As the nurse, how can you support Elmer before he leaves the clinic?