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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

Full Answer Section

Cultural Competence:

Cultural Sensitivity: Understanding and respecting Ms. C's cultural background, beliefs, and preferences can enhance the patient-provider relationship.
Tailored Approach: Adapting communication styles and treatment plans to meet the specific needs and cultural values of the patient.

3. Problem-Solving and Critical Thinking:

Analyzing Complex Problems: Identifying the underlying causes of Ms. C's hypertension and developing a comprehensive treatment plan.
Creative Problem-Solving:
Exploring innovative approaches to address barriers to adherence and lifestyle changes.

Hard Skills

1. Clinical Knowledge:

Pharmacology: Understanding the mechanisms of action, side effects, and interactions of antihypertensive medications.
Pathophysiology: Comprehending the pathophysiology of hypertension and its associated complications.
Diagnostic Skills: Accurately interpreting laboratory results and identifying potential risk factors.

2. Therapeutic Management:

Medication Management: Prescribing appropriate antihypertensive medications and adjusting doses as needed.
Lifestyle Modifications: Providing evidence-based counseling on diet, exercise, and smoking cessation.
Risk Stratification: Assessing Ms. C's cardiovascular risk and implementing preventive measures.

By combining these soft and hard skills, an NP can effectively manage Ms. C's hypertension, improve her overall health, and reduce her risk of cardiovascular disease.

Sample Answer

Essential Soft and Hard Skills for Managing Ms. C

To effectively manage Ms. C's complex health condition, an NP must possess a combination of soft and hard skills.

Soft Skills

1. Effective Communication:

Active Listening: This involves paying full attention to Ms. C's concerns and asking clarifying questions to gain a deeper understanding of her needs and challenges.
Empathy: Demonstrating empathy and understanding can build rapport and encourage trust.
Motivational Interviewing: Using motivational interviewing techniques can help Ms. C recognize the importance of lifestyle changes and increase her motivation to adhere to treatment plans.