A patient diagnosed with hypertension is taking an angiotensin-converting enzyme (ACE) inhibitor. When planning care, which of the following outcomes would be appropriate for the patient?
a. BP will be lower than 135/85 on all occasions.
b. BP will be normal after 2 to 3 weeks on medication.
c. Patient will not experience dizziness on rising.
d. Urine output will increase to at least 50 mL/hr.
A
Goals must be clearly stated so that it is easy to evaluate whether they have been met. "BP . . . lower than 135/85 . . ." is clearly stated and easily evaluated. In contrast, "BP will be normal . . ." does not clearly state the desired endpoint. Freedom from dizziness on rising is probably not achievable because ACE inhibitors are vasodilating agents, which may cause vessel dilation and hypotension, especially when the patient arises from a seated or lying position. Patients should be warned of this effect. The expected/desired effect of the ACE inhibitor is to lower the blood pressure; the urine output is minimally relevant in determining that outcome, if at all.
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