NSG 6005 SU WK 6 Management of Hypertension & GERD in Pregnancy Discussion

NSG 6005 SU WK 6 Management of Hypertension & GERD in Pregnancy Discussion

NSG 6005 SU WK 6 Management of Hypertension & GERD in Pregnancy Discussion


Guidelines: Respond to 2 peers. Support your responses with scholarly academic references using APA style format. Assigned course reading and online library resources are preferred. Weekly lecture notes are designed as overviews to the topic for the respective week and should not serve as a citation or reference. In your discussion question response, provide a substantive response that illustrates a well-reasoned and thoughtful response; is factually correct with relevant scholarly citations, references, and examples; demonstrates a clear connection to the readings In your participation responses to your peers, comments must demonstrate thorough analysis of postings and extend meaningful discussion by building on previous postings.

Peer 1 Amy Weber


Ms. BD is a 33-year-old G2P1 African-American female who presents to your clinic today complaining of unusual fatigue, nausea, and vomiting for the last five days. She has a medical history of chronic hypertension (HTN) that was diagnosed shortly after her first pregnancy two years ago and GERD. MS. BD’s blood pressure is controlled on Lisinopril-Hydrochlorothiazide 20/12.5mg by mouth twice a day, and GERD controlled on Bismuth Subsalicylate 262mg by mouth every 6 hours as needed. During the interview, you learn that she is single, sexually active, has one partner and that her menses is ten days late. She performed a home pregnancy the three days after missing her menstrual cycle, and the results were inconclusive. She states she feels terrible and needs relief. She has no other medical problems, symptoms, or concerns.

Assessment: Physical examination is unremarkable. BP128/68, HR is 74, Urine human chorionic gonadotropin (HCG) positive, beta HCG sent, potassium 4.2, blood
urea nitrogen (BUN) 14, creatinine is 0.6, Alanine aminotransferase (ALT) 29, White blood cells (WBCs) 6.5, hemoglobin (Hgb) 12.8, hematocrit (Hct) 39, and platelets 330,000.

  1. List the additional questions you would need to ask this patient. Explain.

Frequency and number of episodes of vomiting to help determine hydration status.

Anyone else in the household sick with similar symptoms? To rule out gastroenteritis as the cause of her symptoms.

PO intake to assess for hydration status and potential hypoglycemia.

Description of emesis to assess for any blood or bile in the vomit.

  1. What is the safety profile of Lisinopril-hydrochlorothiazide and bismuth subsalicylate in pregnant women? What are the possible complications to the pregnant woman and her fetus?

Lisinopril-hydrochlorothiazide is a combination drug that includes an angiotensin-converting enzyme (ACE) inhibitor and a diuretic that is prescribed for control of the patient’s hypertension. ACE inhibitors should not be used during pregnancy due to potential fetal abnormalities including the risk of death (Woo & Robinson, 2020). Diuretics may be used in pregnancy if prescribed prior to gestation.

Bismuth subsalicylate is an anti-diarrheal medication. This is a pregnancy category C medication, which means that there has been shown to be a negative affect on the fetus during animal studies, but adequate studies have not been done on humans (https://drugs.com). The safety of this medication has not been established for the use in pregnant women.

  1. What is the importance of assessing laboratory values when prescribing medications? How might the laboratory values, in this case, impact your treatment plan?

Assessing lab values when prescribing medications is important because medications are either metabolized in the liver or the kidneys. If the patient has poor hepatic or renal function, this could change the way the drug is metabolized. In the case that is presented, the patient’s lab values are within normal limits. If the patient were to continue the bismuth subsalicylate, monitoring of her liver and kidney function would be necessary, as this medication is metabolized in the liver and excreted in the kidneys (Woo & Robinson, 2020). Liver and kidney function studies would also be important to monitor with the use of the ACE inhibitor. Obtaining electrolytes, checking for hyponatremia and hyperkalemia, prior to initiating ACE inhibitors is indicated. “Hyperkalemia contraindicates use because reduced aldosterone secretion may worsen this electrolyte imbalance” (Woo & Robinson, 2020, p. 273).

  1. Would you make any changes to Ms. BD’s blood pressure and GERD medications? Explain. If yes, what would you prescribe? Discuss the medications safety in pregnancy, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings.

I would stop her lisinopril-hydrochlorothiazide as the ACE inhibitor is contraindicated in pregnancy. Hydrochlorothiazide alone is a pregnancy category B medication, so could be continued in pregnancy. In the case of using antihypertensive medication in pregnancy, it is important to evaluate the risk versus benefits of medication use and the severity of hypertension. According to the Journal of the American Heart Association (2019), calcium channel blockers have been the most widely used antihypertensive medication during pregnancy over the past 30 years (Malha & August, 2019). The medication recommended is nifedipine XL. Nifedipine is “widely accepted as safe in pregnancy, based on many years of experience (Malha & August, 2019, p. 2). The mechanism of action of nifedipine is a calcium-channel blocker, which causes relaxation of the smooth muscle vasculature. The route is oral (PO). Half-life of nifedipine is 2-5 hours. Calcium-channel blockers are metabolized in the liver, nifedipine is excreted 60-80% in the urine, and 15% in feces (Woo & Robinson, 2020). A contraindication would be an ejection fraction less than 40%. There are no black box warnings for nifedipine that I can find.

Bismuth subsalicylate is a pregnancy category C medication, so I would change it to a pregnancy category B medication for the safety of the fetus. Loperamide is one of the pregnancy category B medications that can be used. Loperamide slows gastric motility by binding to the opiate receptors in the intestines. Loperamide is given orally. The average half-life is 10.8 hours. “Loperamide is partially metabolized by the liver and enters enterohepatic recirculation” (Woo & Robinson, 2020, p. 486). Excretion is mainly in feces, with a small portion eliminated in the urine. Loperamide should be used cautiously in patients with irritable bowel syndrome (IBS) due to the risk of toxic megacolon (Woo & Robinson, 2020). There are no black box warnings that I can find with the use of loperamide.

  1. How does ethnopharmacology apply to this patient if she were NOT pregnant? Explain.

Ethnopharmacology applies to this patient because she is African-American. “In general, the African American population has lower renin activity, and so the RAAS is not thought to play a major role” in hypertension (Woo & Robinson, 2020, p. 1210). With this in mind, ACE inhibitors would not be the best choice for antihypertensive medication therapy. It is also noted that salt sensitivity is the pathophysiology related to hypertension in many African Americans. Therefore, limitation of salt intake and possibly diuretic therapy would be considered in the treatment regimen.

  1. What health maintenance or preventive education do you provide in this client case based on your choice of medications/treatment?

The health maintenance education for this patient would be to limit salt intake, maintain a healthy weight, and exercise regularly. For her nausea/vomiting complaint I would educate the patient regarding staying hydrated and signs and symptoms of dehydration.

  1. Would you treat this patient or refer her? Explain. If you refer, where would you refer this patient?

Given the fact that the patient is pregnant, I would refer her to an OB/GYN specialist to follow her pregnancy and ensure proper medication management while pregnant and during lactation after delivery.


FDA pregnancy risk information. (n.d.). https://www.drugs.com/pregnancy-categories.html

Malha, L., & August, P. (2019). Safety of antihypertensive medications in pregnancy: Living with uncertainty. Journal of the American Heart Association (8)15. https://www.ahajournals.org/doi/10.1161/JAHA.119.0…

Woo, T.M., & Robinson, M.V. (2020). Pharmacotherapeutics for advanced practice nurse prescribers (5th ed.). F.A. Davis.

Peer 2Haley White


Additional information that would be important from Ms. BD would be any known allergies, her social history, if she partakes in any alcohol consumption, tobacco products or any recreational drugs. I would also ask if she has any other pertinent medical problems that are not already known. Asking Ms. BD about her sexual and gynecology history is also very important since we know she is pregnant. It would be important to ask if Ms. BD has had any recent or past expose to sexually transmitted infections. I would also ask if Ms. BD had any complications during her last pregnancies such as hypertension or preeclampsia and what medicine was she prescribed if so.

Lisinopril-hydrochlorothiazide is an angiotensin-converterting enzyme inhibitor (ACEI) and an angiotensin II receptor antagonist (ARB) combination. ACEIs and ARBs are contraindicated in pregnancy. Lisinopril-hydrochlorothiazide is not a safe drug choice for Ms. BD since she is pregnant and should be discontinued right away. ACEIs and ARBs can cause fetal and neonatal morbidity and mortality, they are both classified as Pregnancy category C in the first trimester of pregnancy. Bismuth subsalicylate should also be avoided in pregnancy (Woo and Robinson, 2020).

Since lisinopril-hydrochlorothiazide as well as bismuth subsalicylate are both contraindicated in pregnancy, I would definitely change Ms. BD’s medication regimen. Acceptable hypertensive medications for pregnant women are beta blockers or calcium channel blockers. There are inconsistent reports of increased risks of preterm birth, fetal growth restriction and congenital malformations with beta blockers (UpToDate). I would look at prescribing a calcium channel blocker such as Nifedipine. Nifedipine is one of the most widely used calcium channel blockers in pregnant women. Nifedipine is an antihypertensive calcium channel blocker which inhibits the calcium ion which allows relaxation of the coronary vascular smooth muscle and coronary vasodilation, it also reduces peripheral vascular resistance which produces a reduction in arterial blood pressure. Nifedipine has a half-life of 2 to 5 hours in healthy adults, it is metabolized by the liver and excreted in the urine. Nifedipine is administered by oral route. Contraindications include hypersensitivity to nifedipine, severe hypotension, moderate or severe hepatic impairment, and severe gastrointestinal obstructive disorders. I would inform Ms. BD to discontinue the bismuth subsalicylate and instead I would recommend she take an over the counter antacids like tums or Maalox.

Along with the correct medication, physical activity as well as maintaining a proper diet is very important for pregnant women, especially Ms. BD who has a diagnosis hypertension prior to pregnancy. I would recommend that Ms. BD follow an anti-reflux diet. To help relieve Ms. BD’s GERD symptoms I would recommend that she avoid lying down within 3 hours pf eating, avoid wearing tight-fitting clothing. I would also recommend she avoid food that make symptoms worse such as coffee, cola, tea, citrus, chocolate, and fatty foods.

I would refer Ms. BD to her obstetrician. It is important that Ms. BD have access to proper prenatal care and having her blood pressure monitored during her pregnancy is critical to her health as well as the health of her baby.

August, P., Lockwood, C., Bakris, G. (2021). Treatment of hypertension in pregnant and

postpartum women. UpToDate. https://www.uptodate.com/contents/treatment-of-hyp…

UpToDate (2021). Patient education: acid reflux (gastroesophageal reflux disease) during pregnancy (The Basics). https://www.uptodate.com/contents/acid-reflux-



Woo, T., Robinson, M. (2020). Pharmacotherapeutics for Advanced Practice Nurse Prescribers (5th ed.). Philadelphia, PA: F.A. Davis

Lopes Write Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

NSG 6005 SU WK 6 Management of Hypertension & GERD in Pregnancy Discussion
NSG 6005 SU WK 6 Management of Hypertension & GERD in Pregnancy Discussion

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NSG 6005 SU WK 6 Management of Hypertension & GERD in Pregnancy Discussion


Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed
  • Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
  • Here are some helpful links
  • Student paper example
  • Citing Sources
  • The Writing Center is a great resource