HYPERTENSION
Brief History. H.C. is a 55-year-old man who works as an attorney for a large corporation. He is consistently faced with a demanding work schedule, often working 12- to 14-hour days, 6 days each week. In addition, he is 25 to 30 pounds overweight and is a habitual cigarette smoker. He has a long history of high blood pressure, which has been managed fairly successfully over the past 15 years through the use of different drugs. Currently, he is receiving a diuretic (furosemide [Lasix], 160 mg/d), a cardioselective beta blocker (metoprolol [Lopressor], 200 mg/d), and a vasodilator (hydralazine [Apresoline], 200 mg/d). He also takes 81 mg of aspirin each day to prevent myocardial infarction, 20 mg of rosuvastatin (Crestor) to reduce plasma cholesterol, and 10 mg of zolpidem (Ambien) at bedtime when he has trouble falling asleep. While rushing to a business luncheon, H.C. was hit by an automobile as he was crossing the street. He was admitted to the hospital, where radiological examination revealed a fracture of the right pelvis. Further examination did not reveal any other signifi cant internal injuries. The pelvic fracture appeared stable at the time of admission, and internal fi xation was not required. H.C. remained in the hospital and was placed on bed rest. Two days after admission, a physical therapist was called in to consult on the case. The physical therapist suggested a progressive ambulation program using the facility’s therapeutic pool. The buoyancy provided by the pool would allow a gradual increase in weight bearing while protecting the fracture site.
Problem/Influence of Medication. To guard against patient hypothermia, the water temperature in the therapeutic pool was routinely maintained at 95°F. The therapist was concerned that immersing the patient in the pool would cause excessive peripheral vasodilation.
1. How would the combination of the drug regimen and the vasodilation caused by the therapeutic pool affect H.C.’s cardiovascular system?
2. What precautions should the therapist take to avoid adverse cardiovascular changes during the pool interventions?
