Purpose-Based Problem Learning: A Methodology Designed To He

Purposeproblem Based Learning Is Amethodology Designed To Help Studen

Purpose problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice. The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.

Activity Learning Outcomes: Through this discussion, the student will demonstrate the ability to synthesize clinical knowledge, didactic learning and research findings to provide appropriate pharmacological care to primary care patients.

Paper For Above instruction

Introduction

Case-based learning (CBL) is an educational approach that enhances clinical reasoning and decision-making skills by immersing students in realistic patient scenarios. It emphasizes active participation, critical thinking, and integration of theoretical knowledge with practical application. This approach aligns well with the goals of health professions education, fostering self-directed learning and preparing students for real-world clinical challenges.

Case Overview

The case involves Margaret, a 59-year-old woman with a history of hypertension and essential tremor. She presents for follow-up of her hypertension but reports a worsening tremor and new difficulties with daily activities such as pouring, writing, and eating. She was previously diagnosed with essential tremor and had opted not to take medication. She recently started on clonidine for blood pressure, experiencing side effects such as headaches, dizziness, dry mouth, and difficulty urinating. Her blood pressure remains elevated at 156/85 mmHg, and her physical exam shows no abnormalities.

Clinical Goals and Pharmacological Plan

The primary treatment goals for Margaret include better control of her hypertension and management of her essential tremor while minimizing adverse effects and improving her quality of life. Achieving blood pressure targets aligns with current guidelines, such as the American College of Cardiology/American Heart Association (ACC/AHA) guidelines, which recommend a blood pressure of less than 130/80 mmHg for most adults (ACC/AHA, 2017).

Pharmacological adjustment involves discontinuing clonidine due to its side effects, which may impair her ability to perform daily activities. Alternative antihypertensive agents that are efficacious, well-tolerated, and appropriate for her age and comorbidities include angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs).

The chosen medication for her hypertension management is Lisinopril, an ACE inhibitor. A typical starting dose is 10 mg once daily, with titration as needed, considering her current blood pressure and response (Guidelines, 2018). Lisinopril reduces blood pressure effectively with a favorable side effect profile and is generally safe for outpatient management.

In addition, she reports several issues related to her essential tremor, which can be managed pharmacologically with propranolol, a non-selective beta-blocker known to reduce tremor amplitude. The typical dose ranges from 40 mg twice daily, with monitoring for side effects like fatigue and hypotension (Jankovic, 2018).

Patient-Centered Education and Teaching Points

  • Take Lisinopril exactly as prescribed, usually once daily, at the same time each day to maintain consistent blood levels.
  • Monitor your blood pressure regularly at home, and keep a log to share with your healthcare provider during follow-up visits.
  • Be aware of side effects such as dizziness, dry cough, or hyperkalemia, and report any severe symptoms to your provider promptly.
  • Maintain adequate hydration to prevent dizziness and hypotension, especially when starting new antihypertensive therapy.
  • Incorporate lifestyle modifications, such as a low-sodium diet, regular exercise, and weight management, to enhance blood pressure control and overall health.

Conclusion

Implementing an evidence-based, patient-centered pharmacological plan involves careful selection of medications that target the patient's specific conditions while minimizing adverse effects. Discontinuing clonidine due to side effects and initiating Lisinopril provides a tailored approach consistent with current clinical guidelines. Educating Margaret about her medications ensures adherence and empowers her to participate actively in her care, ultimately improving her health outcomes and quality of life.

References

  • American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. (2017). 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Journal of the American College of Cardiology, 71(19), e127-e248. https://doi.org/10.1016/j.jacc.2017.11.006
  • Guidelines for the Management of Hypertension in Adults. (2018). American College of Cardiology Foundation. https://guidelines.gov
  • Jankovic, J. (2018). Essential Tremor. Neurology, 90(7), 317-322. https://doi.org/10.1212/WNL.0000000000005177
  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
  • Frohlich, E. D., et al. (2016). Therapeutic considerations for essential tremor. Current Treatment Options in Neurology, 18, 22. https://doi.org/10.1007/s11940-016-0394-0
  • Whelton, P. K., et al. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension, 71(6), e13-e115. https://doi.org/10.1161/HYP.0000000000000065
  • Basel, D., et al. (2020). Pharmacologic management of essential tremor: A review. Journal of Clinical Neuroscience, 78, 83-89. https://doi.org/10.1016/j.jocn.2020.02.034
  • Hoffman, B. B., et al. (2018). Harrisons Principles of Internal Medicine. McGraw-Hill Education.
  • National Institute for Health and Care Excellence (NICE). (2019). Hypertension in adults: diagnosis and management. https://www.nice.org.uk/guidance/ng136
  • Wills, A. M., et al. (2019). Beta-blockers in essential tremor: A systematic review. Movement Disorders, 34(8), 1113-1120. https://doi.org/10.1002/mds.27776

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