Health Care > EXAM > Nurs 620 Maryville Exam 2(Latest 2022) (All)

Nurs 620 Maryville Exam 2(Latest 2022)

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Risk factors for hypertension 1. age & sex- women older than 55 & men older than 45 2.Obesity 3.Excessive dietary intake of salt 4.cigarette smoking 5.chronic alcohol consumption 6.Family history of high blood pressure and/or cardiovascular disease 7.African American race 8.Stress 9.Sedentary lifestyle Blood pressure goals for JNC8 Healthy patients over 60 years of age is okay if it is below 150/90 Healthy patients less than 60 years of age the blood pressure is okay if less than 140/90 Patients with dx of DM or CKD regardless of age, goal BP is less than 140/90 lifestyle modifications for Weight reduction (BMI 18.5-24.9) DASH diet less than 2.4g a day of sodium Increase Pysical activity to 30min most days of the week Stop smoking Alcohol less than 2 drinks a day JNC8 preferred agents: -general population: thiazide CCB ACEI ARB -black: (without CKD) CCB or thiazide -DM: thiazide CCB ACEI ARB -CKD: ACE ARB Which medications for HTN should not be used together ACE and ARBS HTN therapy for patients over 75years old with impaired kidney function CCB Thiazides Classification of HTN per AHA Normal BP: less than 120 Systolic, diastolic less than 80 Elevated: 120-129 systolic, less than 80 diastolic Stage 1 HTN: 130-139/80-89 Stage 2 HTN: 140+/90+ Hypertensive crisis: 180+/120+ If goal not met for HTN in a month of treatment then what? Increase the intital dose of drug or add a second agent, if goal not achieved with 2 agents consider a 3rd agent. When HTN treatment is initiated or dose changed when should patient follow up 2-4 weeks, then once goal has achieved every 3-6 months. Diagnostic workup for HTN History- any symptoms? Physical examination What are their risk factors? - family history, smoking, drinking, sedentary lifestyle. Labs: BMP, CBC, UA, CMP, TSH, Lipid profile, ECG need to know kidney function, electrolytes, are they spilling protein in their urine. Work up for secondary causes of HTN Cushings- need a 24 hour urine Coarctation of the aorta- CXR Pheochromocytoma- 24 hour urine Primary hyperaldosteronism Renovascular hypertension- Renal arterogram, ultrasound of kidneys Resistant Hypertension failure to reach goal BP in patients who are taking full doses of an appropriate three-drug therapy regimen that includes a diuretic needs referral to cardiologist Causes of resistant HTN 1) Improper BP measurement 2) Excess Na+ intake 3) Inadequate diuretic Tx 4) Med issues such as inadequate doses, drug actions and interactions (e.g. NSAIDs, illicit drugs, sympathomimetics, OCPs), or OTC drugs and herbals 5) Excess EtOH intake 6) Underlying ID causes of HTN (2ndary) 7) White coat hypertension Complications of HTN Left ventricular hypertrophy Heart failure Ischemic Stroke Intracerebral hemmorage Ischemic heart disease CKD, ESRD

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