NR 667- VISE STUDY GUIDE-comprehensive -2022
1. Hypertension
Presentation: Most are not symptomatic, Occipital Headaches, headache on awakening in am, burry vision.
Look for these clinical findings to rule out org
...
NR 667- VISE STUDY GUIDE-comprehensive -2022
1. Hypertension
Presentation: Most are not symptomatic, Occipital Headaches, headache on awakening in am, burry vision.
Look for these clinical findings to rule out organ damage:
Microvascular
• Eyes (HTN retinopathy): AV nicking (causes when arteriole crosses on top of vein), papilledema
• Kidneys: microalbuminuria and proteinuria, elevated serum creatinine and abnormal eGFR, peripheral or generalized edema
Macrovascular
• Heart: S3 (CHF), S4 (LVH), carotid bruits, decreased or absent peripheral pulses
• Brain: TIA or hemorrhagic stroke
Assessment/Exam:
• Asymptomatic
• Occipital headache
• Blurry vision
• Headache upon wakening
• Exam of optic fundi: Look for AV nicking, hemorrhage, papilledema
• LVH (long standing HTN)
• Perform exam of symmetrical pulses
• Auscultate for Carotid bruits, abdominal bruits, and kidney bruits
Diagnostic studies: EKG, fasting lipid profile, fasting blood glucose, TSH, CXR to R/O
cardiomegaly. CBC, CMP, and urinalysis. Measure BP 5 minutes apart. Assess the patients 10- year risk for heart disease (ASCVD)
Diagnosis: > 140/90 mm Hg start on B/P medication.
Pharmacologic Management:
• FIRST LINE DIURETIC: Hydrochlorothiazide (HCTZ) 25 mg/day (max 50mg/day) *May worsen gout and elevate lipids and glucose
• ALTERNATIVE CCB: Amlodipine besylate 5 mg /day. (Watch for lower extremity edema)
• ACE: lisinopril 10mg/day complicated HTN first line
• Consider ACE/ARB in patient with DM, proteinuria, HF. CONTRAINDICATED IN PREGNANCY
• If stage 2, initiate 2 drug classes (Diuretic & CCB most effective in African American)
CONTINUED..........
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