NURSING > STUDY GUIDE > NR 661 Week 4 Vise Assignment Study Guide Common Diagnosis Summer 2022-2023 (All)

NR 661 Week 4 Vise Assignment Study Guide Common Diagnosis Summer 2022-2023

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1. Hypertension Presentation: Most are not symptomatic, Occipital Headaches, headache on awakening in am, blurry vision, Assessment:  Asymptomatic  Occipital headache  Blurry vision  Headache upon wakening  Look for AV nicking  LVH Exam:  Carotid bruits  Abdominal bruits  Kidney bruits Diagnostic studies: to look for secondary causes of HTN like target organ damage and establish ASCVD risk: EKG, fasting lipid profile, fasting blood glucose, CBC, CMP (electrolyte, creatinine, & calcium levels), and urinalysis (checking for proteinuria). Diagnosis: Measure BP 5 minutes apart. Average of 2 or more BP readings on two different visits at > 140/90 mm Hg start then can be diagnosed with HTN. If Stage 1 (ASCVD <10%) then non-pharmacologic management only:  First: Lifestyle modifications: diet and exercise 30 minutes aerobic exercise 5 days per week.  Limit alcohol  stop smoking  stress management.  DASH  Medication compliance  Reduce sodium intake  Measure BP daily If Stage 2 (ASCVD >10% and known CAD) initiate lifestyle + Pharmacologic Management:  Alone: hydrochlorothiazide (HCTZ) 25 mg/day (chlorthalidone is preferred over HCTZ)  Alone: lisinopril 10mg/day complicated HTN first line  Combo: thiazide + ACE or ARB  Alternative CB (especially in isolated HTN seen mainly in older adults)  Black population: thiazide + CCB is recommended first line Follow up:  2-4weeks Referral:  Cardiology if EKG is abnormal Differential:  Secondary hypertension  Pregnant  Pregnancy induced hypertension Hollier: page 62 2 2. Hyperlipidemia Etiology: may be familial, dietary, obesity, hypothyroid, renal disorders, thiazide or beta blocker use, alcohol and/or caffeine intake Presentation: few physical findings  Xanthomata (lipid deposits around the eyes)  Corneal Arcus prior to age 50 years (white iris), normal  Angina  Bruits  MI  Stroke Diagnostics:  Fasting/nonfasting lipid profile (total cholesterol, LDL, and HDL minimally affected by eating)  Glucose,  UA and creatinine (for detection of nephrotic syndrome which can induce dyslipidemia),  TSH (for detection of hypothyroidism) Diagnosis: Pt with LDL >= 190mg/dL Non-pharmacologic Management:  Lifestyle Modification; diet and exercise. Pharmacologic Management Those who benefit most from statin therapy include:  hx of CVD or stroke,  LDL 190 or greater,  DM with LDL 70-189,  no evidence of ASCVD or DM but have LDL 70-189 PLUS an estimated ASCVD risk of 7% or greater  High risk: o Atorvastatin 40 or 80 mg daily o Rosuvastatin 20 or 40 mg daily  Moderate risk: o Atorvastatin 10 or 20 mg daily o (other statin medications also listed in Hollier)  If statins not tolerated, temporarily stop, decrease dose, and re-challenge with 2-3 statins of differing metabolic pathways and intensities. Follow up:  after initiating therapy, follow-up every 6-8 weeks until goal attained then every 6-12 months to evaluate compliance  evaluate lipids every 5 years starting at age 20 if normal values obtained Refer: Nutritionist Differentials: consider secondary causes  Hypothyroidism  Pregnancy  Diabetes  Non-fasting state

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