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NR 603 week 3 responses.

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Professor and Class, What leads demonstrate the ST depression? I found that leads I, II, and V2 to V6 demonstrate ST depression. Acute Coronary Syndrome or ACS is demonstrated on an EKG if ST depression is present in six or more leads. Is Lorene Hypertensive per ACA 2017 Guidelines? Compare the ACA guidelines to JNC 8 guidelines and discuss what treatment you recommend for her BP and why. Yes, Lorene is hypertensive per the guidelines. Lorene’s elevated blood pressure of 146/90 places her at stage 2 hypertension based on the American College of Cardiology (ACC) 2017 guidelines. Essential (primary) hypertension ICD 10 (I10) would be one of Lorene’s secondary diagnose. The ACC/AHA recently lowered the definition of hypertension to allow for earlier intervention in the high blood pressure guidelines because complications can occur at lower blood pressure numbers (Whelton, Carey & Aronow, 2018). The ACC/AHA defines normal blood pressure as a systolic blood pressure less than 120 mmHg and a diastolic blood pressure less than 80 mmHg, stage 1 hypertension is a systolic blood pressure 130- 139 mmHg or a diastolic blood pressure of 80-89 mmHg, and stage II hypertension as a systolic blood pressure greater than or equal to 140 or a diastolic blood pressure greater than or equal to 90 (Whelton, Carey, & Aronow, 2018). The ACC 2017 guidelines differ from the Eight Joint National Commision (JNC 8) guidelines in the blood pressure classification, as well as blood pressure goal targets based on age and comorbidities. Regardless of age and whether the patient has diabetes and/or chronic kidney disease (CKD), the ACC 2017 guidelines recommend a blood pressure goal of less than 130/90. For patients 60 years and older, JNC 8 guidelines recommend pharmacologic treatment for blood pressure goal of less than 150/90. The initial pharmacologic treatment for both guidelines is similar, which includes thiazide diuretics, angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and calcium channel blockers (CCB) (Armstrong, 2014). The ACC/AHA recommendations are based on a 10-year atherosclerotic cardiovascular disease or ASCVD, risk calculator of 10-year risk or higher. In the presence of BP >140/90 mmHg, even if ASCVD risk is <10%, antihypertensive treatment is indicated with a goal of reaching <130/80 mmHg utilizing a two-drug or fixed dose combination. The JNC-8 recommends pharmacological treatment to maintain a goal blood pressure of less than 140/90 if diabetes is present and recommends for the general population with no history of diabetes or chronic kidney disease that are aged 60 or older initiate pharmacologic treatment if systolic BP is greater than 150 mmHg or diastolic B

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