NR 603 Week 3 Case Discussion: Cardiovascular What leads demonstrate the ST depression? Lorene demonstrates ST depression dispersed throughout the EKG. Specifically, the depression is exhibited in leads I, II, V4, V5, a
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NR 603 Week 3 Case Discussion: Cardiovascular What leads demonstrate the ST depression? Lorene demonstrates ST depression dispersed throughout the EKG. Specifically, the depression is exhibited in leads I, II, V4, V5, a slight depression in aVF, and V6. There is also an ST elevation in aVR. The EKG shows signs of acute coronary syndrome (ACS). An EKG for ACS will show ST depression in six or more leads, most significant in leads V4 to V6, particularly when related with inverted T waves and ST elevation in lead aVR. These EKG changes should warrant importantnce for urgent, aggressive evaluation because of the high probability of severe angiographic coronary artery disease (Nikus et al., 2014). 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? According to the American College of Cardiology (ACC), Lorene’s blood pressure, which is 146/90, would place her in stage II hypertension (HTN). The ACC definitions of stage II is systolic greater than or equal to 140 or diastolic greater than or equal to 90. Her blood pressure numbers falls within the guidelines recommendations (Whelton, Carey, & Aronow, 2018). The ACA and JNC 8 guidelines report the difference in opinions about the blood pressure parameters. According to ACA normal blood pressure is systolic less than 120 mm Hg and diastolic less than 80 mm Hg. HTN stage 1 systolic BP (SBP) is 130-139 mm Hg or diastolic BP (DBP) 80-89 mm Hg, and HTN stage 2 SBP greater than or equal to 140 mm Hg or DBP greater than or equal to 140 mm Hg or DBP greater than or equal to 90 mm Hg (Whelton, Carey, & Aronow, 2018). The JNC 8 recommendation is high blood pressure goals and to use fewer medications. The guidelines also factor in the SBP and DBP with age and comorbidity-specific treatment. For example, a patient who is 60 years old without diabetes (ADA) or chronic kidney disease (CKD), the blood pressure goal is to be less than 150/90 mm Hg. In younger patients and patients who is 60 with a history of ADA and CKD, the goal for blood pressure is less than 140/90 mm Hg. The ACA is a stricter guideline, recommending lowering numbers no matter what comorbidities that patient has (American Family Physician, 2014). After reviewing the two guidelines, a slower method of controlling blood pressure will be adopted. Lorene is considered obese. She has hypertension, metabolic Syndrome, and dyslipidemia. She also had a history of gestational diabetes, and her current A1c is elevated at 6.4%. With her current ST changes, Lorene’s blood pressure will need to be lowered. However, starting aggressive treatment is not ideal, and she may feel the effects of lowering her BP to quickly. Lorene needs to go back on medications. However, her belief about controlling her BP with diet and exercise is correct and will be adopted in her treatment plan mentioned later in this case study response.
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