NR667/ NR 667 VISE (Latest 2023/ 2024 Update) Complete Guide with Questions and Verified Answers| 100% Correct- Chamberlain

Etiology: Hypertension - h-No known cause in 90% of cases of primary HTN -Secondary causes: renal failure, kidney disease, renal artery stenosis, Cushing syndrome, hyper/hypo thyroidism, increased ICP, sleep apnea, oral contraceptives, steroids, cocaine, NSAIDs, decongestants, sympathomimetics, alcohol, antidepressants, caffeine jnRisk Factors: Hypertension - h-Modifiable: smoking, DM, high cholesterol, obesity (single most important factor in children), physical inactivity, poor diet, excessive sodium intake, excessive alcohol consumption -Non-modifiable: CKD, family hx, increased age (>55 men, > 65 women), low socioeconomic status, low educational status, male sex, OSA, stress, pregnancy jnAssessment: Hypertension - h-Most are asymptomatic; occipital headache, headache upon waking, blurry vision, fundoscopic exam (AV nicking, exudates, papilledema), left vent. hypertrophy, pregnancy w/HTN and proteinuria, edema, and excessive weight gain jnDifferential Diagnosis: Hypertension - h-Secondary HTN, white coat HTN (artificial elevation d/t medical environment anxiety) jnFinal Diagnosis: Hypertension - h-Urinalysis = proteinuria -Electrolytes, creatinine, calcium -Fasting lipid profile and BS -ECG -Measure BP twice, 5 mins apart -Patient should be seated; use proper cuff size and application jnPrevention: Hypertension - h-Maintaining healthy weight and BMI -Smoking cessation -Regular aerobic exercise -Alcohol in moderation (< 1 oz/day) -Stress management -Medication compliance -Assess for and treat OSA jnNon-pharm management: Hypertension - h-Stage 1: Risk score < 10% =lifestyle modification -Stage 2: lifestyle + medication -DASH eating plan: high fruit, veggies, grains; low fat dairy, fish, poultry, beans, nuts -Reduce dietary sodium to 2,300mg/day, increase K+ -Reduce sat. fat intake -Body weight reduction; 1kg of weight reduction = 1 mm/hg bp reduction -150 mins of aerobic exercise and/or 3 sessions of isometric resistance per week -Treat other underlying diseases -Check bp 2x/week during pregnancy jnPharmacological management: Hypertension - h-Start medication for primary prevention of CVD if pt. has ASCVD risk ≥ 10% and stage 1 HTN or if ASCVD is < 10% with bp >140/90 -Stage 2: start 2 bp-lowering medications -African Americans: 2+ medications recommended; thiazide and CCBs are the most effective *DO NOT use ACE and ARB concurrently -Beta blockers are NOT first line -Thiazides, CCBs, ACEIs, and ARBs can be used alone or in combo jnPregnancy considerations: Hypertension - h-Can use beta blockers (labetalol), methyldopa, CCBs (nifedipine) -AVOID ARBs and ACEIs jnFollow-up: Hypertension - h-Inquire about adherence and any side effects -Reassess monthly until patient reaches goal, then every 3-6 months as needed jnExpected course: Hypertension - h-Only 54% of treated patients are at goal treatment; expect complications if under treated -Most patients require more than one medication to reach goal bp jnPossible Complications: Hypertension - h-Stroke, CAD, MI, renal failure, heart failure, eclampsia (seizures), pulmonary edema, hypertensive crisis, hypertensive retinopathy, ED jnEtiology: Hyperlipidemia - h-Inherited disorder, high dietary intake, obesity, sedentary lifestyle, DM, hypothyroidism, anabolic steroid use, hepatitis, cirrhosis, uremia, nephrotic syndrome, stress, drug-induced (thiazide diuretics, beta blockers, cyclosporine), alcohol, caffeine, metabolic syndrome jnRisk factors: Hyperlipidemia - h-Family history, physical inactivity, smoking, age (men > 45, women > 55 or premature menopause without estrogen replacement), obesity, diet high in sat. fat, DM jnAssessment findings: Hyperlipidemia - h-Few physical findings; xanthomata (fat deposits in the skin), xanthelasma (yellow plaques on the eyelid), corneal arcus prior to age 50 (arc of cholesterol around the iris), bruits, angina pectoris, MI, stroke jnDifferential diagnosis: Hyperlipidemia - h-Secondary causes: hypothyroidism, pregnancy, DM, non-fasting state jnFinal diagnosis: Hyperlipidemia - h-Fasting lipid profile: 9-12 hours -Glucose level -Urinalysis, creatinine (for detection of nephrotic syndrome which can induce dyslipidemia) -Baseline transaminases -TSH for detection of hypothyroidism (which can cause secondary dyslipidemia) -Calculate ASCVD 10-year risk jnPrevention: Hyperlipidemia - h-Healthy lifestyle reduces ASCVD in all age groups -Dietary interventions: encourage mediterranean and DASH diet; limit saturated and trans fats; limit sodium intake; increase fiber, vegetables, fruits, and other whole grains; eat lean meats (poultry, fish); eggs, beans, nuts, low-fat dairy, avoid red meat, limit sugary drinks and sweets