Exam NR 667 / NR667 VISE STUDY GUIDE 2023/ 2024 (Latest Updated)real exam NR 667 / NR667 VISE STUDY GUIDE 2022 (Latest Updated) 1 1. Hypertension Presentation

Exam NR 667 / NR667 VISE STUDY GUIDE 2023/ 2024 (Latest Updated)real exam NR 667 / NR667 VISE STUDY GUIDE 2022 (Latest Updated) 1 1. Hypertension Presentation: Most are not symptomatic, Occipital Headaches, headache on awak Exam NR 667 / NR667 VISE STUDY GUIDE 2022 (Latest Updated) NR 667 / NR667 VISE STUDY GUIDE 2022 (Latest Updated) 1 1. Hypertension Presentation: Most are not symptomatic, Occipital Headaches, headache on awak 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 Exam NR 667 / NR667 VISE STUDY GUIDE 2023/ 2024 (Latest Updated)real exam NR 667 / NR667 VISE STUDY GUIDE 2022 (Latest Updated) 1 1. Hypertension Presentation: Most are not symptomatic, Occipital Headaches, headache on awak • 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 Exam NR 667 / NR667 VISE STUDY GUIDE 2023/ 2024 (Latest Updated)real exam NR 667 / NR667 VISE STUDY GUIDE 2022 (Latest Updated) 1 1. Hypertension Presentation: Most are not symptomatic, Occipital Headaches, headache on awak 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