NR 667 VISE Assignment 271 correct
solutions A+ Graded.
NR 667 VISE Assignment 271 correct
solutions A+ Graded.
Etiology: Hypertension - ANSWER--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
Risk Factors: Hypertension - ANSWER--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
Assessment: Hypertension - ANSWER--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
Differential Diagnosis: Hypertension - ANSWER--Secondary HTN, white coat HTN (artificial elevation d/t
medical environment anxiety)
Final Diagnosis: Hypertension - ANSWER--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
Prevention: Hypertension - ANSWER--Maintaining healthy weight and BMI
-Smoking cessation
,NR 667 VISE Assignment 271 correct
solutions A+ Graded.
-Regular aerobic exercise
-Alcohol in moderation (< 1 oz/day)
-Stress management
-Medication compliance
-Assess for and treat OSA
Non-pharm management: Hypertension - ANSWER--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
Pharmacological management: Hypertension - ANSWER--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
Pregnancy considerations: Hypertension - ANSWER--Can use beta blockers (labetalol), methyldopa, CCBs
(nifedipine)
-AVOID ARBs and ACEIs
,NR 667 VISE Assignment 271 correct
solutions A+ Graded.
Follow-up: Hypertension - ANSWER--Inquire about adherence and any side effects
-Reassess monthly until patient reaches goal, then every 3-6 months as needed
Expected course: Hypertension - ANSWER--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
Possible Complications: Hypertension - ANSWER--Stroke, CAD, MI, renal failure, heart failure, eclampsia
(seizures), pulmonary edema, hypertensive crisis, hypertensive retinopathy, ED
Etiology: Hyperlipidemia - ANSWER--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
Risk factors: Hyperlipidemia - ANSWER--Family history, physical inactivity, smoking, age (men > 45,
women > 55 or premature menopause without estrogen replacement), obesity, diet high in sat. fat, DM
Assessment findings: Hyperlipidemia - ANSWER--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
Differential diagnosis: Hyperlipidemia - ANSWER--Secondary causes: hypothyroidism, pregnancy, DM,
non-fasting state
Final diagnosis: Hyperlipidemia - ANSWER--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
, NR 667 VISE Assignment 271 correct
solutions A+ Graded.
Prevention: Hyperlipidemia - ANSWER--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
-Mod to vigorous exercise of at least 40 mins 3-4x/week (sustained aerobic activity increases HDL,
decreases total cholesterol)
-Avoid tobacco
-Appropriately manage systemic diseases (DM, hypothyroidism, HTN)
Non-pharm management: Hyperlipidemia - ANSWER--Nutrition, weight reduction, increased physical
activity, patient education about risk factors
Pharmacological management: Hyperlipidemia - ANSWER--Assign to a statin treatment group using
ASCVD 10-year risk calculator
-Primary lipid target it LDL
-Statins are 1st-line therapy
-Combo of statin and non-statin in some patients
-Consider adding non-statin if unable to achieve LDL < 70mg/dl, but VERIFY adherence to statins and
lifestyle changes
-Non-statins: ezetimibe (1st), bile acid sequestrant, vibrate, PCSK9 inhibitor
Pregnancy/lactation consideration: Hyperlipidemia - ANSWER--Cholesterol is usually elevated during
pregnancy; measurement is not recommended and treatment is contraindicated
Follow-up: Hyperlipidemia - ANSWER--Check fasting lipid panel 4-12 weeks after starting or adjusting a
statin or non-statin
-Monitor for medication compliance and lifestyle modification, especially if LDL drop is less than
expected
solutions A+ Graded.
NR 667 VISE Assignment 271 correct
solutions A+ Graded.
Etiology: Hypertension - ANSWER--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
Risk Factors: Hypertension - ANSWER--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
Assessment: Hypertension - ANSWER--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
Differential Diagnosis: Hypertension - ANSWER--Secondary HTN, white coat HTN (artificial elevation d/t
medical environment anxiety)
Final Diagnosis: Hypertension - ANSWER--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
Prevention: Hypertension - ANSWER--Maintaining healthy weight and BMI
-Smoking cessation
,NR 667 VISE Assignment 271 correct
solutions A+ Graded.
-Regular aerobic exercise
-Alcohol in moderation (< 1 oz/day)
-Stress management
-Medication compliance
-Assess for and treat OSA
Non-pharm management: Hypertension - ANSWER--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
Pharmacological management: Hypertension - ANSWER--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
Pregnancy considerations: Hypertension - ANSWER--Can use beta blockers (labetalol), methyldopa, CCBs
(nifedipine)
-AVOID ARBs and ACEIs
,NR 667 VISE Assignment 271 correct
solutions A+ Graded.
Follow-up: Hypertension - ANSWER--Inquire about adherence and any side effects
-Reassess monthly until patient reaches goal, then every 3-6 months as needed
Expected course: Hypertension - ANSWER--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
Possible Complications: Hypertension - ANSWER--Stroke, CAD, MI, renal failure, heart failure, eclampsia
(seizures), pulmonary edema, hypertensive crisis, hypertensive retinopathy, ED
Etiology: Hyperlipidemia - ANSWER--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
Risk factors: Hyperlipidemia - ANSWER--Family history, physical inactivity, smoking, age (men > 45,
women > 55 or premature menopause without estrogen replacement), obesity, diet high in sat. fat, DM
Assessment findings: Hyperlipidemia - ANSWER--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
Differential diagnosis: Hyperlipidemia - ANSWER--Secondary causes: hypothyroidism, pregnancy, DM,
non-fasting state
Final diagnosis: Hyperlipidemia - ANSWER--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
, NR 667 VISE Assignment 271 correct
solutions A+ Graded.
Prevention: Hyperlipidemia - ANSWER--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
-Mod to vigorous exercise of at least 40 mins 3-4x/week (sustained aerobic activity increases HDL,
decreases total cholesterol)
-Avoid tobacco
-Appropriately manage systemic diseases (DM, hypothyroidism, HTN)
Non-pharm management: Hyperlipidemia - ANSWER--Nutrition, weight reduction, increased physical
activity, patient education about risk factors
Pharmacological management: Hyperlipidemia - ANSWER--Assign to a statin treatment group using
ASCVD 10-year risk calculator
-Primary lipid target it LDL
-Statins are 1st-line therapy
-Combo of statin and non-statin in some patients
-Consider adding non-statin if unable to achieve LDL < 70mg/dl, but VERIFY adherence to statins and
lifestyle changes
-Non-statins: ezetimibe (1st), bile acid sequestrant, vibrate, PCSK9 inhibitor
Pregnancy/lactation consideration: Hyperlipidemia - ANSWER--Cholesterol is usually elevated during
pregnancy; measurement is not recommended and treatment is contraindicated
Follow-up: Hyperlipidemia - ANSWER--Check fasting lipid panel 4-12 weeks after starting or adjusting a
statin or non-statin
-Monitor for medication compliance and lifestyle modification, especially if LDL drop is less than
expected
