(SUMMARY)NR667 | NR 667 VISE STUDY GUIDE 2023 - CHAMBERLAIN COLLEGE OF NURSING|NEW!!!|A GRADE

1. Hypertension Presentation: Most are not symptomatic, Occipital Headaches, headache on awakening in am, burry vision. Look for these clinical findings to rule out organ damage: Microvascular • Eyes (HTN retinopathy): AV nicking (causes when arteriole crosses on top of vein), papilledema • Kidneys: microalbuminuria and proteinuria, elevated serum creatinine and abnormal eGFR, peripheral or generalized edema Macrovascular • Heart: S3 (CHF), S4 (LVH), carotid bruits, decreased or absent peripheral pulses • Brain: TIA or hemorrhagic stroke Assessment/Exam: • Asymptomatic • Occipital headache • Blurry vision • Headache upon wakening • Exam of optic fundi: Look for AV nicking, hemorrhage, papilledema • LVH (long standing HTN) • Perform exam of symmetrical pulses • Auscultate for Carotid bruits, abdominal bruits, and kidney bruits Diagnostic studies: EKG, fasting lipid profile, fasting blood glucose, TSH, CXR to R/O cardiomegaly. CBC, CMP, and urinalysis. Measure BP 5 minutes apart. Assess the patients 10- year risk for heart disease (ASCVD) Diagnosis: > 140/90 mm Hg start on B/P medication. Pharmacologic Management: • FIRST LINE DIURETIC: Hydrochlorothiazide (HCTZ) 25 mg/day (max 50mg/day) *May worsen gout and elevate lipids and glucose • ALTERNATIVE CCB: Amlodipine besylate 5 mg /day. (Watch for lower extremity edema) • ACE: lisinopril 10mg/day complicated HTN first line • Consider ACE/ARB in patient with DM, proteinuria, HF. CONTRAINDICATED IN PREGNANCY • If stage 2, initiate 2 drug classes (Diuretic & CCB most effective in African American) Follow up: • 2-4weeks Referral: • Cardiology if EKG is abnormal Secondary HTN causes to consider: • CKD, renal artery stenosis, hyperthyroidism, phenochromocytoma, OSA, coartication of the heart (SBP higher in the legs), oral contraceptives, corticosteroids, cocaine, NSAID,decongestants Differential: • Secondary hypertension • White coat syndrome • Pregnant • Pregnancy induced hypertension Education:• First: Lifestyle modifications: diet and exercise 30 minutes aerobic exercise 5 days per week. • Weight loss (BMI 25 and up) • Limit alcohol (men:2 drinks or less per day; women: one drink or less per day) • Stop smoking • Stress management • Eat fatty cold water fish (salmon, anchovy) 3x a week • DASH • Medication compliance • Reduce sodium intake <1,500 mg/day) • Measure BP daily, bring log to next visit, bring home cuff to compare to office • Liek: 1 Hollier: 17, 1 2. Hyperlipidemia Presentation: Most patients are asymptomatic until they develop ASCVD. • Xanthomata (lipid deposits around the eyes) • Corneal Arcus prior to age 50 years (white iris), normal • Angina • Bruits • MI • Stroke Diagnostics: • Fasting/non-fasting lipid profile • Glucose,