NR 667 VISE Assignment Questions and Answers
-No known cause in 90% of cases of primary HTN
-Secondary causes: renal failure, kidney disease, renal
Etiology: Hypertension artery stenosis, Cushing syndrome, hyper/hypo
thyroidism, increased ICP, sleep apnea, oral
contraceptives, steroids, cocaine, NSAIDs,
decongestants, sympathomimetics, alcohol,
antidepressants, caffeine
-Modifiable: smoking, DM, high cholesterol, obesity
(single most important factor in children), physical
Risk Factors: Hypertension 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
-Most are asymptomatic; occipital headache, headache
Assessment: Hypertension 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: -Secondary HTN, white coat HTN (artificial elevation
Hypertension d/t medical environment anxiety)
-Urinalysis = proteinuria
-Electrolytes, creatinine, calcium
-Fasting lipid profile and BS
Final Diagnosis: Hypertension -ECG
-Measure BP twice, 5 mins apart
-Patient should be seated; use proper cuff size and application
, -Maintaining healthy weight and BMI
-Smoking cessation
-Regular aerobic exercise
-Alcohol in moderation (< 1 oz/day)
Prevention: Hypertension
-Stress management
-Medication compliance
-Assess for and treat OSA
-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+
Non-pharm management:
-Reduce sat. fat intake
Hypertension
-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
-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
Pharmacological -Stage 2: start 2 bp-lowering medications
management: -African Americans: 2+ medications recommended;
Hypertension 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: -Can use beta blockers (labetalol), methyldopa, CCBs
Hypertension (nifedipine)
-AVOID ARBs and ACEIs
Follow-up: Hypertension -Inquire about adherence and any side effects
-Reassess monthly until patient reaches goal, then every 3-6
months as needed
, -Only 54% of treated patients are at goal treatment;
Expected course: expect complications if under treated
Hypertension -Most patients require more than one medication to reach goal
bp
Possible Complications: -Stroke, CAD, MI, renal failure, heart failure, eclampsia
Hypertension (seizures), pulmonary edema, hypertensive crisis,
hypertensive retinopathy, ED
-Inherited disorder, high dietary intake, obesity,
sedentary lifestyle, DM, hypothyroidism, anabolic
Etiology: Hyperlipidemia
steroid use, hepatitis, cirrhosis, uremia, nephrotic
syndrome, stress, drug-induced (thiazide diuretics, beta
blockers, cyclosporine), alcohol, caffeine, metabolic
syndrome
Risk factors: Hyperlipidemia -Family history, physical inactivity, smoking, age (men >
45, women > 55 or premature menopause without
estrogen replacement), obesity, diet high in sat. fat, DM
-Few physical findings; xanthomata (fat deposits in the
Assessment findings: skin), xanthelasma (yellow plaques on the eyelid),
Hyperlipidemia
corneal arcus prior to age 50 (arc of cholesterol around
the iris), bruits, angina pectoris, MI, stroke
Differential diagnosis: -Secondary causes: hypothyroidism, pregnancy, DM, non-fasting
Hyperlipidemia state
-Fasting lipid profile: 9-12 hours
-Glucose level
-Urinalysis, creatinine (for detection of nephrotic
Final diagnosis: Hyperlipidemia syndrome which can induce dyslipidemia)
-Baseline transaminases
-TSH for detection of hypothyroidism (which can cause
secondary dyslipidemia)
-Calculate ASCVD 10-year risk
-No known cause in 90% of cases of primary HTN
-Secondary causes: renal failure, kidney disease, renal
Etiology: Hypertension artery stenosis, Cushing syndrome, hyper/hypo
thyroidism, increased ICP, sleep apnea, oral
contraceptives, steroids, cocaine, NSAIDs,
decongestants, sympathomimetics, alcohol,
antidepressants, caffeine
-Modifiable: smoking, DM, high cholesterol, obesity
(single most important factor in children), physical
Risk Factors: Hypertension 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
-Most are asymptomatic; occipital headache, headache
Assessment: Hypertension 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: -Secondary HTN, white coat HTN (artificial elevation
Hypertension d/t medical environment anxiety)
-Urinalysis = proteinuria
-Electrolytes, creatinine, calcium
-Fasting lipid profile and BS
Final Diagnosis: Hypertension -ECG
-Measure BP twice, 5 mins apart
-Patient should be seated; use proper cuff size and application
, -Maintaining healthy weight and BMI
-Smoking cessation
-Regular aerobic exercise
-Alcohol in moderation (< 1 oz/day)
Prevention: Hypertension
-Stress management
-Medication compliance
-Assess for and treat OSA
-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+
Non-pharm management:
-Reduce sat. fat intake
Hypertension
-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
-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
Pharmacological -Stage 2: start 2 bp-lowering medications
management: -African Americans: 2+ medications recommended;
Hypertension 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: -Can use beta blockers (labetalol), methyldopa, CCBs
Hypertension (nifedipine)
-AVOID ARBs and ACEIs
Follow-up: Hypertension -Inquire about adherence and any side effects
-Reassess monthly until patient reaches goal, then every 3-6
months as needed
, -Only 54% of treated patients are at goal treatment;
Expected course: expect complications if under treated
Hypertension -Most patients require more than one medication to reach goal
bp
Possible Complications: -Stroke, CAD, MI, renal failure, heart failure, eclampsia
Hypertension (seizures), pulmonary edema, hypertensive crisis,
hypertensive retinopathy, ED
-Inherited disorder, high dietary intake, obesity,
sedentary lifestyle, DM, hypothyroidism, anabolic
Etiology: Hyperlipidemia
steroid use, hepatitis, cirrhosis, uremia, nephrotic
syndrome, stress, drug-induced (thiazide diuretics, beta
blockers, cyclosporine), alcohol, caffeine, metabolic
syndrome
Risk factors: Hyperlipidemia -Family history, physical inactivity, smoking, age (men >
45, women > 55 or premature menopause without
estrogen replacement), obesity, diet high in sat. fat, DM
-Few physical findings; xanthomata (fat deposits in the
Assessment findings: skin), xanthelasma (yellow plaques on the eyelid),
Hyperlipidemia
corneal arcus prior to age 50 (arc of cholesterol around
the iris), bruits, angina pectoris, MI, stroke
Differential diagnosis: -Secondary causes: hypothyroidism, pregnancy, DM, non-fasting
Hyperlipidemia state
-Fasting lipid profile: 9-12 hours
-Glucose level
-Urinalysis, creatinine (for detection of nephrotic
Final diagnosis: Hyperlipidemia syndrome which can induce dyslipidemia)
-Baseline transaminases
-TSH for detection of hypothyroidism (which can cause
secondary dyslipidemia)
-Calculate ASCVD 10-year risk
