NR 667 VISE , NR 667 FNP Capstone Practicum and Intensive, Chamberlain College of Nursing
16 views 0 purchase
Course
NR 667
Institution
NR 667
NR 667 VISE , NR 667 FNP Capstone Practicum and Intensive, Chamberlain College of Nursing
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 ...
,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,
• UA and creatinine (for detection of nephrotic syndrome which can induce
dyslipidemia),
• TSH (for detection of hypothyroidism)
• CMP
Diagnosis: Optimal goal is <100 mg/dL
Pt with LDL >= 190mg/dL (without ASCVD or DM is a candidate for high-intensity statin)
Non-pharmacologic Management/Education:
• FIRST LINE: Lifestyle Modification; diet and exercise.
• Diet to improve serum lipids: Mediterranean diet, DASH, vegetarian, low-carb, and
low-trans fat.
• Decrease sugar and simple carbs
• Avoid alcohol
• Increase fish diet with Omega-3 (salmon and sardines) twice a week
• Weight loss
• Aerobic type exercise
Pharmacologic Management:
• First Line: Atorvastatin 10mg once a day at bedtime (perform liver function tests
before initiation therapy and then 4-6 and 12 weeks and after dose increase).
a) Low Intensity (lowers LDL on average by <30%): Simvastatin 10mg, Pravastatin
10- 20mg, Lovastatin 20mg
b) Moderate Intenstiy (lowers LDL on average by 30-49%): Atorvastatin 10-20mg
daily, Rosuvastatin 5-10mg, Simvastatin 20-40mg, Pravastatin 40-80mg.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller HIGHSCORE. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $12.49. You're not tied to anything after your purchase.
