NR 667 Vise Answered Assignment
2023-2024 1. Etiology: Hypertension: -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, antide- pressants, caffeine 2. Risk Factors: Hypertension: -Modifiable: smoking, DM, high cholesterol, obe- sity (single most important factor in children), physical inactivity, poor diet, exces- sive 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 3. Assessment: Hypertension: -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 4. Differential Diagnosis: Hypertension: -Secondary HTN, white coat HTN (ar- tificial elevation d/t medical environment anxiety) 5. Final Diagnosis: Hypertension: -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 6. Prevention: Hypertension: -Maintaining healthy weight and BMI -Smoking cessation -Regular aerobic exercise -Alcohol in moderation (< 1 oz/day) -Stress management -Medication compliance -Assess for and treat OSA 7. Non-pharm management: Hypertension: -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 8. Pharmacological management: Hypertension: -Start medication for primary prevention of CVD if pt. has ASCVD risk e 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 9. Pregnancy considerations: Hypertension: -Can use beta blockers (labetalol), methyldopa, CCBs (nifedipine) -AVOID ARBs and ACEIs 10. Follow-up: Hypertension: -Inquire about adherence and any side effects -Reassess monthly until patient reaches goal, then every 3-6 months as needed 11. Expected course: Hypertension: -Only 54% of treated patients are at goal
