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NR 667 VISE Assignment|271 Questions and Answers|100% Accurate.
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NR 667 VISE Assignment|271 Questionsand Answers|100% Accurate.
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, antidepressants, caffeine
-Risk Factors: Hypertension - --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 - --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 - --Secondary HTN, white coat HTN
(artificial elevation d/t medical environment anxiety)
-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
-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
-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
-Pharmacological management: Hypertension - --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 - --Can use beta blockers
(labetalol), methyldopa, CCBs (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
-Expected course: Hypertension - --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 - --Stroke, CAD, MI, renal failure,
heart failure, eclampsia (seizures), pulmonary edema, hypertensive crisis,
hypertensive retinopathy, ED
-Etiology: Hyperlipidemia - --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 - --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 - --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 - --Secondary causes:
hypothyroidism, pregnancy, DM, non-fasting state
-Final diagnosis: Hyperlipidemia - --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
-Prevention: Hyperlipidemia - --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 - --Nutrition, weight reduction,
increased physical activity, patient education about risk factors
-Pharmacological management: Hyperlipidemia - --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 - --Cholesterol is usually
elevated during pregnancy; measurement is not recommended and
treatment is contraindicated
-Follow-up: Hyperlipidemia - --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
, -Expected course: Hyperlipidemia - --Depends on etiology and severity of
disease
-1% decrease in LDL value decreases CHD risk by 2%
-Possible complications: Hyperlipidemia - --CAD, cerebrovascular disease,
PVD, arteriosclerosis
-Etiology: DM II - --Influences by genetics and environmental factors
-High body mass and central obesity
-Drug or chemical-induced: glucocorticoids, highly active antiretroviral
therapy
-Risk factors: DM II - --BMI > 25
-History of gestational DM and/or macrocosmic infant
-Family history of T2DM
-Conditions associated with insulin resistance: PCOS, acanthosis nigricans)
-HDL-C < 35 and/or TG > 250
-HTN
-History of CVD
-Hemochromatosis
-Impaired fasting glucose
-Physically active < 3 days/week
-Assessment findings: DM II - --Usually discovered on routine exam
-CMP and urinalysis: glycosuria, proteinuria, hyperglycemia
-Obesity
-Acanthosis nigricans
-Polydipsia, polyuria, polyphagia
-Fatigue
-Blurred vision
-Chronic skin infections
-Balanitis in men > 65 years
-Chronic candidiasis vulvovaginitis
-Hyperosmolar state or coma
-Differential diagnosis: DM II - --TIDM
-Prediabetes
-Gestational diabetes
-Cushing's syndrome
-Pheochromocytoma
-Acromegaly
-Corticosteroid use
-Pancreatic insufficiency
-Final diagnosis: DM II - --Fasting plasma glucose: > 126
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