Exam (elaborations)
NR 667 VISE Assignment|271 Questions and Answers|100% Accurate.
- Course
- Institution
NR 667 VISE Assignment|271 Questions and Answers|100% Accurate.
[Show more]
Seller
Follow
Victorious23
Reviews received
Content preview
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
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 Victorious23. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $14.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
75323 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now