Case
VISE assignment study guide
- Institution
- Chamberlain College Of Nursing
Vise assignment is intended to help students to study for the assignment that is held in the week 3 -week 5 of the NR677 FNP class.
[Show more]
Seller
Follow
Content preview
1. Hypertension Presentation: Most are not symptomatic, Occipital Headaches, headache on awakening in am, burryvision.
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. c)High Intensity (lowers LDL on average by >50%): Atorvastatin 40-80mg daily. (Never start on 80mg, always titrate up). Rosuvastatin 20-40mg. AVOID GRAPEFRUIT JUICE! Watch for rhabdomylosis
INTOLERANCE TO STATIN: Alternative Welchol (Bile Acid Sequestrants) 625 mg tab daily once a day.
Age 21-75 high intensity therapy
Follow up: q6-8 weeks re-check lipids until goal is achieved, then q 6-12 months to evaluate compliance Risk Factors: DM, FH of HD, HTN, low HDL, age (men older than 45 and women older than 55), smoking, obesity, CAD, PVD, microalbuminuria
Refer: Nutritionist Differentials:
Hypothyroidism
Pregnancy
Diabetes
Liek: 1
Hollier: 29, 1 3. Diabetes type 2 -
Presentation (assessment): insulin resistance in target tissues, abnormal insulin secretion, or decrease in insulin receptors.
**Usually discovered on routine exam!
Polydipsia, Polyuria, Polyphagia, (showing symptoms)
agitation, nervousness, obesity, fatigue
Chronic skin infections
Women: chronic yeast infection
blurry vision
Exam feet, pulses, nail thickness, odor, swelling, mobility
Thyroid palpitation
Skin exam
Diagnostics: EKG, CBC, CMP, LIPIDS, Microalbuminuria , TSH, A1C
Diagnosis: Hgb A1C >or equal to 6.5%
Fasting glucose>126mg/dl and confirmed on a different day
Fasting between 100-126 = impaired glucose
Nonfasting less than 126 = normal values
Recurrent yeast infections
Non-pharmacologic Management : Monitor Blood glucose at home and diary (daily) Lifestyle modification: diet and Exercise avoid alcohol
avoid smoking
Routine oral exams
Pharmacologic Management :
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 yuliyabulatova. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
73918 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now