Case
ACTUAL NR 603 Week 3 Case Discussion: Cardiovascular
- Course
- NR 603
- Institution
- Chamberlain College Of Nursing
QUESTIONS AND ANSWERS
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Thisstudysourcewasdownloadedby100000816649994fromCourseHero.comon04 -03-202103:09:06GMT -05:00 https://www.coursehero.com/file/41064412/Week -3docx/ ACTUAL NR 603 Week 3 Case Discussion: Cardiovascular WhatleadsdemonstratetheST depression? LorenedemonstratesSTdepressiondispersedthroughouttheEKG. Specifically, thedepression is exhibited in leads I, II, V4, V5, a slight depression in aVF, and V6. There is also an ST elevation inaVR. The EKG showssigns ofacute coronarysyndrome (ACS). AnEKG for ACS will show ST depression in six or more leads, most significant in leads V4 to V6, particularly whenrelated with invertedT waves and ST elevationin lead aVR. These EKG changes should warrant importantnceforurgent,aggressiveevaluationbecauseofthehighprobabilityofsevere angiographic coronary artery disease (Nikus et al., 2014) . IsLoreneHy pertensiveperACA2017Guidelines?ComparetheACAguidelinestoJNC8guidelines and discuss what treatment you recommend for her BPand why? According to the American College of Cardiology (ACC), Lorene’s blood pressure, which is 146/90, would place her in stage II hypertension (HTN). The ACC definitions of stage II is systolicgreaterthanorequalto 140or diastolicgreaterthanorequalto 90. Herbloodpressure numbers falls within the guidelines recommendations (Whelton, Carey, &Aronow, 2018) . TheACAandJNC8guidel inesreportthedifferenceinopinionsaboutthebloodpressure parameters. According to ACA normal blood pressure is systolic less than 120 mmHg and diastolic lessthan80 mmHg. HTNstage1systolicBP(SBP)is130 -139 mmHgor diastolicBP (DBP) 80-89mmHg, and HTN stage 2SBP greaterthanor equalto 140 mmHg or DBPgreater than or equalto 140 mm Hg or DBP greater than or equalto 90 mmHg (Whelton, Carey, & Aronow, 2018) . The JNC 8 recommendation is high blood pressure goals and to use fewer medications. The guidelines also factori nthe SBP and DBP withage and comorbidity -specific treatment. For example,apatient who is60 yearsoldwithoutdiabetes(ADA)orchronickidneydisease(CKD), the blood pressure goalisto be lessthan 150/90 mmHg. In younger patientsand patientswho is 60 witha historyo fADAand CKD, the goalfor bloodpressure is less than140/90 mmHg. The ACA is a stricter guideline, recommending lowering numbers no matter what comorbidities that patient has (American Family Physician, 2014) . Afterreviewingthetwoguidelines,aslowermethodofco ntrolling bloodpressurewillbe adopted. Lorene is considered obese. She has hypertension , metabolic Syndrome, and dyslipidemia. She also had a historyofgestational diabetes, and her current A1c is elevated at 6.4%. With her current ST changes, Lorene’s blood pressure will need to be lowered. However, starting aggressive treatment is not ideal, and she may feelthe effects of lowering her BP to quickly. Lorene needs to go back on medications. However, her beliefabout controlling her BP withdiet and exercise is correct and will beadopted in her treatment plan mentioned later inthis case study response. Whatistheprimary diagnosiscausingLorene’schestpain?IncludeICD10 codes. Thisstudysourcewasdownloadedby100000816649994fromCourseHero.comon04 -03-202103:09:06GMT -05:00 https://www.coursehero.com/file/41064412/Week -3docx/ Lorene’ssymptomsareconsistentwithAcuteCoronarySyndrome(ACS),ICD10code I24.9. Her report sugge sts having shortness of breath, discomfort that radiates back and up betweenhershoulderblades.Thediscomforthappensonexertionandresolveswithrest.Sheis
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