NR565 HTN Lipid Protocol 1
NR 565 Week 3 Hypertension Lipid Protocol – Download To
Score An A+
HYPERTENSION PROTOCOL: INITIAL VISIT
1) RATIONALE
a) This protocol will assist in the differentiation between essential hypertension and renal
artery stenosis to aid in the identification of patients in need of referral to nephrology to
prevent further renal damage from an unidentified renal artery stenosis. The design of the
protocol for UTI encompasses these principles.
2) SYMPTOMS
a) HYPERTENSION
i) Blood pressure >140/90 mmHg
ii) Other possible subjective symptoms
(1) Headache
(2) Visual changes
(3) Dyspnea
(4) Chest pain
(5) Sensory or motor deficit
b) RENAL ARTERY STENOSIS
i) Onset of hypertension age >55 years or <30 years
ii) History of accelerated, malignant, or resistant hypertension
iii) History of unexplained kidney dysfunction
iv) History of multivessel coronary artery disease
v) History of other peripheral vascular disease
vi) Abdominal bruit
vii) Sudden or unexplained recurrent pulmonary edema
viii) Other possible factors
(1) Absence of family history of hypertension
(2) Other bruits
(3) History of acute kidney injury after administration of ACE inhibitor or
angiotensin II receptor antagonist (ARB)
3) HISTORY
a) Continue with treatment of hypertension but consult supervising physician if patient has:
i) History of accelerated, malignant, or resistant hypertension
ii) History of unexplained kidney dysfunction
iii) History of multivessel coronary artery disease
iv) History of other peripheral vascular disease
v) Abdominal bruit
vi) Sudden or unexplained recurrent pulmonary edema
4) PHYSICAL EXAM
a) Perform the following examinations:
i) Vital Signs (blood pressure, pulse)
ii) Auscultation for bruits (carotid, abdominal, and femoral)
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, NR565 HTN Lipid Protocol 2
iii) Palpation of thyroid
iv) Cardiac
v) Respiratory
vi) Lower extremities for edema and pulses
vii) Neurological
b) Consult supervising physician if findings of:
i) Abdominal bruit
ii) Another bruit
5) LAB TESTS
a) Metabolic panel
i) Cholesterol
ii) Blood sugar
iii) Uric acid level
b) Glomerular filtration rate
c) Consult supervising physician if:
i) GFR indicates chronic kidney disease (CKD) or renal failure
6) PHARMACOLOGICAL TREATMENT
a) List the hypertension drug classifications and examples you would prescribe in order of
treatment according to clinical practice guidelines without consideration of race or
ethnicity: (Provide generic names for examples. Doses are not needed or required.)
Drug Category/ Example 1 Example 2 Example 3 Example 4
Classification
Thiazide diuretic hydrochlorothiazid triamterene chlorthalidone indapamide
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ACE inhibitor lisinopril benazapril fosinopril quinapril
(ACEI)
Angiotensin candesartan valsartan losartan olmesartan
receptor blocker
(ARB)
Calcium channel amlodipine nifedipine diltiazem verapamil
blocker (CCB)
Citation: James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C.,
Handler, J., Lackland, D. T., LeFevre, M. L., MacKenzie, T. D., Ogedegbe, O., Smith, S. C.,
Svetkey, L. P., Taler, S. J., Townsend, R. R., Wright, J. T., Narva, A. S., &; Ortiz, E. (2014). 2014
evidence-based guideline for the management of high blood pressure in adults. JAMA, 311(5),
507. https://doi.org/10.1001/jama.2013.284427
b) 1st line pharmacological treatment if warranted in a non-African American patient after a
thiazide diuretic has been given and no compelling contraindications/comorbidities are
identified: (Choose a generic drug from the drug class you would like to prescribe to
either add to existing treatment or replace a thiazide.)
i) Drug: Lisinopril
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