NR 667- VISE STUDY GUIDE-comprehensive -2022

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NR 667- VISE STUDY GUIDE-comprehensive -2022 1. Hypertension Presentation: Most are not symptomatic, Occipital Headaches, headache on awakening in am, burry vision. Look for these clinical find... ings 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) CONTINUED.......... [Show More]

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