NR 601 FINAL EXAM ACC 2017 GUIDELINE FOR HIGH BLOOD
PRESSURE IN ADULTS
Adults- 2017 HTN guidelines
• Normal BP is defined as <120/<80 mm Hg
• Elevated BP 120-129/<80 mm Hg
• Hypertension stage 1 is 130-139 or 80-89 mm Hg
• Hypertension stage 2 is ≥140 or ≥90 mm
Hg. Acute prostatitis kennedy 380.
• lower urinary tract symptoms-
o frequency, pain on urination or pain increasing with uriuiation.
• Acute bacterial prostatitis-
o presence of more than 10 WBC per high power field on mid stream urine collection.
• If acutely ill, hospitalization.
o Treat with Cipro 500mg BID x 10 days or Levaquin 500mg daily x 10 days.
o Choose a fluoquinolone - it penetrates prostate tissue well.
• Education
o May need a stool softener. Repeat UA is recommended. Avoid anal intercourse. Use condom
to prevent reintroduction of bacteria into urethra.
Beta blocker side effects in diabetics-
• Can mask the symptoms of
hypoglycemia How to diagnosis HF and
COPD via CXR findings-
• Chest x-ray: for COPD
o This exam can help support the diagnosis of COPD by producing images of the lungs to
evaluate symptoms of shortness of breath or chronic cough.
o While chest x-rays may not show COPD until it is severe, the images may show enlarged lungs,
irregular air pockets ( bullae) or a flattened diaphragm.
o A chest x-ray may also be used to determine if another condition may be causing symptoms
similar to COPD. (Malone 207) –
o chest X-ray in advanced COPD with emphysema May reveal hyperinflation bullae or blebs
and a flat hemidiaphragm.
OA
,HF stages-
• ACCF/AHA STAGES:
o A: At high risk for HF w/o structural heart Dz or Sx
o B: Structural heart dz w/o s/sx of HF
o C: Structural heart dz w/ prior or current sx of HF
o D: Refractory HF requiring specialized interventions
, • New York Heart Association classes-
o I No limitation of physical activity. Ordinary physical activity does not cause undue fatigue,
palpitation, dyspnea (shortness of breath).
o II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results
in fatigue, palpitation, dyspnea (shortness of breath).
o III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity
causes fatigue, palpitation, or dyspnea.
o IV Unable to carry on any physical activity without discomfort. Symptoms of heart failure at
rest. If any physical activity is undertaken, discomfort increases.
Causes for insomnia –
• Anxiety, stress, and depression are some of the most common causes of chronic insomnia.
• Having difficulty sleeping can also make anxiety, stress, and depression symptoms worse.
• Other common emotional and psychological causes include anger, worry, grief, bipolar disorder, and
trauma.
Prescription for insomnia –
• Avoid caffeine for 12 hours before bedtime, d/c alcohol and unnecessary sleep interrupting drugs, OTC
melatonin
• RX ramelteon can be tried, if ineffective initiate a short acting sedative-hypnotic such as zolpidem
(Ambien) or zaleplon (Sonata) for 1 week or less
• If a benzodiazepine is used, temazepam (Restoril) is relatively short acting
• Approved pharmacological therapy includes temazepam for sleep onset insomnia, eszopiclone
(Lunesta) for sleep onset and sleep maintenance, zolpidem CR and zolpidem for sleep maintenance, and
saleplon and ramelteon for sleep onset insomnia
• Kennedy p 597-588
TABLE 232–4 Effective Drugs for Insomnia
Agent (Brand Onset Duration Dos Relativ Comments
Name) e e Cost
(mg) (Brand)
Benzodiazepin May impair AM performance; ?
e receptor anterograde amnesia; modest potential
agonists for abuse, withdrawal, dependence;
drug–drug effects
PRESSURE IN ADULTS
Adults- 2017 HTN guidelines
• Normal BP is defined as <120/<80 mm Hg
• Elevated BP 120-129/<80 mm Hg
• Hypertension stage 1 is 130-139 or 80-89 mm Hg
• Hypertension stage 2 is ≥140 or ≥90 mm
Hg. Acute prostatitis kennedy 380.
• lower urinary tract symptoms-
o frequency, pain on urination or pain increasing with uriuiation.
• Acute bacterial prostatitis-
o presence of more than 10 WBC per high power field on mid stream urine collection.
• If acutely ill, hospitalization.
o Treat with Cipro 500mg BID x 10 days or Levaquin 500mg daily x 10 days.
o Choose a fluoquinolone - it penetrates prostate tissue well.
• Education
o May need a stool softener. Repeat UA is recommended. Avoid anal intercourse. Use condom
to prevent reintroduction of bacteria into urethra.
Beta blocker side effects in diabetics-
• Can mask the symptoms of
hypoglycemia How to diagnosis HF and
COPD via CXR findings-
• Chest x-ray: for COPD
o This exam can help support the diagnosis of COPD by producing images of the lungs to
evaluate symptoms of shortness of breath or chronic cough.
o While chest x-rays may not show COPD until it is severe, the images may show enlarged lungs,
irregular air pockets ( bullae) or a flattened diaphragm.
o A chest x-ray may also be used to determine if another condition may be causing symptoms
similar to COPD. (Malone 207) –
o chest X-ray in advanced COPD with emphysema May reveal hyperinflation bullae or blebs
and a flat hemidiaphragm.
OA
,HF stages-
• ACCF/AHA STAGES:
o A: At high risk for HF w/o structural heart Dz or Sx
o B: Structural heart dz w/o s/sx of HF
o C: Structural heart dz w/ prior or current sx of HF
o D: Refractory HF requiring specialized interventions
, • New York Heart Association classes-
o I No limitation of physical activity. Ordinary physical activity does not cause undue fatigue,
palpitation, dyspnea (shortness of breath).
o II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results
in fatigue, palpitation, dyspnea (shortness of breath).
o III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity
causes fatigue, palpitation, or dyspnea.
o IV Unable to carry on any physical activity without discomfort. Symptoms of heart failure at
rest. If any physical activity is undertaken, discomfort increases.
Causes for insomnia –
• Anxiety, stress, and depression are some of the most common causes of chronic insomnia.
• Having difficulty sleeping can also make anxiety, stress, and depression symptoms worse.
• Other common emotional and psychological causes include anger, worry, grief, bipolar disorder, and
trauma.
Prescription for insomnia –
• Avoid caffeine for 12 hours before bedtime, d/c alcohol and unnecessary sleep interrupting drugs, OTC
melatonin
• RX ramelteon can be tried, if ineffective initiate a short acting sedative-hypnotic such as zolpidem
(Ambien) or zaleplon (Sonata) for 1 week or less
• If a benzodiazepine is used, temazepam (Restoril) is relatively short acting
• Approved pharmacological therapy includes temazepam for sleep onset insomnia, eszopiclone
(Lunesta) for sleep onset and sleep maintenance, zolpidem CR and zolpidem for sleep maintenance, and
saleplon and ramelteon for sleep onset insomnia
• Kennedy p 597-588
TABLE 232–4 Effective Drugs for Insomnia
Agent (Brand Onset Duration Dos Relativ Comments
Name) e e Cost
(mg) (Brand)
Benzodiazepin May impair AM performance; ?
e receptor anterograde amnesia; modest potential
agonists for abuse, withdrawal, dependence;
drug–drug effects
