NR 603 Week 3 Case Discussion: Cardiovascular
What Leads Demonstrate the ST Depression?
Leads V4, V5 and V6 demonstrate the ST depression. Maximal precordial ST-segment
depression in leads V4-V6 is suggestive of severe coronary artery disease involving the left
anterior descending coronary artery or its diagonal branch, in patients with inferior wall acute
myocardial infarction (Shemirani, & Nayeri-Torshizi, 2015).
Is Lorene Hypertensive per ACA 2017 Guidelines? Compare the ACA guidelines to JNC 8
guidelines and discuss what treatment you recommend for her BP and why.
ACA 2017 Guidelines
Lorene’s BP of 146/90 indicates that she is hypertensive according to ACA 2017 guidelines.
Rubenfire (2018), states that according to ACA guidelines, a blood pressure reading of systolic
140 mm Hg and above and diastolic reading of 90 mm Hg is consider as hypertension stage 2.
Prior to labeling a person with hypertension, it is important to use an average based on two or
more readings obtained on two occasions to estimate the individual’s level of BP. Two first-line
drugs of different classes are recommended with stage 2 hypertension. For African American
population, first-line treatment recommendations are thiazide diuretics and calcium-channel
blockers (Williams, et al., 2016).
JNC 8 guidelines
According to the JNC 8 guidelines, Lorene’s BP of 146/90 is consider as hypertensive.
Armstrong (2014), states that adults 60 years and older, should have treatment initiated when the
systolic pressure is 150 mm Hg or higher, or when the diastolic pressure is 90 mm Hg or higher
and patients should be treated to a target systolic pressure of less than 150 mm Hg and a target
diastolic pressure of less than 90 mm Hg. First-line treatment are diuretics or calcium channel
blockers are recommended for monotherapy in blacks (Williams, et al., 2016).
What is the Primary diagnosis causing Lorene's chest pain? Include ICD 10 codes
Acute Coronary Syndrome (I24.9).
Acute coronary syndrome (ACS) refers to a group of clinical syndromes that are associated with
sudden, reduced blood flow to the heart. Symptoms include pain radiating from the chest to the
shoulders, arms, upper abdomen, back, neck or jaw, palpitations, shortness of breath,
diaphoresis, nausea, lightheadedness, generalized weakness, and decreased exercise tolerance
(Avital, & Oji, 2018). Acute coronary syndrome can be diagnose by completing Troponin levels
and an electrocardiogram can be completed to measure the heart’s electrical activity (Avital, &
Oji, 2018). In the case of Lorene, she was having shortness of breath while in dance class. She
also felt "a discomfort" that radiated back and up between her shoulder blades while at the peak
of her exercise routine and was a little nauseous and sweaty. Her EKG results show ST
, depression in multiple leads which indicates NSTEMI. Lorene also has the following risk factors
associated with acute coronary syndrome according to Avital, & Oji (2018), she is above 55-
years of age, has history hypertension, dyslipidemia, gestational diabetes, is overweight, smoke
occasionally and drinks beer and wine.
What other secondary diagnoses does Lorene have that should be addressed?
Diabetes Mellitus Type 2 (E11.9).
Diabetes mellitus, occurs when there is impairment of, beta cell synthesis or release of insulin, or
the inability of tissues to use insulin which results in the inability to metabolism of fat,
carbohydrate and protein. Clinically the patient will present with symptoms of increased fatigue,
polyuria, polydipsia, and polyphagia (Carrera-Boada, & Martínez-Moreno, 2013). Lorene is
overweight despite her efforts to exercise two times a week, her hgbA1C results is 6.4% and
fasting glucose 135mgs/dl. She also has history of gestational diabetes with three pregnancies.
According to Pippitt, and Marlana, (2016), diagnosis of diabetes can be made with an A1C level
of 6.5% or greater, a fasting plasma glucose level of 126 mg /dl. Although this patient’s A1C
results is 6.4% which is consider pre-diabetes, however she has a fasting glucose 135mgs/dl and
history of gestational diabetes with three pregnancies which means she has type 2 diabetes. Type
2 diabetes when left uncontrolled, it affect major organs including the heart, blood vessels,
nerves, eyes and kidneys cause serious complications for the patient (Carrera-Boada, &
Martínez-Moreno, 2013).
Hyperlipidemia, (E78.5).
Hyperlipidemia develops as a result of abnormal lipoprotein metabolism, mainly lowering of
low-density lipoprotein (LDL) receptor expression or activity, and consequently reducing hepatic
LDL clearance from the plasma (Buttaro, et, al., 2013). An individual can develop
hyperlipidemia form hereditary or unhealthy eating, and lack of excises. There are usually no
symptoms manifested by the patient with hyperlipidemia. The only way for a healthcare provider
to detect hyperlipidemia is to perform a blood test or assess a patient who presents with a
cardiovascular event, such as a heart attack or stroke (Buttaro, et, al., 2013). Risk factor for
Lorene having hyperlipidemia include her age, her diagnosis of diabetes and being overweight.
Her cholesterol levels are elevated with, total cholesterol 230 mg/dl, LDL 180 mg/dl; HDL
38mg/dl, Triglycerides 180mgs/dl. Hyperlipidemia is caused by excessive fat accumulate in the
blood over time, forming plaques on the walls of the arteries and blood vessels. The plaques
narrows the walls of the arteries and blood vessels making it hard for the heart to pump blood
through putting this patient at risk for a heart attack or stroke (Buttaro, et, al., 2013).
Design a treatment plan and discuss how each intervention is applicable to Lorene's case
Referrals/Follow up
Lorene’s EKG results and her symptoms indicates a cardiac ischemia. Cardiac ischemia is a
medical emergency and time to start treatment is critical (Switaj, Christensen, & Brewer, 2017).
In the case of Lorene, I will call 911 and transfer her to the emergency department. While she is
on her way to the emergency department will call the emergency department and give report of
What Leads Demonstrate the ST Depression?
Leads V4, V5 and V6 demonstrate the ST depression. Maximal precordial ST-segment
depression in leads V4-V6 is suggestive of severe coronary artery disease involving the left
anterior descending coronary artery or its diagonal branch, in patients with inferior wall acute
myocardial infarction (Shemirani, & Nayeri-Torshizi, 2015).
Is Lorene Hypertensive per ACA 2017 Guidelines? Compare the ACA guidelines to JNC 8
guidelines and discuss what treatment you recommend for her BP and why.
ACA 2017 Guidelines
Lorene’s BP of 146/90 indicates that she is hypertensive according to ACA 2017 guidelines.
Rubenfire (2018), states that according to ACA guidelines, a blood pressure reading of systolic
140 mm Hg and above and diastolic reading of 90 mm Hg is consider as hypertension stage 2.
Prior to labeling a person with hypertension, it is important to use an average based on two or
more readings obtained on two occasions to estimate the individual’s level of BP. Two first-line
drugs of different classes are recommended with stage 2 hypertension. For African American
population, first-line treatment recommendations are thiazide diuretics and calcium-channel
blockers (Williams, et al., 2016).
JNC 8 guidelines
According to the JNC 8 guidelines, Lorene’s BP of 146/90 is consider as hypertensive.
Armstrong (2014), states that adults 60 years and older, should have treatment initiated when the
systolic pressure is 150 mm Hg or higher, or when the diastolic pressure is 90 mm Hg or higher
and patients should be treated to a target systolic pressure of less than 150 mm Hg and a target
diastolic pressure of less than 90 mm Hg. First-line treatment are diuretics or calcium channel
blockers are recommended for monotherapy in blacks (Williams, et al., 2016).
What is the Primary diagnosis causing Lorene's chest pain? Include ICD 10 codes
Acute Coronary Syndrome (I24.9).
Acute coronary syndrome (ACS) refers to a group of clinical syndromes that are associated with
sudden, reduced blood flow to the heart. Symptoms include pain radiating from the chest to the
shoulders, arms, upper abdomen, back, neck or jaw, palpitations, shortness of breath,
diaphoresis, nausea, lightheadedness, generalized weakness, and decreased exercise tolerance
(Avital, & Oji, 2018). Acute coronary syndrome can be diagnose by completing Troponin levels
and an electrocardiogram can be completed to measure the heart’s electrical activity (Avital, &
Oji, 2018). In the case of Lorene, she was having shortness of breath while in dance class. She
also felt "a discomfort" that radiated back and up between her shoulder blades while at the peak
of her exercise routine and was a little nauseous and sweaty. Her EKG results show ST
, depression in multiple leads which indicates NSTEMI. Lorene also has the following risk factors
associated with acute coronary syndrome according to Avital, & Oji (2018), she is above 55-
years of age, has history hypertension, dyslipidemia, gestational diabetes, is overweight, smoke
occasionally and drinks beer and wine.
What other secondary diagnoses does Lorene have that should be addressed?
Diabetes Mellitus Type 2 (E11.9).
Diabetes mellitus, occurs when there is impairment of, beta cell synthesis or release of insulin, or
the inability of tissues to use insulin which results in the inability to metabolism of fat,
carbohydrate and protein. Clinically the patient will present with symptoms of increased fatigue,
polyuria, polydipsia, and polyphagia (Carrera-Boada, & Martínez-Moreno, 2013). Lorene is
overweight despite her efforts to exercise two times a week, her hgbA1C results is 6.4% and
fasting glucose 135mgs/dl. She also has history of gestational diabetes with three pregnancies.
According to Pippitt, and Marlana, (2016), diagnosis of diabetes can be made with an A1C level
of 6.5% or greater, a fasting plasma glucose level of 126 mg /dl. Although this patient’s A1C
results is 6.4% which is consider pre-diabetes, however she has a fasting glucose 135mgs/dl and
history of gestational diabetes with three pregnancies which means she has type 2 diabetes. Type
2 diabetes when left uncontrolled, it affect major organs including the heart, blood vessels,
nerves, eyes and kidneys cause serious complications for the patient (Carrera-Boada, &
Martínez-Moreno, 2013).
Hyperlipidemia, (E78.5).
Hyperlipidemia develops as a result of abnormal lipoprotein metabolism, mainly lowering of
low-density lipoprotein (LDL) receptor expression or activity, and consequently reducing hepatic
LDL clearance from the plasma (Buttaro, et, al., 2013). An individual can develop
hyperlipidemia form hereditary or unhealthy eating, and lack of excises. There are usually no
symptoms manifested by the patient with hyperlipidemia. The only way for a healthcare provider
to detect hyperlipidemia is to perform a blood test or assess a patient who presents with a
cardiovascular event, such as a heart attack or stroke (Buttaro, et, al., 2013). Risk factor for
Lorene having hyperlipidemia include her age, her diagnosis of diabetes and being overweight.
Her cholesterol levels are elevated with, total cholesterol 230 mg/dl, LDL 180 mg/dl; HDL
38mg/dl, Triglycerides 180mgs/dl. Hyperlipidemia is caused by excessive fat accumulate in the
blood over time, forming plaques on the walls of the arteries and blood vessels. The plaques
narrows the walls of the arteries and blood vessels making it hard for the heart to pump blood
through putting this patient at risk for a heart attack or stroke (Buttaro, et, al., 2013).
Design a treatment plan and discuss how each intervention is applicable to Lorene's case
Referrals/Follow up
Lorene’s EKG results and her symptoms indicates a cardiac ischemia. Cardiac ischemia is a
medical emergency and time to start treatment is critical (Switaj, Christensen, & Brewer, 2017).
In the case of Lorene, I will call 911 and transfer her to the emergency department. While she is
on her way to the emergency department will call the emergency department and give report of
