NR 603 Week 3 DB Cardiovascular
NR 603: Advanced Clinical Diagnosis and Practice across
the Lifespan
, 1. What leads demonstrate the ST depression?
The leads that ST depression is seen are leads I, aVR, V4, II, V5, and V6. A ST segment
variable may be depression, elevation, or horizontal change (Mishra, Mishra, & Mishra, 2018).
2. 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?
According to Welton et al. (2017), the patient does have stage to hypertension as evidence by a
blood pressure reading above 140/90. The patient’s blood pressure in the office today was
146/90. According to the Joint National Committee (JNC) 8 (2014), hypertension is defined as a
blood pressure reading above 140/90 in people younger than 60 or the blood pressure should be
treated in a patient with hypertension and diabetes when the blood pressure is above 140/90.
Both of these guidelines confirm that the patient is hypertensive and requires medical
management. Welton et al. (2017) states that African Americans (AA) with hypertension but
without heart failure or chronic kidney disease and including those with diabetes should be
started on a thiazide diuretic or calcium channel blocker (CCB) with the blood pressure goal to
be less than 130/80. The JNC 8 (2014) states that patients of an AA heritage should be started
on a thiazide diuretic or a CCB for hypertension.
The writer would recommend starting the patient on a thiazide diuretic. The patient has trace
edema in bilateral lower extremities and a diuretic would assist to pull off excess fluid and
decrease the stroke volume. A study showed that AA who took a thiazide diuretic had fewer
cerebrovascular and cardiovascular events and a lower rate of heart failure compared to those
who took an ace inhibitor. The same study showed that diuretics were more effective than CCBs
in preventing heart failure, but no difference in overall mortality (Mahvan & Mlodinow, 2015).
The writer would start the patient on hydrochlorothiazide (HCTZ) (Mahvan & Mlodinow, 2015).
HCTZ 12.5mg is on the Walmart $4 prescription list (Walmart, 2019).
3. What is the primary diagnosis causing Lorene’s chest pain? Include ICD 10 codes
(no differentials)
Lorene’s ECG performed in house shows an ST segment depression. According to Mishra,
Mishra, & Mishra (2018), an ST depression can be caused from ischemia, acute coronary
syndrome (ACS), electrolyte imbalance, posterior myocardial infarction, pulmonary embolism,
etc. The patient also complains of fatigue since the event.
I24.9 Acute Ischemic Heart Disease, unspecified.
4. What other secondary diagnoses does Lorene have that should be addressed?
NR 603: Advanced Clinical Diagnosis and Practice across
the Lifespan
, 1. What leads demonstrate the ST depression?
The leads that ST depression is seen are leads I, aVR, V4, II, V5, and V6. A ST segment
variable may be depression, elevation, or horizontal change (Mishra, Mishra, & Mishra, 2018).
2. 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?
According to Welton et al. (2017), the patient does have stage to hypertension as evidence by a
blood pressure reading above 140/90. The patient’s blood pressure in the office today was
146/90. According to the Joint National Committee (JNC) 8 (2014), hypertension is defined as a
blood pressure reading above 140/90 in people younger than 60 or the blood pressure should be
treated in a patient with hypertension and diabetes when the blood pressure is above 140/90.
Both of these guidelines confirm that the patient is hypertensive and requires medical
management. Welton et al. (2017) states that African Americans (AA) with hypertension but
without heart failure or chronic kidney disease and including those with diabetes should be
started on a thiazide diuretic or calcium channel blocker (CCB) with the blood pressure goal to
be less than 130/80. The JNC 8 (2014) states that patients of an AA heritage should be started
on a thiazide diuretic or a CCB for hypertension.
The writer would recommend starting the patient on a thiazide diuretic. The patient has trace
edema in bilateral lower extremities and a diuretic would assist to pull off excess fluid and
decrease the stroke volume. A study showed that AA who took a thiazide diuretic had fewer
cerebrovascular and cardiovascular events and a lower rate of heart failure compared to those
who took an ace inhibitor. The same study showed that diuretics were more effective than CCBs
in preventing heart failure, but no difference in overall mortality (Mahvan & Mlodinow, 2015).
The writer would start the patient on hydrochlorothiazide (HCTZ) (Mahvan & Mlodinow, 2015).
HCTZ 12.5mg is on the Walmart $4 prescription list (Walmart, 2019).
3. What is the primary diagnosis causing Lorene’s chest pain? Include ICD 10 codes
(no differentials)
Lorene’s ECG performed in house shows an ST segment depression. According to Mishra,
Mishra, & Mishra (2018), an ST depression can be caused from ischemia, acute coronary
syndrome (ACS), electrolyte imbalance, posterior myocardial infarction, pulmonary embolism,
etc. The patient also complains of fatigue since the event.
I24.9 Acute Ischemic Heart Disease, unspecified.
4. What other secondary diagnoses does Lorene have that should be addressed?
