NR 603 Cardiovascular Case Study-
Week 3 Case Discussion
Cardiovascular
NR 603: Advanced Clinical Diagnosis and Practice Across the Lifespan
Chamberlain University
,Week 3: Case Discussion: Cardiovascular
What Leads Demonstrate the ST Depression?
Based on the EKG in the office today, leads I, II, V2, V3, V4, V5, and V6 have
ST depression.
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 the ACA 2017 Guidelines, Lorene has hypertension stage 2
because her SBP is greater than 140 mm Hg and DBP greater than or equal
to 90 mm Hg (146/90) (Whelton et al., 2017). Additional it is recommended
to screening for coexisting hypertension and chronic conditions to screen for
modifiable cardiovascular risk factors such as hypercholesterolemia and
diabetes (Whelton et al., 2017). The recommendation from JNC 8, the
general population 60 years or older with diabetes the SBP goal is less than
140 mm Hg and DBP less than 90 mm Hg (Ripley & Barbato, 2018). With her
Hgb A1c of 6.4%, she falls into the pre-diabetic category putting her at
higher risk (Hollier, 2018). If she did not have a diabetes risk associated, she
would not fall under the hypertension category as the JNC 8 states that
patients age 60 and older without DM should have a goal of SBP less than
150 and DBP less than 90 (Ripley & Barbato, 2018) Guidelines from the ACC
do not recommend thiazide diuretics for initial treatment of hypertension
patients with metabolic syndrome due to an increased risk for worsening
insulin resistance. This is in contrast to the recommended medication for
black hypertensive patients which consists of thiazide diuretics and calcium
channel blockers (Whelton, et al., 2017). The JNC 8 recommends treating the
general black population, and including the population with diabetes, initially
with a thiazide-type diuretic or calcium channel blocker (CCB) or with both
(Ripley & Barbato, 2018). Since the risk of having a cough interfered with
Lorene’s compliance, I would recommend chlorthalidone 12.5mg daily in the
morning. Which is categorized as a Thiazide diuretic that also lowers the
blood pressure by relaxing the blood vessels allowing easier blood flow
(Cunha, 2017).
What is the Primary diagnosis causing Lorene's chest pain? Include ICD 10
codes (no differentials)
Acute coronary syndrome (ACS) (I24.9) The in-office EKG is diagnostic of
myocardial ischemia based on ST depression (Kashou, Basit, & Malik, 2019).
The EKG in conjunction with Lorene’s description of the cardiac injury, and
new onset of heart failure symptoms lead to this diagnosis as well. Lorene
has several risk factors for cardiovascular disease including obesity,
, metabolic syndrome, hypertension, African- American, age, sedentary
lifestyle, and alcohol and tobacco usage.
Week 3 Case Discussion
Cardiovascular
NR 603: Advanced Clinical Diagnosis and Practice Across the Lifespan
Chamberlain University
,Week 3: Case Discussion: Cardiovascular
What Leads Demonstrate the ST Depression?
Based on the EKG in the office today, leads I, II, V2, V3, V4, V5, and V6 have
ST depression.
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 the ACA 2017 Guidelines, Lorene has hypertension stage 2
because her SBP is greater than 140 mm Hg and DBP greater than or equal
to 90 mm Hg (146/90) (Whelton et al., 2017). Additional it is recommended
to screening for coexisting hypertension and chronic conditions to screen for
modifiable cardiovascular risk factors such as hypercholesterolemia and
diabetes (Whelton et al., 2017). The recommendation from JNC 8, the
general population 60 years or older with diabetes the SBP goal is less than
140 mm Hg and DBP less than 90 mm Hg (Ripley & Barbato, 2018). With her
Hgb A1c of 6.4%, she falls into the pre-diabetic category putting her at
higher risk (Hollier, 2018). If she did not have a diabetes risk associated, she
would not fall under the hypertension category as the JNC 8 states that
patients age 60 and older without DM should have a goal of SBP less than
150 and DBP less than 90 (Ripley & Barbato, 2018) Guidelines from the ACC
do not recommend thiazide diuretics for initial treatment of hypertension
patients with metabolic syndrome due to an increased risk for worsening
insulin resistance. This is in contrast to the recommended medication for
black hypertensive patients which consists of thiazide diuretics and calcium
channel blockers (Whelton, et al., 2017). The JNC 8 recommends treating the
general black population, and including the population with diabetes, initially
with a thiazide-type diuretic or calcium channel blocker (CCB) or with both
(Ripley & Barbato, 2018). Since the risk of having a cough interfered with
Lorene’s compliance, I would recommend chlorthalidone 12.5mg daily in the
morning. Which is categorized as a Thiazide diuretic that also lowers the
blood pressure by relaxing the blood vessels allowing easier blood flow
(Cunha, 2017).
What is the Primary diagnosis causing Lorene's chest pain? Include ICD 10
codes (no differentials)
Acute coronary syndrome (ACS) (I24.9) The in-office EKG is diagnostic of
myocardial ischemia based on ST depression (Kashou, Basit, & Malik, 2019).
The EKG in conjunction with Lorene’s description of the cardiac injury, and
new onset of heart failure symptoms lead to this diagnosis as well. Lorene
has several risk factors for cardiovascular disease including obesity,
, metabolic syndrome, hypertension, African- American, age, sedentary
lifestyle, and alcohol and tobacco usage.
