NR 603 Cardiovascular Case Study-Week 3 Case Discussion
Cardiovascular
NR 603: Advanced Clinical Diagnosis and Practice Across the Lifespan
Chamberlain University
, 1. What Leads Demonstrate the ST Depression?
ST depression is displayed when the ST segment of an
electrocardiogram tracing is below the baseline. ST depression can
indicate cardiac diseases, an increase in risk for cardiac events, and an
increased myocardial ischemia (American College of Cardiology &
American Heart Association, 2019). ST depression can show past
myocardial assault as well as acute changes (Mishra et al., 2018).
Coronary artery disease is indicated when the patient has ST
depression in leads V4-V6 (Shemirani, 2016). In Lorene’s case, leads I,
II, V2, V3, V4, V5, and V6 show ST depressions. Her EKG in the office
show ST expression in multiple leads which indicates NSTEMI.
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.
JNC8 guidelines consider hypertension with a blood pressure of 150/90 or
higher in a patient 60 years and older. In a patient 60 or younger, 140/90 is
considered hypertension. ACA guidelines suggest hypertension is a blood
pressure (BP)reading of 140/90 or greater, home blood pressure reading of
135/85 or greater, daytime ambulatory blood pressure 135/85, nighttime
ABPM 120/70. This is based on an average of 2 or more readings on 2 or
more occasions. Lorene is hypertensive according to both guidelines with
an in-office BP reading of 146/90 and a previous diagnosis of hypertension
in which she discontinued her prescribed medication of lisinopril. JNC8
(2014) recommendation is treating the African American population initially
with a thiazide diuretic or a calcium channel blocker. The BP goal is less
than 140/90. When looking at the ACA 2017 guidelines on hypertension,
Lorene would be considered hypertensive. Hypertension has two stages of
which stage one is classified as a systolic of 130-139 or a diastolic of 80-89
and stage two is classified as a systolic of greater than or equal to 140 or a
diastolic greater than or equal to 90. When comparing the ACA 2017
guidelines with the JNC-8 guidelines there are many similarities, but also
several differences. Both have similar ideas on what hypertension is
however the JNC-8 guidelines breaks down the classification of when to
treat further depending upon age, race, and other conditions such as
diabetes or kidney disease.
The ACA 2017 guidelines base their recommendations around the 10 year
risk of atherosclerotic cardiovascular disease. Both guidelines consider
thiazide diuretics, CCBs and ACE inhibitors or ARBs as first line treatment for
hypertension. The goal blood pressure in the ACA 2017 guidelines for most
criteria is 130/80 whereas the JNC- 8 has different goals dependent upon the
comorbidities of the patient. After reviewing both guidelines, there is a
, common recommendation that in the general black population including
those with diabetes, first line treatment would include a thiazide diuretic
and/or a calcium channel blocker. Since the patient has trace edema in
bilateral
Cardiovascular
NR 603: Advanced Clinical Diagnosis and Practice Across the Lifespan
Chamberlain University
, 1. What Leads Demonstrate the ST Depression?
ST depression is displayed when the ST segment of an
electrocardiogram tracing is below the baseline. ST depression can
indicate cardiac diseases, an increase in risk for cardiac events, and an
increased myocardial ischemia (American College of Cardiology &
American Heart Association, 2019). ST depression can show past
myocardial assault as well as acute changes (Mishra et al., 2018).
Coronary artery disease is indicated when the patient has ST
depression in leads V4-V6 (Shemirani, 2016). In Lorene’s case, leads I,
II, V2, V3, V4, V5, and V6 show ST depressions. Her EKG in the office
show ST expression in multiple leads which indicates NSTEMI.
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.
JNC8 guidelines consider hypertension with a blood pressure of 150/90 or
higher in a patient 60 years and older. In a patient 60 or younger, 140/90 is
considered hypertension. ACA guidelines suggest hypertension is a blood
pressure (BP)reading of 140/90 or greater, home blood pressure reading of
135/85 or greater, daytime ambulatory blood pressure 135/85, nighttime
ABPM 120/70. This is based on an average of 2 or more readings on 2 or
more occasions. Lorene is hypertensive according to both guidelines with
an in-office BP reading of 146/90 and a previous diagnosis of hypertension
in which she discontinued her prescribed medication of lisinopril. JNC8
(2014) recommendation is treating the African American population initially
with a thiazide diuretic or a calcium channel blocker. The BP goal is less
than 140/90. When looking at the ACA 2017 guidelines on hypertension,
Lorene would be considered hypertensive. Hypertension has two stages of
which stage one is classified as a systolic of 130-139 or a diastolic of 80-89
and stage two is classified as a systolic of greater than or equal to 140 or a
diastolic greater than or equal to 90. When comparing the ACA 2017
guidelines with the JNC-8 guidelines there are many similarities, but also
several differences. Both have similar ideas on what hypertension is
however the JNC-8 guidelines breaks down the classification of when to
treat further depending upon age, race, and other conditions such as
diabetes or kidney disease.
The ACA 2017 guidelines base their recommendations around the 10 year
risk of atherosclerotic cardiovascular disease. Both guidelines consider
thiazide diuretics, CCBs and ACE inhibitors or ARBs as first line treatment for
hypertension. The goal blood pressure in the ACA 2017 guidelines for most
criteria is 130/80 whereas the JNC- 8 has different goals dependent upon the
comorbidities of the patient. After reviewing both guidelines, there is a
, common recommendation that in the general black population including
those with diabetes, first line treatment would include a thiazide diuretic
and/or a calcium channel blocker. Since the patient has trace edema in
bilateral
