FAMILY NUR NR667 661 vise study guide- UPDATED

1. Hypertension
Presentation: Most are not symptomatic, Occipital Headaches, headache on awakening in am,
blurry vision,
Assessment:
• Asymptomatic
• Occipital headache
• Blurry vision
• Headache upon wakening
• Look for AV nicking
• LVH
Exam:
• Carotid bruits
• Abdominal bruits
• Kidney bruits
Diagnostic studies: to look for secondary causes of HTN like target organ damage and establish
ASCVD risk: EKG, fasting lipid profile, fasting blood glucose, CBC, CMP (electrolyte,
creatinine, & calcium levels), and urinalysis (checking for proteinuria).
Diagnosis: Measure BP 5 minutes apart. Average of 2 or more BP readings on two different
visits at > 140/90 mm Hg start then can be diagnosed with HTN.
If Stage 1 (ASCVD <10%) then non-pharmacologic management only:
• First: Lifestyle modifications: diet and exercise 30 minutes aerobic exercise 5
days per week.
• Limit alcohol
• stop smoking
• stress management.
• DASH
• Medication compliance
• Reduce sodium intake
• Measure BP daily
If Stage 2 (ASCVD >10% and known CAD) initiate lifestyle + Pharmacologic
Management:
• Alone: hydrochlorothiazide (HCTZ) 25 mg/day (chlorthalidone is preferred over
HCTZ)
• Alone: lisinopril 10mg/day complicated HTN first line
• Combo: thiazide + ACE or ARB
• Alternative CB (especially in isolated HTN seen mainly in older adults)
• Black population: thiazide + CCB is recommended first line
Follow up:
• 2-4weeks
Referral:
• Cardiology if EKG is abnormal
Differential:
• Secondary hypertension
• Pregnant
• Pregnancy induced hypertension
Hollier: page 62