NR 667 / NR667 VISE STUDY GUIDE 2022 (Latest Updated)
Health Care / Study Guide
NR 667 / NR667 VISE STUDY GUIDE 2022 (Latest Updated) 1 1. Hypertension Presentation: Most are not symptomatic, Occipital Headaches, headache on awak ening 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
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