NR 603 Week 3: Cardiovascular Case Study

NR 603 Week 3: Cardiovascular Case Study

NR 603 Week 3: Cardiovascular Case Study

Cardiovascular Case Study

Question 1

            The leads that demonstrate ST depression include leads V4-V6 (Namdar et al., 2018).

Question 2

            According to the ACA guidelines for 2017, the patient has hypertension stage two. This is attributed to the fact that the systolic blood pressure is more than 140 mm Hg while diastolic blood pressure is more than 90 mm Hg. The recommended treatment for the patient’s condition is the use of interventions that include lifestyle modification and initiation of antihypertensive therapy. This is because of her presenting symptoms and daytime ABPM being more than 130/80 mm Hg (Whelton et al., 2017). According to the JNC 8 guidelines, the patient is hypertensive. This is attributed to her being less than 60 years with blood pressure more than 140/90 mm Hg. Based on their classification, the patient should be initiated on anti-hypertensive treatment regardless of age due to be being diabetic (Armstrong, 2014).

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Question 3

            The primary diagnosis causing the patient’s chest pain is acute coronary syndrome. This is based on her presenting symptoms such as shortness of breath, discomfort radiating to the shoulders, and her back. There is also ST depression in leads V4 to V6. These symptoms arise when exercising and subside when the patient is at rest (Handberg & Anderson, 2017). These symptoms align with those of acute coronary syndrome.

Question 4

            The other secondary that should be addressed include obesity, metabolic syndrome, and elevated level of A1C and hyperlipidemia. The increase in the patient’s waist circumference indicated metabolic syndrome. Elevation of her A1C level results in the diagnosis of pre-diabetes. The elevation of her blood pressure also makes her hypertensive. The patients BMI is also high, which indicates obesity.

Question 5

            The patient needs to be initiated on anti-hypertensive medications and initiation of lifestyle and behavioral modifications to manage the patient’s health problems. According to JNC 8 hypertension guidelines, the patient should be initiated thiazide, ARB (angiotensin receptor blockers), ACEI (angiotensin converting enzyme inhibitors), or CCB (calcium channel blockers) alone or in combination. The plan of management should be discussed with a cardiologist since the patient is at a risk of developing heart failure. The patient should be referred to tobacco cessation clinic to assist the patient in addressing her tobacco dependence problem. Follow-up should be undertaken after four weeks to determine whether the symptoms have resolved with the prescribed management. The education that should be shared with the patient include smoke cessation, drug adherence, eating healthy, reducing sodium in diet, and engaging in moderate physical activity 3-4 days a week lasting for an average of 40 minutes in every session. The drugs of choice for this patient include angiotensin converting enzyme inhibitors alone or in combination with either calcium channel blockers or a diuretic. The drugs will inhibit over excitation of the heart muscles alongside fluid loss through the renal system with the use of diuretics (Rodriguez-Saldana, 2019). The patient should be encouraged to take diets preferred in her culture that has low fat and sodium.

References

Armstrong, C. (2014). JNC8 guidelines for the management of hypertension in adults. American family physician90(7), 503-504.

Handberg, E., & Anderson, R. D. (2017). Acute Coronary Syndrome: Urgent and Follow-up Care (Vol. 3). Cardiotext Publishing.

Namdar, H., Imani, L., Ghaffari, S., Aslanabadi, N., Reshadati, N., Samani, Z., … & Separham, A. (2018). ST-segment depression in left precordial leads in electrocardiogram of patients with acute inferior myocardial infarction undergoing primary percutaneous coronary intervention. Interventional Medicine and Applied Science10(4), 191-197.

Rodriguez-Saldana, J. (Ed.). (2019). The Diabetes Textbook: Clinical Principles, Patient Management and Public Health Issues. Springer.

Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C. D., … & MacLaughlin, E. J. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology71(19), e127-e248.

uvia.com – The Marketplace to Buy and Sell your Study Material NR 603 Week 3 Case Discussion: Cardiovascular What leads demonstrate the ST depression? Lorene demonstrates ST depression dispersed throughout the EKG. Specifically, the depression is exhibited in leads I, II, V4, V5, a slight depression in aVF, and V6. There is also an ST elevation in aVR. The EKG shows signs of acute coronary syndrome (ACS). An EKG for ACS will show ST depression in six or more leads, most significant in leads V4 to V6, particularly when related with inverted T waves and ST elevation in lead aVR. These EKG changes should warrant importantnce for urgent, aggressive evaluation because of the high probability of severe angiographic coronary artery disease (Nikus et al., 2014). 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 American College of Cardiology (ACC), Lorene’s blood pressure, which is 146/90, would place her in stage II hypertension (HTN). The ACC definitions of stage II is systolic greater than or equal to 140 or diastolic greater than or equal to 90. Her blood pressure numbers falls within the guidelines recommendations (Whelton, Carey, & Aronow, 2018). The ACA and JNC 8 guidelines report the difference in opinions about the blood pressure parameters. According to ACA normal blood pressure is systolic less than 120 mm Hg and diastolic less than 80 mm Hg. HTN

Grading Rubric Guidelines

Performance Category109840
ScholarlinessDemonstrates achievement of scholarly inquiry for professional and academic decisions.Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisionsEvaluates literature resources to develop a comprehensive analysis or synthesis.Uses valid, relevant, and reliable outside sources to contribute to the threaded discussionProvides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions.Evaluates information from source(s) to develop a coherent analysis or synthesis.Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis.Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion.Demonstrates little or no understanding of the topic.Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.Information is taken from source(s) without any interpretation/evaluation.The posting uses information that is not valid, relevant, or reliableNo evidence of the use of scholarly inquiry to inform or change professional or academic decisions.Information is not valid, relevant, or reliable
Performance Category 109840
Application of Course Knowledge -Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situationsPosts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources;Applies concepts to personal experience in the professional setting and or relevant application to real life.Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources.Applies concepts to personal experience in their professional setting and or relevant application to real lifeInteractions with classmates are relevant to the discussion topic but do not make direct reference to lesson contentPosts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson.Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real lifeDoes not demonstrate a solid understanding of the principles and concepts presented in the lessonPosts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post.Posts are superficial and do not reflect an understanding of the lesson contentDoes not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real lifePosts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignoredNo discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category 54320
Interactive DialogueReplies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days.(5 points possible per graded thread)Exceeds minimum post requirementsReplies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days.Replies to a post posed by faculty and to a peerSummarizes what was learned from the lesson, readings, and other student posts for the week.Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate daysReplies to a question posed by a peerSummarizes what was learned from the lesson, readings, and other student posts for the week.Meets expectations of 2 posts on 2 different days.The main post is not made by the Wednesday deadlineDoes not reply to a question posed by a peer or facultyHas only one post for the weekDiscussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ commentsDoes not post to the threadNo connections are made to the topic
 Minus 1 PointMinus 2 PointMinus 3 PointMinus 4 PointMinus 5 Point
Grammar, Syntax, APANote: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted.Points deducted for improper grammar, syntax and APA style of writing.The source of information is the APA Manual 6th Edition2-3 errors in APA format.Written responses have 2-3 grammatical, spelling, and punctuation errors.Writing style is generally clear, focused, and facilitates communication.4-5 errors in APA format.Writing responses have 4-5 grammatical, spelling and punctuation errors.Writing style is somewhat focused.6-7 errors in APA format.Writing responses have 6-7 grammatical, spelling and punctuation errors.Writing style is slightly focused making discussion difficult to understand.8-10 errors in APA format.Writing responses have 8-10 grammatical, spelling and punctuation errors.Writing style is not focused, making discussion difficult to understand.Post contains greater than 10 errors in APA format.Written responses have more than 10 grammatical, spelling and punctuation errors.Writing style does not facilitate communication.The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
0 points lost   -5 points lost
Total Participation Requirementsper discussion threadThe student answers the threaded discussion question or topic on one day and posts a second response on another day.   The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirementper discussion threadThe student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.   The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.

NOTE: To receive credit for a week’s discussion, students may begin posting no earlier than the Sunday immediately before each week opens. Unless otherwise specified, access to most weeks begins on Sunday at 12:01 a.m. MT, and that week’s assignments are due by the next Sunday by 11:59 p.m. MT. Week 8 opens at 12:01 a.m. MT Sunday and closes at 11:59 p.m. MT Wednesday.

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