Hypertension

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Hypertension

James, P.A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfard, C., Handler, J., … Ortiz, E. (2014). Evidence-based guideline for the management of high blood pressure in adults: (JNC8). Journal of the American Medical Association, 311(5), 507-20. Retrieved from https://jamanetwork.com/journals/jama/fullarticle/1791497

Clinical Practice Guideline  (CPG) Instructions:

Disease & Background Student: 

1) Identifies the disease condition 

2) Gives a brief statement of incidence and prevalence in the US 

3) The student briefly summarizes the disease pathophysiology and 

4) Identifies the typical clinical presentation seen in a patient with the disease (4 critical elements).

· Exceptional- Student identifies the disease topic AND Student states the incidence and prevalence in the US AND Student provides a pathophysiology statement AND Student states the typical clinical presentation seen in a patient with the disease.

Publication & Applicability in Primary Care The student: 

1) Identifies the author, organization or group that developed the CPG, 

2) Student denotes the year of the original guideline publication, 

3) Student identifies any subsequent revisions (student’s reference should be the most recent version), and 

4) Student discusses the applicability for use of this CPG in the primary care setting (4 critical elements).

· Exceptional- Student presents a maximum of 5 relevant recommendations AND Student denotes the evidence strength for EACH recommendation AND Student discusses ONLY the ones applicable to primary care

Application in Clinical 

1) Using an example of a patient from their clinical rotation with the same condition, 

2) Student discusses how the diagnosis and treatment of their patient compared to the recommendations given in the guidelines, and 

3). Specific examples of what was done well or what could have been done better is noted (3 critical elements). 

· Exceptional- The student uses a patient example from their clinical setting with the same condition AND The student discusses how the diagnosis & treatment of their patient compared to those recommended in the guideline AND Specific examples are given on what was done well or what could have been done better (Make a patient up for this part)

Please use scholarly sources only** years 2014-2019**. NO SOURCES before 2014!!

Please use proper grammar, punctuation, citation. Also Provide a PowerPoint Transcript. 

Thank you in advance. 

 
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Soap Note Asthma

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ame: Mr. W.S.

Age: 65-year-old

Sex: Male

Source: Patient

Allergies: None

Current Medications: Atorvastatin tab 20 mg, 1-tab PO at bedtime

PMH: Hypercholesterolemia

Immunizations: Influenza last 2018-year, tetanus, and hepatitis A and B 4 years ago.

Surgical History: Appendectomy 47 years ago.

Family History: Father- died 81 does not report information

Mother-alive, 88 years old, Diabetes Mellitus, HTN

Daughter-alive, 34 years old, healthy

Social Hx: No smoking history or illicit drug use, occasional alcoholic beverage consumption on social celebrations. Retired, widow, he lives alone.

SUBJECTIVE:

Chief complain: “headaches” that started two weeks ago

Symptom analysis/HPI:

The patient is 65 years old male who complaining of episodes of headaches and on 3 different occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100 respectively). Patient noticed the problem started two weeks ago and sometimes it is accompanied by dizziness. He states that he has been under stress in his workplace for the last month.

Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting.

ROS:

CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizzeness as describe above. Denies changes in LOC. Denies history of tremors or seizures.

HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing.

Respiratory: Patient denies shortness of breath, cough or hemoptysis.

Cardiovascular: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal

dyspnea.

Gastrointestinal: Denies abdominal pain or discomfort. Denies flatulence, nausea, vomiting or

diarrhea.

Genitourinary: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence.

MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound.

Skin: No change of coloration such as cyanosis or jaundice, no rashes or pruritus.

Objective Data

CONSTITUTIONAL: Vital signs: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20, PO2-98% on room air, Ht- 6’4”, Wt 200 lb, BMI 25. Report pain 0/10.

General appearance: The patient is alert and oriented x 3. No acute distress noted. NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.

HEENT: Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary sinuses no tenderness. Nasal mucosa moist without bleeding. Oral mucosa moist without lesions,.Lids non-remarkable and appropriate for race.

Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling or masses.

Cardiovascular: S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2 sec.

Respiratory: No dyspnea or use of accessory muscles observed. No egophony, whispered pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on auscultation.

Gastrointestinal: No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no rebound no distention or organomegaly noted on palpation

Musculoskeletal: No pain to palpation. Active and passive ROM within normal limits, no stiffness.

Integumentary: intact, no lesions or rashes, no cyanosis or jaundice.

Assessment

Essential (Primary) Hypertension (ICD10 I10): Given the symptoms and high blood pressure (156/92 mmhg), classified as stage 2. Once the organic cause of hypertension has been ruled out, such as renal, adrenal or thyroid, this diagnosis is confirmed.

Differential diagnosis:

· Renal artery stenosis (ICD10 I70.1)

· Chronic kidney disease (ICD10 I12.9)

· Hyperthyroidism (ICD10 E05.90)

Plan

Diagnosis is based on the clinical evaluation through history, physical examination, and routine laboratory tests to assess risk factors, reveal identifiable causes and detect target-organ damage, including evidence of cardiovascular disease.

These basic laboratory tests are:

· CMP

· Complete blood count

· Lipid profile

· Thyroid-stimulating hormone

· Urinalysis

· Electrocardiogram

· Pharmacological treatment:

The treatment of choice in this case would be:

Thiazide-like diuretic and/or a CCB

· Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily.

· Non-Pharmacologic treatment:

· Weight loss

· Healthy diet (DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and trans l fat

· Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d reduction in most adults

· Enhanced intake of dietary potassium

· Regular physical activity (Aerobic): 90–150 min/wk

· Tobacco cessation

· Measures to release stress and effective coping mechanisms.

Education

· Provide with nutrition/dietary information.

· Daily blood pressure monitoring at home twice a day for 7 days, keep a record, bring the record on the next visit with her PCP

· Instruction about medication intake compliance.

· Education of possible complications such as stroke, heart attack, and other problems.

· Patient was educated on course of hypertension, as well as warning signs and symptoms, which could indicate the need to attend the E.R/U.C. Answered all pt. questions/concerns. Pt verbalizes understanding to all

Follow-ups/Referrals

· Evaluation with PCP in 1 weeks for managing blood pressure and to evaluate current hypotensive therapy. Urgent Care visit prn.

· No referrals needed at this time.

References

Domino, F., Baldor, R., Golding, J., Stephens, M. (2017). The 5-Minute Clinical Consult 2017 (25th ed.). Print (The 5-Minute Consult Series).

Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.). ISBN 978-0-8261-3424-0

 
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What is the difference between a DNP and a PhD in nursing? Which of these would you choose to pursue if you decide to continue your education to the doctoral level?

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What is the difference between a DNP and a PhD in nursing? Which of these would you choose to pursue if you decide to continue your education to the doctoral level?

 
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Clinical Practice Guideline (CPG) Instructions:

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Powerpoint assignment 

Topic/Article:

Hypertension

James, P.A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfard, C., Handler, J., … Ortiz, E. (2014). Evidence-based guideline for the management of high blood pressure in adults: (JNC8). Journal of the American Medical Association, 311(5), 507-20. Retrieved from https://jamanetwork.com/journals/jama/fullarticle/1791497

Clinical Practice Guideline  (CPG) Instructions:

Disease & Background Student: 

1) Identifies the disease condition 

2) Gives a brief statement of incidence and prevalence in the US 

3) The student briefly summarizes the disease pathophysiology and 

4) Identifies the typical clinical presentation seen in a patient with the disease (4 critical elements).

· Exceptional- Student identifies the disease topic AND Student states the incidence and prevalence in the US AND Student provides a pathophysiology statement AND Student states the typical clinical presentation seen in a patient with the disease.

Publication & Applicability in Primary Care The student: 

1) Identifies the author, organization or group that developed the CPG, 

2) Student denotes the year of the original guideline publication, 

3) Student identifies any subsequent revisions (student’s reference should be the most recent version), and 

4) Student discusses the applicability for use of this CPG in the primary care setting (4 critical elements).

· Exceptional- Student presents a maximum of 5 relevant recommendations AND Student denotes the evidence strength for EACH recommendation AND Student discusses ONLY the ones applicable to primary care

Application in Clinical 

1) Using an example of a patient from their clinical rotation with the same condition, 

2) Student discusses how the diagnosis and treatment of their patient compared to the recommendations given in the guidelines, and 

3). Specific examples of what was done well or what could have been done better is noted (3 critical elements). 

· Exceptional- The student uses a patient example from their clinical setting with the same condition AND The student discusses how the diagnosis & treatment of their patient compared to those recommended in the guideline AND Specific examples are given on what was done well or what could have been done better (Make a patient up for this part)

 
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Most Importance Screening Tools in Advanced Clinical Practices The Guide to Clinical Preventive Services released in 2014 comprises of updated recommendations that are intended for usage for the patient care

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Most Importance Screening Tools in Advanced Clinical Practices The Guide to Clinical Preventive Services released in 2014 comprises of updated recommendations that are intended for usage for the patient care. The recommendations are offered only as a backing for doctors making clinical resolutions concerning the health care of the patients. Therefore, these recommendations cannot be substituted for the individual decision presented by every single clinical condition by the patient’s personal doctor (Maciosek et al., 2017). As with the cases with all the clinical reference capitals, they reveal the best intellectual capacity of the discipline of medicine when they are published (Ali, Ryan, & De Silva, 2016). However, these recommendations should be utilized with the clear knowledge that continued study may result in new data and recommendations. One of the most important screening tools from these recommendations for advanced nursing practices is population screening. Through population screening, advanced nurses are able to get good data and information in their effort for the preventative health care drive (AAFP, 2017). The nurses are able to provide general education to the population being screen about the ways and importance of preventive heal care practices (Maciosek et al., 2017). They are at able to identify the at-risk patients in the populations and help them accordingly. Through population screening, advanced nurses are able to deliver health access to many people. The other importance screen tool from the recommendations is the risk assessment screening tool. The tool helps the advanced nurses to identify those patients or people who are at more risk of suffering or ailing from the particular illness under screening (Ali et al., 2016). Through risk assessment screening, the physicians are able to come up with means and ways to mitigate the occurrence of such diseases hence inhibiting its spread to other people (AAFP, 2017). Risk assessment screening creates awareness on the people more susceptible to attack by an infection or a disease.   References Ali, G., Ryan, G., & De Silva, M. J. (2016). Validated screening tools for common mental disorders in low and middle income countries: a systematic review. PloS One, 11(6), 1-14. American Academy of Family Physicians [AAFP]. (2017). Summary of recommendations for clinical preventive services. Retrieved from https://www.aafp.org/dam/AAFP/documents/ patient_care/clinical_recommendations/cps- recommendations.pdf. Maciosek, M. V., LaFrance, A. B., Dehmer, S. P., McGree, D. A., Flottemesch, T. J., Xu, Z., & Solberg, L. I. (2017). Updated priorities among effective clinical preventive services. The Annals of Family Medicine, 15(1), 14-22.

Bottom of Form 1

Discussion # 2 peer post (Eduardo)

The U.S. Preventive Services Task Force (USPSTF) makes recommendations about clinical preventive services. This organization examines chains of direct and indirect evidence to demonstrate the effectiveness of a clinical preventive service. Missing links across the chains of evidence reflect gaps in the research. Common types of evidence gaps include limited evidence in primary care settings and populations, a lack of appropriate health outcomes, limited evidence linking behavior change to health outcomes, and a lack of evidence for effective preventive services in diverse populations (Mabry, et al., 2018).The USPSTF recommendations, on more than 84 preventive health services topics, are based on a systematic review of the evidence and a determination of the net balance of benefits and provides the USPSTF recommendation grades). The USPSTF aims to update and revise each recommendation regularly and considers new topics to add each year (Kurth, et al., 2018).

Population screening can make a big difference to people’s health. Individuals who are at a high risk for certain diseases can begin their medical follow-up and personalized prevention plans sooner, rather than later. Early intervention can slow or stop the progression of disease, or help prevent its development. For example, for asymptomatic adults with sustained blood pressure greater than 135/80 mm Hg the USPSTF recommends to screen for type 2 diabetes mellitus. These recommendations apply to adults with no symptoms of type 2 diabetes mellitus or evidence of possible complications of diabetes. Blood pressure measurement is an important predictor of cardiovascular complications in people with type 2 diabetes mellitus. The first step in applying this recommendation should be measurement of blood pressure (BP). Adults with treated or untreated BP >135/80 mm Hg should be screened for diabetes (Agency for Healthcare Research and Quality, 2014) .

Health risk assessment is one of the most widely used screening tools in the field of health promotion and is often the first step in multi-component health promotion programs. A health risk assessment includes a questionnaire, an assessment of health status, and personalized feedback about actions that can be taken to reduce risks, maintain health, and prevent disease. For example in high blood pressure risk assessment there are hereditary and physical risk factors such as: family history, age, gender, race. And there are modifiable risk factors such as: lack of physical activity, unhealthy diet, being overweight or obese, drinking too much alcohol, smoking, stress, etc (Agency for Healthcare Research and Quality, 2014).

References:

Agency for Healthcare Research and Quality. (2014). A Guide to Clinical Preventive Services. Retrieved from www.ahrq.gov/sites/default/files/publications/files/cpsguide.pdf

Kurth, A., Krist, A., Borsky, A., Ciofu, L., Curry, S., Davidson, K., . . . Pignoni, M. (2018). U.S. Preventive Services Task Force Methods to Communicate and Disseminate Clinical Preventive Services Recommendations. American Journal of Preventive Medicine, 81-87. doi:10.1016/j.amepre.2017.07.004

Mabry, I., Curry, S., Phillips, W., Garcia, F., Davidson, K., & Epling, J. (2018). U.S. Preventive Services Task Force Priorities for Prevention Research. American Journal of Preventive Medicine, 54(1), 95-103. doi:10.1016/j.amepre.2017.08.014

 
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Health Care Policies

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DB6.  Week 8. Health care policies 

As an advanced practice nurse, one can engage in activism in order to achieve desired policy change at various levels including their own organization. Examine the following questions, should nurses be unionized and how does being unionized impact a workforce culture of safety? Be sure to include one MSN Essential in your discussion that relates to this topic.

 Image result for nursing workplace culture of safety 

**As a reminder, all questions must be answered to receive full credit for this discussion. please include your name in the title bar of the discussion. Also, make sure to use scholarly sources to support your discussion.**

 
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Health As A Right A Priviliege

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Report Issue

Using the guidelines presented on pages 194-205 of your text go to the website Procon.org and using the guidelines below discuss the topic of Health Care as a right or a privilege.  This should be a 3-4 page paper and I will be looking for primary source citations.

Please use standard margins and set line spacing at 1.5.

Suggested Subheadings:

Background: Express your opinion/position about the issues addressed by this topic. (1-2 paragraphs)

Disclosure: Describe your knowledge about the topic and identify your attitudes, beliefs, values and any bias you may have about the issues associated with the topic (1-2 paragraphs)

My Knowledge: Is your understanding of the issues balanced; can you articulate both sides of the issues? (1-2 paragraphs)

Factual Findings:  What are the facts for and against the issues related to the topic? What factual information did you find to support your position?  Describe at least 2 pieces of factual information that refutes your position or bias. (2-3 paragraphs)

Pro-Con Summary: What were two arguments presented for and against that are new, or added to your list of things to consider? If after reading the Pro-Con arguments you have discovered new information express what you’ve learned and describe how that has influenced your position (1-2 paragraphs)

Facts vs. Opinion:  If there is factual evidence to your position state it here.  If not, are there strong opinions that work in your favor?  If no factual information was presented, identify at least 2 opinions that are used to state a position. (1-2 paragraphs)

Support for My Position:  Identify the two arguments that best support your position. (1-2 paragraphs)

Opposition to My Position Identify the two strongest arguments that oppose your view about the topic. (1-2 paragraphs)

Summary: Summarize whether your position has been enhanced or weakened by the arguments presented in favor or against your original position. (2-3 paragraphs)

 
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Application Of Statistics In Health Care

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Statistical application and the interpretation of data is important in health care. Review the statistical concepts covered in this topic. In a 750-1,000 word paper, discuss the significance of statistical application in health care. Include the following:

  1. Describe the application of statistics in health care. Specifically discuss its significance to quality, safety, health promotion, and leadership.
  2. Consider your organization or specialty area and how you utilize statistical knowledge. Discuss how you obtain statistical data, how statistical knowledge is used in day-to-day operations and how you apply it or use it in decision making.

Three peer-reviewed, scholarly or professional references are required.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

 
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Congestive Heart Failure

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Main discussion Post:

Congestive Heart Failure

     Understanding the pathophysiology of cardiac diseases involving the heart is important to completely understand the structures and functions within the heart.  Congestive heart failure (CHF) affects the cardiovascular system and mainly the left side.  Congestive heart failure is caused by the inability to pump blood at a sufficient rate to the rest of the body (Laureate Education, Inc. 2012a).  CHF can result from volume overload or pressure, loss of muscle contraction, or peripheral demands on the heart.  There is an inability for muscle contraction causing an increasing pressure of the left atria causing pulmonary congestion resulting in dyspnea.  The most common cause of left heart failure (CHF) is myocardial infarction.  The heart is unable to accommodate the energy needed which leads to increasing toxic metabolites (Huether  & McCance, 2017).  There is pressure in the heart causing the cardiac muscle to weaken leading to the pumping of oxygenated blood to decrease that supplies the organs throughout the body.

Factors

     The factors that influence cardiovascular disorders are being looked at more closely by researchers.  CHF affects men and women equally, and all ages (Emory Healthcare 2017). African-Americans are more likely to develop CHF.  My son who was 3 was born with a congenital birth defect and was developing CHF prior to having open heart surgery.  He was born with an atrial septal defect. Today the surgery is not as invasive as it was in the early 1990s. Oxygenated and deoxygenated blood is not passing through the heart, decreasing the oxygen transported to vital organs in the body.  The heart pumps harder and faster causing pressure in the heart and backing up into the pulmonary arteries which are the result of pulmonary hypertension.  Symptoms produced include fatigue and weakness, edema, and nasal flaring.  Nurse practitioners need to be aware of the early signs and symptoms of all age groups for proper treatment and diagnosis.

References

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Laureate Education, Inc. (Executive Producer). (2012a). Alterations of cardiovascular functions PPT lecture. Baltimore, MD: Author.

Emory Healthcare. (2017).  Heart and Vascular: Conditions & Treatments.  Retrieved on 20 June 2017 from https://www.emoryhealthcare.org/heart-vascular/wellness/heart-failure-statistics.html

 
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Coronary Artery Disease (CAD) Pathophysiology of CAD

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Coronary artery disease is when the heart muscle is weakened and cannot pump the oxygen and nutrition’s needed efficiently (Huether & McCance, 2017; Hammer & McPhee, 2019). CAD decreased myocardial blood supply causing ischemia (Huether & McCance, 2017). Ischemia is defined as a temporary loss of blood supply to the cell, which becomes damaged and cannot function normally (Huether & MCCance, 2017). Ischemia occurs two ways when there is an increasing demand for oxygen related to the supply, or a decrease in oxygen supply (Hammer & McPhee, 2019). The leading cause of CAD is atherosclerosis, which is fatty streaks in the vessels that cause narrowing of arteries (Hammer & McPhee, 2019).

Aging and CAD

The normal aging process will increase the thicken and stiffness of vessels and arteries in the heart (American Heart Association, [AHA], 2019). Thinking and stiffening of veins will increase the need for the blood to pump harder, which increases blood pressure. Coronary artery disease is common amongst the elderly population (Madhavan, Gersh, Alexander, Granger, & Stone, 2018).  29.9% of patients ages 75-84 develop CAD compared to 3.9% in ages 45-54 (Madhavan et al., 2018). Men have a slightly high prevalence than women to develop CAD (Madhavan et al., 2018).

Effects of Hypertension for CAD

High blood pressures cause strain on the heart to forcefully push blood out into the arteries and vessels (American Heart Association [AHA], 2019). The forcefully push of blood causes damage to the lining (AHA, 2019). These tears in the lining allow a build-up of fat, and cholesterol called plaque (AHA, 2019). When the plaque forms, it slows the flow of blood back, and the more plaque, the more the vessels and arteries get blocked, eventually causing myocardial infarction or heath attack (AHA, 2019). Hypertension increases the risk for CAD for all age’s groups, and both genders (Rosendorff et al., 2015) Hypertension increases the risk of CAD 2 or 3 times (Hammer & McPhee, 2019). 

Other Risk Factors

Family history can increase the risk of developing CAD (Huether & McCance, 2017). Modifiable risks include smoking, obesity, diabetes, and dyslipidemia (Huether & McCance, 2017).

Reducing the risk by making healthy lifestyle modification can reduce the risk of CAD. Controlling high blood pressure can also reduce risk.

Reference

American Heart Association [AHA]. (2019). HBP and the cardiovascular system. Retrieved from: https://watchlearnlive.heart.org/CVML_Player.php?moduleSelect=highbp

Madhavan, M. V., Gersh, B. J., Alexander, K. P., Granger, C. B., & Stone, G. W. (2018). Coronary artery disease in patients ≥80 years of age. Journal of the American College of Cardiology, 71(18), 2015–2040. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jacc.2017.12.068

Rosendorff, C., Lackland, D. T., Allison, M., Aronow, W. S., Black, H. R., Blumenthal, R. S., … White, W. B. (2015). Treatment of hypertension in patients with coronary artery disease: A scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Journal of the A

 
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