Treatment Plan for Lorene's Acute Coronary Syndrome, Exams of Nursing

Download Treatment Plan for Lorene's Acute Coronary Syndrome and more Exams Nursing in PDF only on Docsity! NURSING 603 WEEK 3 DISCUSSIONS Q & A WITH REFERENCES. Download to score 1) What Leads Demonstrate the ST Depression? 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. 3) What is the Primary diagnosis causing Lorene's chest pain? Include ICD 10 codes (no differentials) 4) What other secondary diagnoses does Lorene have that should be addressed? (Include the rationale and a reference for your diagnoses) 5) Design a treatment plan and discuss how each intervention is applicable to Lorene's case. Consider the following interventions:  Labs  Durable Medical Equipment Diagnostic tests- discuss the goal/purpose  Any consultation with outside providers/services  Medications- discuss why you chose each specific medication  Referrals- who and why  Follow up- why and when  Education- specific and measureable  Lifestyle Changes- specific to her cultural preferences, values and beliefs What Leads Demonstrate the ST Depression? The leads that develop ST Depression in this EKG is leads II, V2, V3, V4, V5, and V6. 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. NURSING 603 WEEK 3 DISCUSSIONS Q & A WITH REFERENCES. Download to score According to American College of Cardiology, (2017) Lorene Blood Pressure of 146/90 places her at stage 2 hypertension (Whelton et al., 2017). The JNC 8 and ACA have a difference in blood pressure parameters. The ACA believes that the normal blood pressure is 120/80. Stage 1 hypertension is 130-139- or 80-89-mm Hg, and hypertension stage 2 is ≥140 or ≥90 mm Hg (Whelton et al., 2017). In JNC 8 guidelines, they believe blood pressure should be treated when greater than 150/90. The guidelines factor in SBP and DBP with age and comorbidity specific treatment. The ACA has a stricter guideline, recommending lowering numbers no matter what comorbidities that patient has (American Family Physician, 2014). When looking at both of these guidelines, I would recommend hydrochlorothiazide 12.5 mg PO daily and monitor her blood pressure. If her blood pressure does not respond well, then a calcium channel blocker like Norvasc 5 mg daily will be added. Both of these medications are recommended for controlling hypertension in African Americans by ACA (Whelton et al., 2017). What is the Primary diagnosis causing Lorene's chest pain? Include ICD 10 codes (no differentials) The primary diagnosis, in this case, causing Lorene’s chest pain is acute coronary syndrome (ACS) I24.9. This diagnosis is based on her symptoms, as well as her EKG. Lorene had NURSING 603 WEEK 3 DISCUSSIONS Q & A WITH REFERENCES. Download to score Medications- discuss why you chose each specific medication Aspirin 81 mg PO daily. Aspirin can help in preventing blood clots from forming and all patients who are having acute coronary syndrome should receive this (Amsterdam et al.,). To control her blood pressure, the first medications Lorene will receive is a thiazide diuretic. The goal is to reduce her blood pressure to less than 140/90mm Hg. If this is not achieved after the first month, then she will be placed on a calcium channel blocker. The thiazide controls blood pressure by inhibiting distal convoluted tubule sodium and chloride reabsorption (American Family Physician, 2014). Hydrochlorothiazide 12.5 mg PO daily then Norvasc 5 mg daily, only if blood pressure is not controlled in a month. Lipitor 40 mg BID. Take one in the morning, then the second tablet in the evening. Lipitor According to the ACC risk cacluator, Lorene is 40.7% risk for Atherosclerotic Coronary Disease. (ASCVD). She should be prescribed a high-intensity statin therapy because she has multiple ASCVD risk factors (American College of Cardiology, 2019). Referrals- who and why Lorene will need a referral to a cardiologist to help manage her medications and any other further tests she may need. She will also need a dietician to help her manage her weight and reduce her risk for future cardiac events by diet and exercise. Follow up- why and when As for following up, the primary care provider and the cardiologist can work together creating strategies to control risk factors, such as cholesterol levels, hypertension, and weight management (Swiataj, Christensen, & Brewer, 2017). NURSING 603 WEEK 3 DISCUSSIONS Q & A WITH REFERENCES. Download to score Education Lorene should be educated on how to take her blood pressure since she will be doing this daily. She would need to be told to purchase an automatic blood pressure machine for home monitoring. She should know that her blood pressure goal should be less than 130/80. She should be educated on the parameters of the blood pressure medications and what to do if they are to low (Whelton et al., 2017). Signs and symptoms of hypotension should be discussed. Lorene needs to know why it is important for her to control her diet and exercise due to her being prediabetic. She will also need to understand that statin medications can cause leg cramps. If this occurs, the medications will need to be lowered. As for anti-platelet therapy, Lorene will need to understand that she is at a high risk for bleeding. Any cut with a sharp object or a fall can cause her severe damage and risk for an increased bleeding (Whelton et al., 2017). Lifestyle changes NURSING 603 WEEK 3 DISCUSSIONS Q & A WITH REFERENCES. Download to score According to the ACC/AHA (2017) the dash diet is recommended to help reduce her blood pressure. By changing things in her diet, from how she eats, what she buys, or how the food is being prepared are important for Lorene to know. References: American Heart Association. (2020). Acute Coronary Syndrome. Retrieved from https://www.heart.org/en/health-topics/heart-attack/about-heart-attacks/acute-coronary-syndrome American Family Physician. (2014). JNC 8 Guidelines for the Management of Hypertension in Adults. American Family Physician, 90(7), 503-504. Retrieved from https://www.aafp.org/afp/2014/1001/p503.html Amsterdam, E. A., Wenger, N. K., Brindis, R. G., Casey, D. E., Ganiats, T. G., Holmes, D. R., ... Zieman, S. J. (2014, September 23). 2014 AHA/ACC Guideline for the management of patients with Non–ST-Elevation Acute Coronary Syndromes: Executive summary. Circulation, 130, 2354-2394. https://doi.org/10.1161/CIR.0000000000000133 Switaj, T., Christensen, S. R., & Brewer, D. M. (2017). Acute Coronary Syndrome: Current Treatment. American Family Physician, 95(4), 232-240. Retrieved from https://www.aafp.org/afp/2017/0215/p232.html Veauthier, B., Sievers, K., & Hornecker, J. (2015). Acute Coronary Syndrome: Emergency Department Evaluation and Management. - PubMed - NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26439394 Whelton, P. K., Carey, R. M., & Aronow, W. S. (2018). Correction to: 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. Hypertension, 71(6), e127-e248.