NURSING NR 603 Week 3 assignment final with complete solution

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What Leads Demonstrate the ST Depression? Leads V4, V5 and V6 demonstrate the ST depression. Maximal precordial ST-segment depression in leads V4-V6 is suggestive of severe coronary artery disease i... nvolving the left anterior descending coronary artery or its diagonal branch, in patients with inferior wall acute myocardial infarction (Shemirani, & Nayeri-Torshizi, 2015). 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. ACA 2017 Guidelines Lorene’s BP of 146/90 indicates that she is hypertensive according to ACA 2017 guidelines. Rubenfire (2018), states that according to ACA guidelines, a blood pressure reading of systolic 140 mm Hg and above and diastolic reading of 90 mm Hg is consider as hypertension stage 2. Prior to labeling a person with hypertension, it is important to use an average based on two or more readings obtained on two occasions to estimate the individual’s level of BP. Two first-line drugs of different classes are recommended with stage 2 hypertension. For African American population, first-line treatment recommendations are thiazide diuretics and calcium-channel blockers (Williams, et al., 2016). JNC 8 guidelines According to the JNC 8 guidelines, Lorene’s BP of 146/90 is consider as hypertensive. Armstrong (2014), states that adults 60 years and older, should have treatment initiated when the systolic pressure is 150 mm Hg or higher, or when the diastolic pressure is 90 mm Hg or higher and patients should be treated to a target systolic pressure of less than 150 mm Hg and a target diastolic pressure of less than 90 mm Hg. First-line treatment are diuretics or calcium channel blockers are recommended for monotherapy in blacks (Williams, et al., 2016). What is the Primary diagnosis causing Lorene's chest pain? Include ICD 10 codes Acute Coronary Syndrome (I24.9). Acute coronary syndrome (ACS) refers to a group of clinical syndromes that are associated with sudden, reduced blood flow to the heart. Symptoms include pain radiating from the chest to the shoulders, arms, upper abdomen, back, neck or jaw, palpitations, shortness of breath, diaphoresis, nausea, lightheadedness, generalized weakness, and decreased exercise tolerance (Avital, & Oji, 2018). Acute coronary syndrome can be diagnose by completing Troponin levels and an electrocardiogram can be completed to measure the heart’s electrical activity (Avital, & Oji, 2018). In the case of Lorene, she was having shortness of breath while in dance class. She also felt "a discomfort" that radiated back and up between her shoulder blades while at the peak of her exercise routine and was a little nauseous and sweaty. Her EKG results show ST depression in multiple leads which indicates NSTEMI. Lorene also has the following risk factors associated with acute coronary syndrome according to Avital, & Oji (2018), she is above 55-years of age, has history hypertension, dyslipidemia, gestational diabetes, is overweight, smoke occasionally and drinks beer and wine. https://www.coursehero.com/file/42382909/Week-3-assignment-finaldocx/ This study resource was shared via CourseHero.com What other secondary diagnoses does Lorene have that should be addressed? Diabetes Mellitus Type 2 (E11.9). Diabetes mellitus, occurs when there is impairment of, beta cell synthesis or release of insulin, or the inability of tissues to use insulin which results in the inability to metabolism of fat, carbohydrate and protein. Clinically the patient will present with symptoms of increased fatigue, polyuria, polydipsia, and polyphagia (Carrera-Boada, & Martínez-Moreno, 2013). Lorene is overweight despite her efforts to exercise two times a week, her hgbA1C results is 6.4% and fasting glucose 135mgs/dl. She also has history of gestational diabetes with three pregnancies. According to Pippitt, and Marlana, (2016), diagnosis of diabetes can be made with an A1C level of 6.5% or greater, a fasting plasma glucose level of 126 mg /dl. Although this patient’s A1C results is 6.4% which is consider pre-diabetes, however she has a fasting glucose 135mgs/dl and history of gestational diabetes with three pregnancies which means she has type 2 diabetes. Type 2 diabetes when left uncontrolled, it affect major org [Show More]

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