NR 603 Week 3 Final Case Discussion: Cardiovascular|Chamberlain College of Nursing

NR 603 WEEK 3 FINAL ASSIGNMENT

CARDIOVASCULAR

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 involving 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