Exam I My notes - ADULT HEALTH I EXAM I OUTLINE Be sure to review guidelines for diseases and conditions Presenting signs and symptoms Think about your

Exam I My notes - ADULT HEALTH I EXAM I OUTLINE Be sure to...

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ADULT HEALTH I EXAM I OUTLINE Be sure to review guidelines for diseases and conditions Presenting signs and symptoms Think about your case studies Diagnostic testing Differential Diagnosis for common HEEENT and Cardiovascular conditions Treatment regimens utilizing updated guidelines found in your readings for common disorders and diseases seen in clinic. JNC- 8, USPSTF Guidelines, AHA/ACC guidelines, to name a few. Review patient education, esp. about medication side effects, when to report back to the clinic, what to watch out for, other non-pharmacological modalities. Know the different stages of Hypertension and be aware of the criteria for each stage, for example Stage 1 SBP 140–159 mm Hg, DBP 90–99 mm Hg Review the JNC-8 guidelines for HTN Think back to the Case Studies and how you gave you rationale and were able to use updated guidelines and diagnostic criteria for those. 12 Lead EKG, ie LVH what would you see on an EKG? What symptoms might the pt present with for this condition. Funduscopic exam, esp. for Retinopathy Cholesterol panel normal and abnormal ranges, remember recommended guidelines for initial treatment. What is best to target LDL and or Triglycerides. Be able to recognize signs of target organ damage ie Renal, cardiac muscle, ocular, cerebrovascular, etc. Review pharmacologic management of HTN as per the JNC 8 guidelines iee CCB, ACE, and Beta Blockers
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CARDIAC Hypertension o Risk Factors Age, gender, race, obestity, fam hx, excess ETOH, sedentary life, Cig smoking, psych stress o Most common condition in primary care (50mill deaths annually) o Essential HTN has no identifiable cause Inbalance between vasodilative and vasoconstrictive substances Renin lvl can be abnormal increased BP and blood volume Low rennin Na sensitive HTN pts o Malignant HTN Severely elevated BP > or = to 180/110 w/ evidence of acute organ damage HYPERTENSIVE EMERGENCY Hypertensive URGENCY HTN w/o organ damage o Diff Dx (workup ruleouts) Obesity sleep apnea drug induced/related Cushings 24 hour urinary free cortisol CKD Primary hyperaldosteronism K+ level Plasma aldosterone and renin renovascular dz renal arteriogram Ultrasound MRI angio Coarctation of aorta CXR- rib notching Pheochromocytoma Plasma and 24 hr urine for catecholamine CT scan of adrenal glands Thyroid/parathyroid dz o Workup Hx Physical exam Labs CBC, UA, CMP, TSH, Lipid profile o Diagnosis 2 separate readings
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No caffeine or nicotine for 30 minutes prior Sit for 5 minutes before check o Lifestyle Changes Weight loss (BMI 18.5-24.9 is goal) DASH diet (fruits and veggies) Low sodium (2.4g/day) 30+min per day most days of the week for activity Limit ETOH to less than 2/day o Treatment Recs Goals Adults >60 150/90 Adults <60 140/90 NONBLACK w or wo DM Initial Thiazide diuretic, CCB, ACEI, or ARB BLACK w or wo DM Initial
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