Target BP in adults younger than 60 is a BP less than 14090 American Family

Target bp in adults younger than 60 is a bp less than

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started when the SBP is 140mm Hg or higher, or when the DBP is 90mm Hg or higher. Target BPin adults younger than 60 is a BP less than 140/90 (American Family Physician, 2014). According to the JNC guidelines Sean is not hypertensive. Sean also does not have a history of chronic kidney disease or diabetes, which would put him at a higher risk for hypertension. According to the American College of Cardiology (2014) ASCVD risk estimator, Sean has a 10-year ASCVD risk of 14.8% and a lifetime ASCVD risk of 50%. This estimates 10 year and lifetime risks for atherosclerotic cardiovascular disease (ASCVD), defined as coronary death, nonfatal myocardial infarction, fatal or nonfatal stroke. This risk estimator is intended for the usein adults currently without ASCVD and with a LDL < 190.Primary Diagnosis:Non-ST elevation (NSTEMI) myocardial infarction (I21.4) - NSTE-ACS most commonly presents as a pressure-type chest pain, occurring at rest or with minimal exertion, lasting greater or equal to 10 minutes. Patients also present with diaphoresis, dyspnea, nausea, abdominal pain, or syncope. Unexplained new onset or exertional dyspnea is the most common angina equivalent. Changes in 12-lead ECG include ST depression, transient ST-elevation, or new onset T-wave inversion (JACC, 2014). Rational- Sean has ST depression on his 12-lead EKG and his symptoms (diaphoresis, chest pressure, nausea), are all indicative of a NSTEMI.Further diagnostic work up: Referral to the ER for further work up, serial Troponin’s and EKG’s, stress test, and cardiology consult. It is reasonable to monitor patients with possible ACS who have normal ECG and cardiac troponins in a telemetry unit for serial ECG’s and cardiac troponins at admission, 3 and 6 hour intervals (JACC, 2014).
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Troponins (the most sensitive and specific biomarkers for NSTEMI) (JACC, 2014)Coronary CT angiography (in patients with possible acute coronary syndrome and a normal ECG, normal troponins, and no history of CAD, it is reasonable to perform this test or exclude myocardial ischemia) (JACC, 2014).Medications: Aspirin 325mg tablet1 tablet daily(JACC, 2014)Nitroglycerin 0.3mg tablet1 tablet SL every 5 minutes up to 3 doses for chest pain.(JACC, 2014)Simvastatin 20mg tablet1 tablet Q HSACC, 2014)Referrals: Referral to the ER for further work up, serial Troponin’s and EKG’s, stress test, and cardiology consult. It is reasonable to monitor patients with possible ACS who have normal ECGand cardiac troponins in a telemetry unit for serial ECG’s and cardiac troponins at admission, 3 and 6 hour intervals (JACC, 2014).Conservative measures: Lifestyle changes including heart healthy diet and smoking cessation (Goroll & Mulley, 2014).Education:Risk assessments are used to determine the likelihood of you developing cardiovascular disease, heart attack or stroke in the future (ACC, 2014). You have a 10-year ASCVD risk of 14.8% and alifetime ASCVD risk of 50%. This estimates 10 year and lifetime risks for atherosclerotic cardiovascular disease (ASCVD), defined as coronary death, nonfatal myocardial infarction,
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fatal or nonfatal stroke. This risk estimator is intended for the use in adults currently without ASCVD and with a LDL < 190.Your 12 lead EKG showed ST depression. There is something called non-ST elevation acute
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