NR565 Week 3 Hypertension and Lipid Protocol
NR565 Week 3 Hypertension and Lipid Protocol – Step-by-Step Guide
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It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.
How to Research and Prepare for NR565 Week 3 Hypertension and Lipid Protocol
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You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.
How to Write the Introduction for NR565 Week 3 Hypertension and Lipid Protocol
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How to Write the Body for NR565 Week 3 Hypertension and Lipid Protocol
The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.
How to Write the In-text Citations for NR565 Week 3 Hypertension and Lipid Protocol
In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:
The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.
How to Write the Conclusion for NR565 Week 3 Hypertension and Lipid Protocol
When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.
How to Format the Reference List for NR565 Week 3 Hypertension and Lipid Protocol
The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication.
Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:
References
Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456
Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.
NR565 Week 3 Hypertension and Lipid Protocol Assignment Instructions
Purpose
The purpose of this assignment is to develop a standardized procedure or protocol that is applicable to the nurse practitioner role. This assignment will allow for discovery into protocol development as well as establishing a standardized treatment plan for a given diagnosis according to current evidence. This assignment supports the professional formation of the FNP, AGACNP, AGACNP, and PMHNP practice role.
Course Outcomes
This assignment enables the student to meet the following course outcomes:
• CO1: Identify the most commonly prescribed agents in the major drug classes.
• CO2: Make appropriate evidence-based therapeutic treatment decisions for individual patients utilizing drugs from the major drug classes.
• CO3: Apply knowledge of pharmacokinetics, pharmacodynamics and pharmacogenomics in prescribing patient treatment.
• CO4: Distinguish internal and external environment factors affecting drug action, reaction, efficacy, and interaction.
• CO5: Identify client indicators of therapeutic, ineffective, adverse responses and side effects to drug therapy.
Preparing the Assignment
Follow these guidelines when completing each component of the assignment. Contact your course faculty if you have questions.
- Complete the outline template
Links to an external site. provided for the sections highlighted in yellow and the click to enter text here is indicated.
Provide references for your protocol at the bottom of the form where indicated. References should come from the following sources:
- Clinical Practice Guidelines
- Dyslipidemia
NR565 Week 3 Hypertension and Lipid Protocol Example
HYPERTENSION PROTOCOL: INITIAL VISIT 1) RATIONALE
a) This protocol will assist in the differentiation between essential hypertension and renal artery stenosis to aid in the identification of patients in need of referral to nephrology to prevent further renal damage from an unidentified renal artery stenosis.
2) SYMPTOMS
a) HYPERTENSION
i) Blood pressure >140/90 mmHg ii) Other possible subjective symptoms
- Headache
- Visual changes
- Dyspnea
- Chest pain
- Sensory or motor deficit
b) RENAL ARTERY STENOSIS
i) Onset of hypertension age >55 years or <30 years ii) History of accelerated, malignant, or resistant hypertension iii) History of unexplained kidney dysfunction iv) History of multivessel coronary artery disease v) History of other peripheral vascular disease vi) Abdominal bruit
vii) Sudden or unexplained recurrent pulmonary edema viii) Other possible factors
- Absence of family history of hypertension
- Other bruits
- History of acute kidney injury after administration of ACE inhibitor or angiotensin II receptor antagonist (ARB)
3) HISTORY
a) Continue with treatment of hypertension but consult supervising physician if patient has:
i) History of accelerated, malignant, or resistant hypertension ii) History of unexplained kidney dysfunction iii) History of multivessel coronary artery disease iv) History of other peripheral vascular disease v) Abdominal bruit
vi) Sudden or unexplained recurrent pulmonary edema
4) PHYSICAL EXAM
- Perform the following examinations:
- Vital Signs (blood pressure, pulse) ii) Auscultation for bruits (carotid, abdominal, and femoral) iii) Palpation of thyroid
- Cardiac
- Respiratory vi) Lower extremities for edema and pulses vii) Neurological
- Consult supervising physician if findings of:
- Abdominal bruit ii) Another bruit
5) LAB TESTS
- Metabolic panel
- Cholesterol ii) Blood sugar iii) Uric acid level
- Glomerular filtration rate
- Consult supervising physician if:
- GFR indicates chronic kidney disease (CKD) or renal failure
6) PHARMACOLOGICAL TREATMENT
- List the hypertension drug classifications and examples you would prescribe in order of treatment according to clinical practice guidelines without consideration of race or ethnicity: (Provide generic names for examples. Doses are not needed or required.)
Drug Category/ Classification | Example 1 | Example 2 | Example 3 | Example 4 |
ACE-Inhibitors (ACEI) | Prinivil | Lotensin | Monopril | Accupril |
Angiotesin Receptor Blockers (ARB) | Cozaar | Atacand | Diovan | Benicar |
Thiazide Diuretics | Microzide | Hygroton | Diuril | Zaroxolyn |
Calcium Channel Blocker (CCB) | Norvasc | Adalat | Cardizem | Isoptin SR |
Citation (Provide (Author, year) and not full reference): (James et al., 2014)
- 1st line pharmacological treatment if warranted in a non-African American patient after a thiazide diuretic has been given and no compelling contraindications/comorbidities are identified: (Choose a generic drug from the drug class you would like to prescribe to either add to existing treatment or replace a thiazide.) i) Drug: Prinivil ii) Dose: 10 mg iii) Route: Per Oral iv) Frequency: Once Daily
v) Instructions to provide patient: (1) Take with or without food
(2) If a dose is missed, take it as soon as possible, but if it is close to the next
scheduled dose, skip the missed dose and take the next one at the regular time (3) Keep the tablets at a temperature between 15-30 degrees Celsius, and store in a place that is protected from moisture.
- Caution/Precautions: (1) There is a risk of anaphylactoid reactions
- Hematologic effects include agranulocytosis and neutropenia
- Excessive hypotension occurs with concomitant diuretics
- Risk of hyperkalemia
- Angioedema of the face, extremities, lips, tongue, and/or larynx, can happen at any time during treatment
- When taken with neprilysin inhibitors (Sacubitril), the risk of angioedema increases
- A dry, hacking cough may develop a few months after starting the medication
- Caution should be used in patients with renal problems
- Simultaneously using ACE inhibitors and ARBs can cause significant hypotension, hyperkalemia, syncope, and changes in kidney function
- In patients undergoing surgery or being given anesthesia with drugs that lower blood pressure, Prinivil may exacerbate hypotension, which can be corrected by volume expansion
- Using a source such as GoodRX, what is an estimated cost of this drug for a 30-day supply? The lowest price found on GoodRX for Prinivil, 10mg, and 30 tablets is $51.59. viii) What patient education is needed for this drug? (1) Follow the instructions for taking the medication as directed/observe adherence
- Avoid taking potassium supplements or eating high potassium foods, such as bananas and grapefruit, while on the medication.
- Be careful when standing up from a sitting or lying down position as the medication may cause hypotension and make you feel dizzy.
Citation (Provide (Author, year) and not full reference): (James et al., 2014)
- 1st line pharmacological treatment if warranted in an African American patient after a thiazide diuretic has been given and no compelling contraindications/comorbidities are identified: (Choose a generic drug from the drug class you would like to prescribe to either add to existing treatment or replace a thiazide.) i) Drug: Norvasc ii) Dose: 5 mg iii) Route: Per Oral iv) Frequency: Once Daily
- Instructions to provide patient: Take one pill daily at a consistent time, with food to avoid GI upset. Do not crush or chew the tablet, swallow it whole with a glass of water. Keep the medication in a room at a temperature between 15-30 degrees Celsius.
- Caution/Precautions: (1) Symptomatic hypotension is possible (2) worsening of angina and acute myocardial infarction can develop after dose is started or increased (3) Extensively metabolized by the liver and plasma elimination half-life is 56 hr in patients with hepatic impairments; titrate slowly when treating patients with severe hepatic impairment
- Using a source such as GoodRX, what is an estimated cost of this drug for a 30-day supply? At CostCo, 30 tabs of 5 mg Norvasc cost $0.46 with free coupon
- What patient education is needed for this drug?(1) Follow the instructions for taking the medication as directed/observe adherence
- Consume with food to prevent GI upset
- Be aware of potential side effects such as edema, headaches, fatigue, and palpitations
- Measure blood pressure daily to assess progress towards target levels
- Attend regular check-ups at a clinic to review and refill the medication
- If there are any issues or concerns, schedule a follow-up appointment promptly.
- What patient education is needed for this drug?(1) Follow the instructions for taking the medication as directed/observe adherence
Citation (Provide (Author, year) and not full reference): (James et al., 2014; Whelton et al., 2018)
- When should ACEIs be used in African Americans according to the course textbook?
Include a citation with matching reference in the reference section.
- Used in individuals who cannot tolerate thiazide diuretics or CCBs
- Given as an additional treatment option for African American patients who have not met their blood pressure targets using thiazide or CCB medication.
- Utilized in specific situations where there is a compelling indication, such as in patients with hypertension who also have diabetes and chronic kidney disease (CKD). Citation (Provide (Author, year) and not full reference): (Helmer et al., 2018)
- Prescribe statin therapy according to the prescription table which follows:
Complete the following table to indicate which drug at which dose would be used for different intensity statin therapies to treat high low-density lipoprotein (LDL) as noted in the course textbook. Each drug listed in each column should be a different drug with a specific dose or dose rans as indicated in your course textbook.
High-Intensity Therapy | Moderate-Intensity Therapy | Low-Intensity Therapy |
Daily dose lowers LDL-C on average by ≥50% | Daily dose lowers LDL-C on average by 30% to 49% | Daily dose lowers LDL-C on average by <30% |
Drug/Dose 1: Atorvastatin/80 mg PO OD Drug/Dose 2: Rosuvastain/20 mg PO OD | Drug/Dose 1: Atorvastatin/20 mg PO OD Drug/Dose 2:Pravastatin 40 mg PO OD | Drug/Dose 1: Simvastatin/10 mg PO OD Drug/Dose 2:Pravastatin 10-20 mg PO OD |
Drug/Dose 3:Lovastatin 40 mg PO OD Drug/Dose 4:Fluvastatin 40 mg PO BD Drug/Dose 5:Pitavastatin 14 mg PO OD | Drug/Dose 3:Lovastatin 20 mg PO OD | |
What patient education is needed when prescribing statins? Consider any patient counseling points and adverse effects they may need to be aware of or report if experienced. | Educate patients about the proper use of the medication and the potential side effects. Some key points to discuss with patients include the following: The purpose of the medication: Statins are used to manage hypercholesterolemia and reduce the risk of cardiovascular events Proper dosing: Patients should be instructed on the proper dosage of their medication, as well as the frequency and timing of doses. Take the medication as prescribed by the doctor 3. Potential side effects: Statins can cause a number of side effects, including myopathy, rhabdomyolysis, hepatotoxicity, and an increased risk of diabetes. Patients should report any symptoms to their healthcare provider. Importance of monitoring: Patients should be instructed to have their cholesterol levels and liver function checked regularly while taking statins, as the medication can potentially cause liver damage. Interaction with other medications: Patients should inform their healthcare provider of any other medications they are taking, as statins can interact with other drugs and supplements. For instance, taking simvastatin with gemfibrozil, a fibrate, can lead to an increased concentration of simvastatin and a higher risk of myopathy. This combination should be avoided. Advice on lifestyle change: Stress the importance of lifestyle change such as regular exercise, healthy diet, and weight management, as statins work most effectively when combined with these lifestyle change Compliance: Encourage patient to take the medication as prescribed and to not discontinue the medication without consulting the doctor. |
Citation (Provide (Author, year) and not full reference): (Grundy et al., 2019)
7) TREATMENT MONITORING
- How long until a follow up appointment should be done with patient?
Fasting lipid panel monitoring measured at baseline and 4-12 weeks after statin intiation or dose adjustment
Follow-up montoring occurs every 3-12 months
- Monitoring needs for blood pressure medication prescribed: (Include physical assessments as well as lab/diagnostics as applicable. If not applicable, enter N/A to show you find it not applicable.) i) Physical Assessments:
-Blood pressure measurements: Blood pressure should be measured in both arms and legs to check for any significant differences and determine if the medication is effective in lowering blood pressure.
-Heart and lung examination: Listening to the heart and lungs for any irregular heartbeats or murmurs, or any signs of fluid in the lungs.
-Examining the peripheral pulses: to check for any abnormalities
-Blood pressure measurement in lying, sitting and standing position: in order to evaluate the effectiveness of medication and to check if patient has orthostatic hypotension.
-Assessing the signs of the target organ damage: eg: Funduscopic examination for retinal changes in hypertension, peripheral neuropathy examination in diabetes patient ii) Labs/Diagnostics:
-Electrocardiogram (ECG) to check for any changes in the heart’s electrical activity -Blood tests to check for electrolyte levels, kidney function, and glucose levels.
-Urinalysis: which can indicate possible renal disease
-Lipid profile: to check the cholesterol levels and blood sugar levels
-Other tests such as Echocardiogram, CT scan, MRI may be done based on the indication and need
Citation (Provide (Author, year) and not full reference): (Rabi et al., 2020)
c) Monitoring needs for statin medication prescribed: (Include physical assessments as well as lab/diagnostics as applicable. If not applicable, enter N/A to show you find it not applicable.)
- Physical Assessments:
-Muscle examination: checking for muscle weakness or pain, which can be a side effect of statins
-Check for any signs of liver damage, which is a rare but possible side effect of statins (check for jaundice, dark urine, pale stool etc.)
-Vital signs: to check if medication is causing any changes in heart rate, blood pressure
-Assessing the signs of the target organ damage: eg: Funduscopic examination for retinal changes in hypertension, peripheral neuropathy examination in diabetes patient
- Labs/Diagnostics:
-Blood tests to check liver function and muscle enzymes (creatine phosphokinase (CPK)): Elevated levels of these enzymes can indicate muscle damage or liver dysfunction
-Lipid profile: to check cholesterol levels and monitor the effectiveness of the medication
-Glucose level test: to check for an increase in blood sugar levels as some statin have been associated with risk of hyperglycemia
-Additional test may be done based on indication, for example for patients with a high
risk of muscle or liver dysfunction or for those who have symptom that suggest these issues.
Citation (Provide (Author, year) and not full reference): (Grundy et al., 2019)
8) TREATMENT FAILURE
a) How will you know if the treatment is not working or needs to progress? Include a citation with matching reference in the reference section.
Antihypertensive medications
- One way is by monitoring the patient’s blood pressure readings over time. If the medication is not controlling the patient’s blood pressure to the target goal, the healthcare provider may consider adjusting the dosage or adding another medication.
- Another way is by evaluating the patient’s symptoms, such as chest pain, shortness of breath, headache, or difficulty breathing. These symptoms can indicate that the blood pressure is not well controlled and may require adjustments to the treatment plan.
- Additionally, lab test such as electrolyte levels, kidney function, glucose levels and lipid profile can be done to check for any abnormal changes and monitor the efficacy of the medication and also check for any adverse effects.
- Target organ damage such as retinopathy, left ventricular hypertrophy, peripheral neuropathy also can be used to evaluate treatment success.
It is worth noting that managing hypertension can be difficult and in some cases, the condition may become resistant hypertension (RHTN). This is when the blood pressure is not controlled despite the use of 3 or more different types of antihypertensive medications. Another term, refractory hypertension, is when blood pressure remains uncontrolled even when taking the maximum or near-maximum dose of 5 or more different types of antihypertensive medications.
Statin Medications
Determining treatment failure in statin therapy can be achieved by utilizing similar criteria as with antihypertensive medications.
- Monitor cholesterol levels over time, if not decreasing or not reaching desired goal, consider adjusting dosage or adding another medication
- Monitor symptoms such as muscle weakness or pain, which may indicate muscle damage, adjust dosage or switch medication if necessary
- Check liver function test, creatine phosphokinase, and lipid profile to check for abnormal changes and monitor medication efficacy
Citation (Provide (Author, year) and not full reference): (Acelajado et al., 2019; Grundy et al., 2019)
References
Acelajado, M. C., Hughes, Z. H., Oparil, S., & Calhoun, D. A. (2019). Treatment of resistant and refractory hypertension. Circulation Research, 124(7), 1061–1070. https://doi.org/10.1161/CIRCRESAHA.118.312156
Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., Braun, L. T., de Ferranti, S., Faiella-Tommasino, J., Forman, D. E., Goldberg, R., Heidenreich, P. A., Hlatky, M. A., Jones, D. W., Lloyd-Jones, D., Lopez-Pajares, N., Ndumele, C. E., Orringer, C. E., Peralta, C. A., … Yeboah, J. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American college of cardiology/American heart association task force on clinical practice guidelines: A report of the American college of cardiology/American heart association task force on clinical practice guidelines. Circulation, 139(25), e1082–e1143. https://doi.org/10.1161/CIR.0000000000000625
Helmer, A., Slater, N., & Smithgall, S. (2018). A review of ACE inhibitors and ARBs in black patients with hypertension. The Annals of Pharmacotherapy, 52(11), 1143–1151. https://doi.org/10.1177/1060028018779082
James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., Lackland, D. T., LeFevre, M. L., MacKenzie, T. D., Ogedegbe, O., Smith, S. C., Jr, Svetkey, L. P., Taler, S. J., Townsend, R. R., Wright, J. T., Jr, Narva, A. S., & Ortiz, E. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8): Report from the panel members appointed to the eighth joint national committee (JNC 8). JAMA: The Journal of the American Medical Association, 311(5), 507–520. https://doi.org/10.1001/jama.2013.284427
Rabi, D. M., McBrien, K. A., Sapir-Pichhadze, R., Nakhla, M., Ahmed, S. B., Dumanski, S. M., Butalia, S., Leung, A. A., Harris, K. C., Cloutier, L., Zarnke, K. B., Ruzicka, M., Hiremath, S., Feldman, R. D., Tobe, S. W., Campbell, T. S., Bacon, S. L., Nerenberg, K. A., Dresser, G. K., … Daskalopoulou, S. S. (2020). Hypertension Canada’s 2020 comprehensive guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children. The Canadian Journal of Cardiology, 36(5), 596–624. https://doi.org/10.1016/j.cjca.2020.02.086
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Jr, Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Jr, Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A., Sr, … Wright, J. T., Jr. (2018). 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. Journal of the American College of Cardiology, 71(19), e127–e248. https://doi.org/10.1016/j.jacc.2017.11.006