565_HTN_Lipid_Protocol_Student_Form_MAR23_v2

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Chamberlain College of Nursing *

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565

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Information Systems

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Apr 3, 2024

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NR565 HTN Lipid Protocol 1 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. The design of the protocol for UTI encompasses these principles. 2) SYMPTOMS a) HYPERTENSION i) Blood pressure >140/90 mmHg ii) Other possible subjective symptoms (1) Headache (2) Visual changes (3) Dyspnea (4) Chest pain (5) 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 (1) Absence of family history of hypertension (2) Other bruits (3) 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 a) Perform the following examinations: i) Vital Signs (blood pressure, pulse) ii) Auscultation for bruits (carotid, abdominal, and femoral)

NR565 HTN Lipid Protocol 2 iii) Palpation of thyroid iv) Cardiac v) Respiratory vi) Lower extremities for edema and pulses vii)Neurological b) Consult supervising physician if findings of: i) Abdominal bruit ii) Another bruit 5) LAB TESTS a) Metabolic panel i) Cholesterol ii) Blood sugar iii) Uric acid level b) Glomerular filtration rate c) Consult supervising physician if: i) GFR indicates chronic kidney disease (CKD) or renal failure 6) PHARMACOLOGICAL TREATMENT a) 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 Thiazide diuretic Bendroflumethiazide Chlorthalidone Hydrochlorothiazide Indapamide Angiotensin receptor blockers Losartan Valsartan Eprosartan Candesartan Calcium Channel Blockers Amlodipine Nifedipine Verapamil Dilitiazem ACE inhibitor Captopril Enalapril Lisinopril Quinapril Citation (Provide (Author, year) and not full reference): (Paul, J.A. et al. 2014), (Burchum & Rosenthal, 2021). b) 1 st 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: Enalapril ii) Dose: 5mg iii) Route: By mouth iv) Frequency: Once daily v) Instructions to provide patient: Take 1 tablet by mouth daily with or without meals. If you miss a dose, take it as soon as you remember. If it is almost time for your next

NR565 HTN Lipid Protocol 3 dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. vi) Caution/Precautions: Enalapril is not safe during pregnancy, contact your doctor immediately if you become pregnant. Contact your doctor if you experience any of the following adverse effects including angioedema, cholestatic jaundice, cough, hematologic effects, hyperkalemia, hypersensitivity reactions, hypotension/syncope, and renal function deterioration. vii)Using a source such as GoodRX, what is an estimated cost of this drug for a 30-day supply? A 30-day supply is between $9.26-$18.80. viii) What patient education is needed for this drug? Limit salt substitutions, which are high in potassium, or a potassium-rich diet as these can lead to hyperkalemia. Hyperkalemia can cause an abnormal heartbeat, confusion, dizziness, fainting, weakness, shortness of breath, numbness, and tingling. Be aware of your blood pressure prior to treatment and monitor it often after beginning treatment. Periodic labs may need to be drawn to monitor your kidney function. Do not abruptly discontinue medication without consulting your doctor first. Citation (Provide (Author, year) and not full reference): (Access Medicine, 2023), (GoodRx, 2023), (Mayo Clinic, 2023). c) 1 st 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: Amlodipine ii) Dose: 5mg iii) Route: By mouth. iv) Frequency: Once daily. v) Instructions to provide patient: Take 1 tablet by mouth daily with or without meals. If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. vi) Caution/Precautions: Dizziness, lightheadedness, or fainting may occur with hot weather, exercise, or getting up from a sitting to a standing position too quickly. Do not abruptly discontinue medication without consulting your doctor first. Consult your doctor if you have signs of liver problems including pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. vii)Using a source such as GoodRX, what is an estimated cost of this drug for a 30-day supply? A 30-day supply is between $6.29-$17.67 viii) What patient education is needed for this drug? Frequent side effects include fatigue, loss of strength or energy, flushing, nausea, and abdominal pain. Contact your doctor if these side effects do not improve or become severe. Be aware of your blood pressure prior to treatment and monitor it often after beginning treatment. Periodic labs may need to be drawn to monitor your liver function.

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