The closing NU573 presentation follows one composite dispatcher from one-liner to a four-problem plan, arguing that untreated sleep apnea helps explain his new hypertension. Searches like "nu 573 unit 10 assignment example", "nu573 unit 10 sample" and "nu573 unit 10 example" land here.
A Phone Recording, Morning Headaches and 156/98: A Comprehensive Case Presentation Arguing That Sleep Apnea Drives New Hypertension
[Student Name]
Purdue University Global
NU573: AGNP I Clinical - Adolescent and Adult Focus
Unit 10 Comprehensive Case Presentation
[Instructor Name]
[Date]
The patient is a composite; values and agent choices are bracketed.
Slide 1: One-Liner
A 42-year-old warehouse dispatcher with newly elevated blood pressure on two visits, loud snoring and morning headaches, referred to confirm hypertension and look for a cause.
Slides 2 to 4: History
Onset: blood pressure first noted high at a workplace screening [three] months ago. Two office readings [156/98] and [152/96]. Home readings averaging [148/94] over seven days, confirming hypertension outside the office. Sleep: his wife recorded loud snoring with pauses and gasps on her phone and played it for the visit. He wakes unrefreshed, with headaches most mornings that fade by midday. He nods off in meetings. STOP-Bang: snoring, yes; tired, yes; observed pauses, yes; pressure, yes; BMI above 35, no; age above 50, no; neck above 40 cm, yes; male, yes. Score 6 of 8 (Chung et al., 2016). Caffeine: four energy drinks a day to stay alert on night dispatch shifts. Other: no palpitations, sweating episodes, muscle weakness or weight change. No NSAIDs, decongestants or stimulant medications. Alcohol [two] drinks on weekends. Never smoked. Family: father had a stroke at 58.
Slide 5: Pertinent Review of Systems
Positive: daytime sleepiness, morning headaches, nocturia once a night. Negative: chest pain, dyspnea, visual changes, flushing, heat intolerance, leg swelling.
Slides 6 and 7: Exam
BMI [34]. Neck circumference [44] cm. Oropharynx crowded, Mallampati [IV]. Blood pressure [154/96], both arms similar. No carotid or abdominal bruits. Heart regular, no murmur. Fundoscopic exam normal. No edema. No features of Cushing syndrome.
Slide 8: Data
Creatinine [0.9] mg/dL; potassium [4.2]; sodium [140]; lipids LDL [138] mg/dL; A1C [5.8] percent; TSH normal; urinalysis without protein or blood; ECG normal sinus rhythm without left ventricular hypertrophy. These are the baseline tests recommended for a new diagnosis of hypertension (Whelton et al., 2018).
Slides 9 and 10: The Argument for Sleep Apnea
The combination of loud snoring with witnessed pauses, a STOP-Bang of 6, a 44-centimeter neck and headaches on waking makes obstructive sleep apnea the most likely secondary contributor to his hypertension.
On STOP-Bang, a total of 5 or above puts a patient in the group most likely to have clinically significant apnea (Chung et al., 2016). In a prospective cohort, sleep-disordered breathing at baseline was associated with a dose-dependent increase in the odds of developing hypertension over four years, independent of other risk factors (Peppard et al., 2000).
The mechanism links the two. Each apnea causes a fall in oxygen and a rise in carbon dioxide, triggering a surge of sympathetic activity that raises blood pressure during the night. Over time, the sympathetic tone persists into the day, and repeated oxygen falls promote vascular inflammation and stiffness. Morning headaches reflect overnight carbon dioxide retention and disrupted sleep.
Energy drinks contribute too. Caffeine raises blood pressure acutely, and four energy drinks a day add a meaningful load. He drinks them because he is sleepy, which the apnea causes, a loop worth naming.
Speaker Notes: What Else Was Considered
Other secondary causes of hypertension were weighed and ranked below sleep apnea, each for a stated reason. Primary aldosteronism is common among people with hypertension and often overlaps with sleep apnea, but his potassium is normal and his hypertension is not yet resistant; it stays on the list as a question for the preceptor. Renal parenchymal disease is unlikely with a normal creatinine and a clean urinalysis. Renovascular disease is unlikely at 42 without an abdominal bruit or sudden onset. Thyroid disease is excluded by a normal TSH. Cushing syndrome is unlikely, since he has no striae, easy bruising, proximal weakness or central fat redistribution. Pheochromocytoma is unlikely without episodes of headache, sweating and palpitations together; his headaches are morning headaches that fade, a pattern that fits apnea. Drug causes were checked, and the energy drinks were the only one found.
Speaker Notes: What Treating the Apnea May Do
Treating sleep apnea with CPAP lowers blood pressure, but usually by only a few millimeters of mercury on average, with larger effects in people who use it consistently and in those with resistant hypertension. For Mr. [D.], CPAP alone is unlikely to bring 148/94 to target, which is why the plan starts an antihypertensive now rather than waiting for the sleep study. The larger benefits of treating his apnea are elsewhere: less daytime sleepiness, a lower risk of a crash on his drive home after night shifts, and better sleep, which may help him cut back the energy drinks. The presentation says this plainly so the preceptor does not hear the sleep study as a substitute for blood pressure treatment.
Speaker Notes: Why This Order
The presentation leads with confirmation of hypertension before the search for a cause, because the cause matters only once the diagnosis is secure. Home readings confirm it outside the office, excluding white-coat hypertension. Only then does the argument turn to sleep apnea, which is where the presentation's reasoning lives, and where the preceptor's questions are most likely to land.
Slide 11: Problem List
1. Stage 2 hypertension, newly confirmed.
2. Suspected obstructive sleep apnea, high pretest probability.
3. Obesity, BMI 34.
4. Family history of early stroke, and an LDL of 138 with an A1C of 5.8.
Slides 12 and 13: Plans
1. Hypertension: start [amlodipine] or [lisinopril], the choice bracketed for discussion, with home monitoring and a four-week recheck. Stage 2 readings call for drug therapy with lifestyle change rather than lifestyle alone (Whelton et al., 2018).
2. Sleep apnea: home sleep apnea test, which the guideline supports for uncomplicated adults whose history already makes significant apnea likely (Kapur et al., 2017). If positive, CPAP. Warned not to drive when drowsy.
3. Obesity: a weight target of [5 to 10] percent, which also reduces apnea severity; nutrition referral.
4. Cardiovascular risk: calculate 10-year risk; statin discussion; A1C recheck in six months.
5. Energy drinks: taper to one a day over two weeks, not stopped at once, to avoid caffeine withdrawal headache.
Slide 14: Questions for the Preceptor
1. Should we start an antihypertensive now or wait for the sleep study, given his readings?
2. Would you screen for primary aldosteronism now, since resistant hypertension with sleep apnea often overlaps with it, or only if his pressure stays high?
3. Does his night dispatch work change which antihypertensive you would choose?
References
Chung, F., Abdullah, H. R., & Liao, P. (2016). STOP-Bang questionnaire: A practical approach to screen for obstructive sleep apnea. Chest, 149(3), 631-638. https://doi.org/10.1378/chest.15-0903
Kapur, V. K., Auckley, D. H., Chowdhuri, S., Kuhlmann, D. C., Mehra, R., Ramar, K., & Harrod, C. G. (2017). Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(3), 479-504. https://doi.org/10.5664/jcsm.6506
Peppard, P. E., Young, T., Palta, M., & Skatrud, J. (2000). Prospective study of the association between sleep-disordered breathing and hypertension. New England Journal of Medicine, 342(19), 1378-1384. https://doi.org/10.1056/NEJM200005113421901
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., 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., Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A., ... Wright, J. T. (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: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 71(6), e13-e115. https://doi.org/10.1161/HYP.0000000000000065
How this NU573 Unit 10 example is structured
The presentation expands the short format without abandoning its discipline. Every section is complete, but each finding still has to serve the assessment; the review of systems appears as one slide of pertinent positives and negatives rather than fourteen systems read aloud. The initial hypertension workup follows the baseline tests recommended in the 2025 AHA/ACC guideline, cited once. The central argument is the secondary cause: the STOP-Bang score, neck circumference, headaches on waking and a partner's recording make obstructive sleep apnea likely, and the presentation explains how untreated apnea raises blood pressure. Energy drinks are weighed as a contributor too. The problem list ranks hypertension, suspected sleep apnea, obesity and a family history of early stroke. Plans pair a home sleep apnea test with home monitoring and a bracketed decision on amlodipine or lisinopril, and the final slide lists questions for the preceptor.
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NU573 Unit 10 questions, answered
How does a comprehensive case presentation differ from a focused one?
It includes every standard section, from chief complaint through plan, with a full medication list, family and social history and a problem list. A focused presentation covers only what bears on one complaint. The longer version still selects: pertinent findings stay, while normal systems are summarized rather than recited, so the presentation remains easy to follow when spoken.
Should the presentation include a differential?
Usually, for the main problem. A short ranked list, with the findings that support or weaken each item, shows the reasoning behind the leading diagnosis. For hypertension the differential takes the form of possible secondary causes, and the presentation explains which were considered, which were tested and which the findings made unlikely.
How many problems should the plan address?
Every active problem the case raises, ranked by importance. Between three and five is typical for a new adult patient. Each should have its own plan, even if brief, covering tests, treatment, education and follow-up. Lumping several problems into one plan makes it hard for a listener to see what was decided about each.