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hypertension ch18

Care of Patients with Hypertension

How to take blood pressure Taken in seated postition; Use calibrated instrument; seated quietly 5 mins in chair, feet on floor, arm supported at heart level. cuff over 80% of arm. Take 2 b/p readings, tell pt readings.
Classification of hypertension Pre-hypertension: 120-139 / 80-89 mm Hg Stage 1 Hypertension: 140-159 / 90-99 mm Hg Stage 2 Hypertension: >160 / >100 mm Hg
Follow up care of hypertension Normal BP: 2 Years; pre-hypertension: 1 yr; Stage 1 Hypertension: 2 mths; Stage 2 Hypertension: 1 mth; >180/110 mm Hg: Immediate tx.
What is blood pressure Pressure exerted by blood on walls of blood vessels; Determined by cardiac output, peripheral vascular resistance, vessel stretch, blood visocosity, blood volume.
Primary Hypertension Unknown Cause
Secondary Hypertension Known Cause
Isolated Systolic Hypertension SBP Over 140 mm Hg
Hypertension Signs/Symptoms None "Silent Killer" Rare - Headache, bloody nose, anxiety, dyspnea
Target Organ Disease Damage to blood vessels of heart, kidney, brain, eyes
Diagnosis of hypertension History, Signs and symptoms; kidney or heart disease; medications; blood pressure readings.
Diagnostic Tests ECG; Blood glucose; hematocrit; potassium; calcium; lipoprotein, cholesterol, triglyceride levels.
Hypertension risk factors Nonmodifiable; Family history, age, ethnicity, diabetes mellitus; Modifiable: Weight, diet (sodium, caffeine) Alcohol use, exercise, smoking stress mgmt.
Hypertensive emergency SBP > 180 mm Hg Systolic; DBP > 120 mm Hg diastolic; risk for/progression for target organ dysfunction. Gradual reduction of B/P.
Hypertensive Urgency Severe b/p elev w/o target organ dysfunction progression. Follow up in several days. Oral meds.
arterial disease symptoms Pulse: Diminished, weak, or absent; Skin: Pallor, dependent, rubor, thin, dry, shiny, cool; Edema: Absent or mild; Ulceration: On toes or pres points on feet; Gangrene likely; Pain: claudication, sharp stabbing; Nails: thick, brittle. Hair loss.
Venous Disease Symptoms Strong & symmetrical; may be ifficult to palpate because of edema; skin: mottling w/brn pigment at ankles. Edema present; gangrene unlikely; aching cramping, may have nocturnal cramps. Hair and nails normal.
What to do for arterial problems Provide a warm environment; cover with warm blankets; dress in warm clothing; avoid extremes of cold and heat. Do not elevate legs.
What to do for venous problems Periodic elevation of the lower extremities; well-distrubuted support of the vessels; exercise; avoiding smoking; moderate alcohol & vasodilation; Avoid heating devices.
Created by: krislynn