Patient & Hypertension

Patient Assessment Risk Factors: hypertension Tobacco USE metabolic syndrome diabetes mellitus Stress inspection Baroceptors Stretch *f stretch HR vasodilation • stretch= THR vasoconstriction. Chronic HTN receptors recognize new "normal" Factors infivencing BP Baroreceptors stress 'Skin color, venous pattern, edema, clubbing pain APE-TO-MAN auscultation Split 62 puiments area. S3 Sy arrial gallop ↓ ventricular gallop Hypertension conceptual focus adherence •position changes Regulation of Cardiovascular System "platelet adhesion, coagularion regulation -regulating fivia control in vessel extravascular space Factors Influencing BP: Rerial System proenaglandins vasodilation: BP secrete renin in response to SNS+ blood flow Not Fluids electrolytes perfusion self-management ACE inhibitors: "pris" stop conversion of Angio I. Angio II. Background PBP: risk: MI, HF, stroke, renal disease Non-modifiable Risk Factors Blood Pressure Cox Sypremic Vascunar resistance Medications Review chasinergic: PNS response adrenergic: SNS SNS HTN norepinephrine vasoconstriction epinephrine Baroreceptors respond to pressure or stretch Laserse onder age "gender family history Modifiable alcohol tobacco excese sodium 'obesity Primary Hypertension idio pathic Secondary Hypertension *ervated BP wlidentified cause rexi preschromocyrome: Denign tumor on adrensi giard: fBe Older Adults • IsHalsoland systole hypertension • > 60yrS *widered pulse pretoure: 158P • 4 riGe of BornoGratiL mede: aired drug absorption Manifestations ""silent wither" digainess percitations angina dysprea • hypertensive crisis: severe ncadache THOROMOS Complications "Peripheral vascular disease atherosclertois " ovD aortic dissection • Lidney ' CKD • Eyes * Brain "blurry lloss of vision •TIA: mini stroke Management LaDs: EleCtronIcs, BUN, CR, ONKOBE urinalyos, 2une: creatinine lipia panes vric acid LECG Overall Goals 1• manage Bp prerent organ disease 2. contros cholesieros 3. reduce lonDon sugar 4. 105e weight B. 610p omoxing Physical Actitity • 30 mins • muscle strengthening ax /weck DASH DiCt • healthy dict: low sodium 200ong lday •+ dictary potasolum Hypertension: Classification cierated SBP 120-129 DBP 480 hypervention stage 1 180-139 or 80-89 hupertension Stage 2 7 140 or 210 * treatment: fot line med: thiazide diuretic (Hirz), calcium channer blocker, ACE/MAD L take in morning a Antinyperingires from a different classes L "olor" - Eeta. DICKArS "pri" - ACE - "Sartan" - ARBS. Hypertension Resistant Hypertensire * improper BP measurement • volume overidad • atsociatia conditions Heart Failure: reart carnor keep up wibody's demand SIs: 508 Righe vS. fatigue easily v appetite coc ma. edema "neart o pumping biosd weight gain left * 50B • palpitations •fatigue + tiredness BP goal: *130/80 Hypertonsire Crisis → > 180/120 ejection traction measure of the % or bread to the lett ventrice pumps out wieach contraction • aortic diffectión • head injury • preeclampoin + reboond hypertension •normal: 50 - 702. • 2407. = HF LieH ventricular) 110= a tiser portusion impaired gas exchange Causes • HTN+ CAD • co-morbidities: diabers, druglaiconol use fwia volume inbaranu v functional ability Hypertensive Urgency • no targer organ symptoms → more common may not require nospitarizations Joe wimperiersion not taking meas Hyperterolve Emergency •target organ symproms / damage SIS: Headacha N+V → possibu complications: Mi Selaures cacma. Left-sided Heart Failur * most common inatlity & LV: "Empty adequatery euring ayerol: redures eyection frackien • An adequately during diastole *HTN * common coute digoxin: + contracility de heart Drug Therapy "nitroglycerin • fitrate → * MAP SlOwy CVA • SIS • pulmonary congestion a edema * PND: poroxymal noctural dyspnea: periodical night-time 50% • taunyprea • cough • Confusion "tachycardia ' restessness ascites caeme. perioneral edema Acute Decompensated Heart Fallure • suaden 1 in Symptoms de ME * pulmonary edema common mitral Clinicas Assessment • LAD6: BNP *Abbs • I2 Lcad *CXR + Echocardiogram Chronic Heart Failure progressive synacome • V Co + + venous pressure • compansatery mechanioms ' SNS + * infiammatory response → Interprofessiona! Care: treat undertying cause drag therapy dally weignts Sodi om restriction oxygen Drug Therapy • diuretico: 100p: lasix • Deta blockers prigne position asix ce intioners igoxin fierload (4) odium restriction est (KI, Dig, AB60) Intective Endocarditis infection of inner lining of wears *lor ved "rior factors *. W drug use * prostitic vaives nemodialy 6is meumatic nears • CAUSCO: bacterial mast comman * 00h Virus cur fungi 'LEt-sidea: more to brain, kidneys, spun •rignisloca) mart to lunge 1 PE Manifestarions 'fever * Chits, scamos, mataise, farigue, anorexia • back pain, abdominal discomton, seigne 1055 *splinter nernortnages: reminal lesions • sancuray lesiano: not paintas • Oster's rodes: palnto "petechiae "newlersening mermur • MF "systemic infection * sharp, stabbing pain wlinspiration + pior Diagnestic Criteria -Dure Crikria 4 0100d costures 4 a separar bicos coMurEs - Echo I ECG, X-ray • CBC, CAP, EGR