STUDY - Technical - New Dacian's Medicine
blood
pressure increase (hypertension) (Classical / Allopathic
Medicine)
Elevated blood
pressure (hypertension) - an intermittent or sustained
increase in blood pressure to 140/90 mm Hg or greater -
strikes more men than women and twice as many blacks as
whites. For many patients, it's easy to ignore this common
sign because they can't see or feel it; however, its causes
can be life-threatening.
Elevated blood
pressure may develop suddenly or gradually. A sudden, severe
rise in blood pressure (to more than 200/120 mm Hg) indicates
a life-threatening hypertensive crisis. However, even a
less-dramatic rise may be equally significant if it heralds
dissecting aortic aneurysm, increased intracranial pressure, a
myocardial infarction, eclampsia, or thyrotoxicosis.
Usually associated
with essential hypertension, elevated blood pressure may also
result from a renal or endocrine disorder; a treatment, such
as a dialysis, that affects fluid status; or therapy with
certain drugs. Ingestion of large amounts of certain foods,
such as black licorice and cheddar cheese, may temporarily
elevate blood pressure. Serial readings may be necessary to
establish elevated blood pressure.
ALERT:
If you detect sharply elevated blood pressure:
- quickly rule out possible life-threatening causes
- initiate emergency measures if blood pressure exceeds 200/120 mm Hg.
After ruling out life-threatening causes, perform a focused assessment.
If you detect sharply elevated blood pressure:
- quickly rule out possible life-threatening causes
- initiate emergency measures if blood pressure exceeds 200/120 mm Hg.
After ruling out life-threatening causes, perform a focused assessment.
HISTORY:
Ask the patient about a family history of high blood pressure, pheochromocytoma, and polycystic kidney disease.
Ask the patient his age.
Ask the patient if he has experienced headaches, palpitations, blurred vision, or sweating.
Ask the patient if he has experienced punch-colored urine or decreased urine output.
Obtain a drug history, including prescription and over-the-counter drugs (especially decongestants), herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
If the patient is already taking an antihypertensive, determine how well he complies with the regime.
Ask the patient about a family history of high blood pressure, pheochromocytoma, and polycystic kidney disease.
Ask the patient his age.
Ask the patient if he has experienced headaches, palpitations, blurred vision, or sweating.
Ask the patient if he has experienced punch-colored urine or decreased urine output.
Obtain a drug history, including prescription and over-the-counter drugs (especially decongestants), herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
If the patient is already taking an antihypertensive, determine how well he complies with the regime.
PHYSICAL
ASSESSMENT:
Take the patient's blood pressure while he's lying in a supine position, sitting, and standing.
Check for carotid bruits and neck vein distention.
Assess skin color, temperature, and turgor.
Palpate peripheral pulses.
Auscultate for abnormal heart sounds, rate, and rhythm.
Auscultate for abnormal breath sounds, rate, and rhythm.
Palpate the abdomen for tenderness, masses, or liver enlargement.
Auscultate for abdominal bruits.
Obtain a urine sample to check for microscopic hematuria.
Take the patient's blood pressure while he's lying in a supine position, sitting, and standing.
Check for carotid bruits and neck vein distention.
Assess skin color, temperature, and turgor.
Palpate peripheral pulses.
Auscultate for abnormal heart sounds, rate, and rhythm.
Auscultate for abnormal breath sounds, rate, and rhythm.
Palpate the abdomen for tenderness, masses, or liver enlargement.
Auscultate for abdominal bruits.
Obtain a urine sample to check for microscopic hematuria.
SPECIAL
CONSIDERATIONS:
Be aware that the patient may experience elevated blood pressure only when in the physician's office (known as “white coat” hypertension). Twenty-four-hour blood pressure monitoring is indicated in such cases to confirm elevated readings in other settings.
Be aware that the patient may experience elevated blood pressure only when in the physician's office (known as “white coat” hypertension). Twenty-four-hour blood pressure monitoring is indicated in such cases to confirm elevated readings in other settings.
PEDIATRIC
POINTERS:
Normally, blood pressure in children is lower than that in adults.
Elevated blood pressure in children may result from lead or mercury poisoning, essential hypertension, renovascular stenosis, chronic pyelonephritis, coarctation of the aorta, patent ductus arteriosus, glomerulonephritis, adrenogenital syndrome, or neuroblastoma.
Normally, blood pressure in children is lower than that in adults.
Elevated blood pressure in children may result from lead or mercury poisoning, essential hypertension, renovascular stenosis, chronic pyelonephritis, coarctation of the aorta, patent ductus arteriosus, glomerulonephritis, adrenogenital syndrome, or neuroblastoma.
AGING ISSUES:
Atherosclerosis commonly produces isolated systolic hypertension in elderly patients. Treatment is warranted to prevent long-term complications.
Atherosclerosis commonly produces isolated systolic hypertension in elderly patients. Treatment is warranted to prevent long-term complications.
PATIENT
COUNSELING:
If routine testing detects high blood pressure, stresses to the patient the need for follow-up diagnostic testing.
If routine testing detects high blood pressure, stresses to the patient the need for follow-up diagnostic testing.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)