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Ocular Pathophysiology > Blood Pressure > Flashcards

Blood Pressure Flashcards

1
Q

The higher the BP, the greater the chance of:

A. Myocardial infarction
B. Cerebral vascular attack
C. Heart failure
D. Kidney disease
E. All of the above
A

E. All of the above

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2
Q

Hypertension is also known as the “____”. Why?

A

“Silent killer” due to few symptoms

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3
Q

Characterized by severe headaches, nausea or vomiting, confusion, changes in vision, and nosebleeds

A

Severe acute hypertension

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4
Q

What are the risk factors for elevated blood pressure?

A

Age, race, weight, family history

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5
Q

Variables affecting BP

A
  1. Diet/exercise
  2. Anxiety/stress
  3. Posture
  4. Diurnal variation
  5. Bladder distension
  6. Tobacco
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6
Q

What is essential hypertension?

A

When the cause is unknown. This is the majority of HTN incidence: 90-95%

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7
Q

When taking blood pressure, how many measurements should you take and how long between the measurements should you wait?

A

Take 2 blood pressure measurements at least 2 minutes apart

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8
Q

Which reading is the more important finding related to stroke & heart attack?

A

The systolic reading

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9
Q

What is normal BP?

A

Systolic: <120
AND
Diastolic: <80

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10
Q

What is elevated BP?

A

Systolic: 120 - 129
AND
Diastolic: <80

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11
Q

What blood pressures would classify stage 1 hypertension?

A

Systolic: 130 - 139
OR
Diastolic: 80 - 89

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12
Q

What blood pressures would classify stage 2 hypertension?

A

Systolic: > or equal to 140 OR
Diastolic: > or equal to 90

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13
Q

How would you categorize the following BP measurement: 122/79?

A

Systolic is between 120 - 129, which is considered elevated. Diastolic is 79 which is considered normal.

BP is elevated.

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14
Q

How would you categorize the following BP measurement: 116/86?

A

Systolic is < 120 which is normal. Diastolic is between 80 - 90.

BP is stage 1 hypertension.

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15
Q

True or false:
Individuals with systolic blood pressure (SBP) and diastolic blood pressure (DBP) in 2 categories should be designated to the higher BP category.

A

True

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16
Q

Not all BPs that are elevated are bad.

Give an example of when the above is true.

A

People who have had a stroke. We want them to have good oxygen getting to their brain (i.e., good perfusion), and an elevated BP does that.

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17
Q

What are the two branches of Hypertensive Crisis?

A
  1. Hypertensive urgencies

2. Hypertensive emergencies

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18
Q

What distinguishes a hypertensive urgency from a hypertensive emergency?

A

In hypertensive emergencies, associated signs or symptoms of target organ damage (TOD) is present.

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19
Q

What characterizes hypertensive urgencies?

A

Upper level of stage II HTN (>180/120) and ABSENCE of TOD

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20
Q

What characterizes hypertensive emergencies?

A

Upper level of stage II HTN (>180/120) and PRESENCE of TOD

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21
Q

Provide examples of target organ damage (TOD)

A

a. Acute ischemic or hemorrhagic stroke
b. Acute myocardial infarction
c. Acute heart failure
d. Acute renal failure
e. Papilledema
f. Cotton wool spots, hemorrhages, exudates
g. ***Vitreous hemorrhage

22
Q

What is papilledema?

A

The swelling of the optic nerve due to pressure build up in the head.

23
Q

If a patient answers “yes” to experiencing shortness of breath, dizziness, disorientation OR if you see papilledema, what is this considered?

A

Hypertension emergency. The patient is at imminent risk of a heart attack.

24
Q

You are seeing a patient and their BP reading is >180/110 mmHg.

What type of HTN is this considered and what treatment timeline do you provide?

A

Systolic equal to or greater than 140 OR diastolic equal to or > 90 is considered stage 2 hypertension (severe HTN).

The treatment timeline would be see PCP to get BP under control within 3 to 7 days.

25
Q

You are seeing a patient and their BP reading is > 180/120 mmHg. The patient denies headaches, dyspnea, and you do not see peripheral edema.

What type of HTN is this considered and what treatment timeline do you provide?

A

BP > 180/120 is considered a hypertensive crises. This patient denies symptoms associated with target organ damage, and there are no signs of it either. This is a hypertensive urgency.

The treatment timeline would be to consult PCP and get BP under control within 24-72 hours.

26
Q

You are seeing a patient and their BP reading is > 180/120mmHg. The patient complains of chest pain, severe dyspnea, headaches, and you observe papilledema.

What type of HTN is this considered and what treatment timeline do you provide?

A

BP > 180/120 is considered a hypertensive crises. This patient confirms symptoms associated with target organ damage, and there are signs of papilledema. This is a hypertensive emergency.

The treatment timeline would be go to the ER - emergent care needed as patient needs BP reduced immediately.

27
Q

I have a patient with BP in clinic SBP > 180 or DBP > 120. What do I do next?

A

Ensure you check with manual (automatic BP cuff alone is NOT acceptable).

Check manual BP a 2nd time to verify.

28
Q

I have a patient with BP in clinic SBP > 180 or DBP > 120. What symptoms do I check/ask for?

A

+/- headaches
+/- dyspnea (difficult/labored breathing)
+/- peripheral edema
+/- chest pain
+/- neurological deficit (altered state/disorientation)

29
Q

I have a patient with BP in clinic SBP > 180 or DBP > 120. What signs do I look for?

A

+/- papilledema (*)
+/- cotton wool spots
+/- intraretinal hemorrhages

Note: If the patient confirms any symptoms OR if papilledema is seen, it is a hypertension emergency.

30
Q

How is BP documented?

A
  • Systolic/diastolic
  • Time
  • Right arm or left arm
  • Posture: sitting, standing, or lying down
  • Location (arm, wrist)
  • Automatic/manual

For example:
118/75mmHg 11:30 AM, RAS manual
- RAS = Right Arm Sitting

31
Q

Ventricular contraction

A

Systole

32
Q

Ventricular relaxation

A

Diastole

33
Q

Heart sounds: “Lub”

Describe what is happening.

A

The AV valves are closing.

This is the first sound heard.

34
Q

Heart sound: “Dub”

Describe what is happening.

A

The semilunar valves are closing.

This is the second sound heard.

35
Q

What are the sounds heard during the measurement of blood pressure called?

A

Korotkoff sounds

36
Q

Are Korotkoff sounds the same as ‘lub’ and ‘dub’?

A

No.

37
Q

Explain phase 1 of Korotkoff sounds

A

Phase 1 = systolic pressure

  • Onset of tapping
  • The sound is the flow of blood from under the narrowed artery under the cuff to the wider artery distal to the cuff
38
Q

Explain phase 2 of Korotkoff sounds

A
  • Murmur/swishing

* Arterial wall vibration

39
Q

Explain phase 3 of Korotkoff sounds

A
  • High pitched tapping/knocking sound
40
Q

Explain phase 4 of Korotkoff sounds

A
  • Muffling/swishing of sound
41
Q

Explain phase 5 of Korotkoff sounds

A
  • Disappearance of sound = diastolic pressure

- 2mm below last sound heard

42
Q

What are some techniques you can employ to get enhancement of Korotkoff sounds?

A
  1. Raise the arm before inflating the cuff, then brining the arm to the usual position to continue BP measurement.
    - This drains the venous blood from the forearm.
  2. Having the patient make a fist 8-10x after cuff inflation and before deflation
  3. Inflate the cuff rapidly
    - The veins are cut off first
43
Q

Describe proper technique in taking BP.

A
  1. Select the proper cuff size
  2. Inflate the cuff to 200 mmHg
  3. Create a slow steady air release
  4. Do not re-pump up the cuff 1/2 way down
  5. Record
    - Time
    - Arm
    - Body position
44
Q

What is auscultatory gap?

A

Some patients (HTN) will have a sound-free period between phases 1 and 2

     240 (phase 1, SBP)
       |
       |
     220 
       .
       .   (auscultatory gap)
       .
       |
       |   (phases 2-5)
       |
45
Q

How do we avoid an auscultatory gap?

A
  • Palpate the radial pulse (by the thumb) while inflating the cuff until the pulse disappears
  • Note the pressure when this happens
  • Continue to inflate 30mmHg above this value
  • Deflate the cuff and note when the pulse returns (palpable systolic BP) and continue to deflate
  • Wait 15-30 seconds
  • Take the measurement in the usual manner but inflate the cuff 30mmHg above the palpable systolic BP
46
Q

You are checking BPs manually and notice an auscultatory gap. You proceed to palpate the radial pulse. What do you do after?

A

Take a 2nd BP measurement manually, but this time inflate the cuff 30mmHg above the palpable systolic BP from the previous measurement.

47
Q

BP Tips

A
  • Let air out 2-3 mmHg/sec
  • Record in even numbers
  • Avoid bunching of clothing
  • Fully expose the upper arm
  • Support the forearm at the level of the heart
48
Q

What is hypertension a disease of?

A

Of larger blood vessels

49
Q

What does HTN result in?

A
  • Occlusion/infarcts in vessels

* Hemorrhage/leakage onto retina

50
Q

Ocular characteristics of hypertensive retinopathy

A
  • Decrease in A/V ratio
  • From 0.7 to 0.4
  • Change in vessel color due to wall thickening
  • Appearance of copper or silver vessels due to hardening
  • Arteries cross over veins (AV crossings)
  • Hemorrhages
51
Q

What shape are ocular hemorrhages caused by HTN?

A

Flame shaped

Ocular Pathophysiology (4 decks)

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