Cardiovascular system part 3 Flashcards
Hypertension
Definition: Abnormally high arterial blood pressure (anything over 140/90- systolic/diastolic)
Manual BP: the cuff is compressed thereby compressing the artery as the cuff pressure is released the artery is auscultated or listened to and the first number or the systolic measurement is the pressure within the artery at which blood first flows through the cuff pressure continues to release until the artery is completely relaxed the sounds disappear and this number the diastolic is the pressure within the artery at rest
-measured in millimeters of mercury
“Vascular” Hypertension
Hypertension (140/90) is classified as either primary or essential and secondary meaning caused by another disease, 95% of all cases of hypertension are essential hypertension that means there is no underlying cause of the high blood pressure and a smaller percentage of cases high blood pressure is caused by some other disease.
Anesthetic management of hypertensive patients
-preoperatively when we see a patient who has documented high blood pressure we must first determine the adequacy of control
-next we have to review the anti-hypertensive medication’s the more medication the patient is on the more difficult it is to control this patient’s blood pressure
-next we have to evaluate if the patient has any associated organ dysfunction, heart disease, kidney disease or orthostatic hypertension where the blood pressure falls when the patient stands up.
other causes:
-be aware that this patient may also have atherosclerotic cardiovascular disease if the patient suddenly discontinued his medication, they can get rebound, hypertension or the blood pressure is higher than it normally is the patient may also have renal failure the kidneys and high blood pressure are closely intertwined the kidneys filter, blood through the arteries feed it. If the pressure within those arteries is too high, the kidney cannot fill the blood well high blood pressure can also cause the kidneys to fail. Also, the kidneys produce hormones that control high blood pressure when the kidneys fail they don’t produce the hormones and the patient’s blood pressure goes up , and finally there are cases of a rare adrenal tumor, called a chromocytoma that produce arise and blood pressure
control of Hypertension determines the safety of the procedure
treatment considerations
Control of the blood pressure determines a safety of the procedure a patient with well-controlled blood pressure can be managed like a normal patient. If the blood pressure is greater than 160/100 refer the patient to his physician before treatment if the diastolic is greater than 120 refer the patient for immediate treatment
therefore treating the hypertensive patient know the baseline blood pressure if the patient has a normal blood pressure 140/85 and elevated blood pressure enter operatively of 152/96 is not that big of a jump but if the normal baseline is 120/75 and intraoperative the monitor show 152/96 the difference is significant the cut offs are blood pressure greater than 160/110 or the diastolic greater than 120 set the limits for the treatment at what limit the procedure will be terminated. Stress reduction is important. Sometimes of light sedation is beneficial to reduce pressure consider using a local anesthetic without any epinephrine
anesthetic management of hypertensive patients
concerns
hypertensive crisis
hypertension-hypertensive crisis
symptoms
-during anesthesia expect somewhat exaggerated blood pressure changes during the patient’s course of treatment
-avoid myocardial, ischemia by adequate oxygenation, stress, reduction, and pain control
-critical elevations of blood pressure, increase the patient’s risk for hypertensive crisis or cerebral vascular accident commonly known as a stroke
- hypertensive crisis is defined as a sudden significant increase of blood pressure. The blood pressure may approach 240 to 250/140 at these pressures.
- The patient at risk for brain, heart and kidney failure and the patient makes a come to a stroke.
-The factors that contribute to the crisis include pain, anxiety, hypoxia hypercarbia, which is increased CO2 or cardiopulmonary compromise meaning, the pump action of the heart isn’t working adrenergic stimulation leads to vasal constriction tachycardia, and increased contractility of the heart through alpha and beta stimulation that’s why we continually monitor the patient’s blood pressure
-interoperative intervention should begin prior to reaching critical levels.
-If the patient is awake, he may complain of headache or dizziness treatment.
Treatment hypertension initial
hypertension prevention
-Treatment Includes terminating the procedure placing the patient in a comfortable position, and the clothing, pain control hundred percent oxygen and reassure the patient if he’s conscious
-medication used to treat her blood pressure targeted to two places, one dilating arteries, or vasodilation or two, decreasing the rate and the force of contraction by use of the beta blocker
-obviously, the goal would be to prevent such a crisis. This involves a thorough medical history note the multiple medication’s may indicate more difficult control and take note of the patient compliance.
-If there’s any doubt consult with the patient’s physician, be sure the patient continues to take his medication’s as scheduled. A lot of patients think that since they were instructed not to eat or drink anything they can’t take their medication. This is dangerous since the patient may experience rebound hypertension
-be sure to achieve good local anesthetic consider using local anesthetics without any vasal constrictor and again sedation may be a good option for this patient.
Cerebrovascular accident “CVA” stroke
-cerebral vascular accident, or CVA, commonly known as a stroke.
-There are two types of stroke, hemorrhagic or ischemic
-hemorrhagic refers to bleeding a vessel rupture and bleed it to the brain tissue itself, because the brain is in a confined space by the cranium, the ensuing blood clot, will cause pressure on the brain tissue.
-The word ischemia refers to lack of oxygen. This can result from obstructive blood vessel, if a plaque or clot, breaks off and travels to the brain, it can result in an ischemic stroke,
-whatever the reason the CVA indicates are areas of the brain that are deprived of oxygen
-true stroke is major, neurologic deficit, lasting greater than 24 hours
-there are smaller incidences called a transient ischemic attack TIA, which last last less than 24 hours commonly called a mini stroke
The warning signs of a stroke
How do you tell if the patients having a stroke? Remember the abbreviation fast
F- refers to face: sudden, numbness or weakness of the face usually in one side,
A- refers to arm: have the patient extend their arms straight out in front of them does one arm drift downward?
S-refers to speech: slurred is the patient unable to speak or hard to understand? Ask the person to repeat a simple sentence like the sky is blue. is a sentence repeated correctly? does the patient have sudden trouble walking, dizziness, loss of balance or coordination?
T refers to time it is a necessity to call 911 quickly time is of the essence
-The warning signs of a stroke include a sudden, severe headache. The patient says this is the worst headache of my life, and has sudden trouble seeing in both eyes.
CVA patients treatment considerations
-may be on anticoagulants (coumadin, plavix, ASA)
-lipid lowering drugs- reduce plaque formation (ex lipitor)
-need to keep blood pressure “normal”
