Hypertension & Taking Blood Pressure Flashcards
What are possible complications of hypertension?
Angina (restricted blood to heart muscle) MI Heart failure Stroke Peripheral vascular disease Kidney damage Eye damage
What are the implications for hypertension diagnosis?
No cure - lifelong treatment, usually controlled by 2 or more meds
Many treatments = side effects and interactions
Increased cost to individual and NHS - regular monitoring and blood tests
Can patients with irregular heart beats e.g. atrial fibrillation use automatic monitors?
No - need auscultatory method
List the risk factors for high BP and heart disease
Family history High cholesterol, high LDL High triglycerides, low HDL Smoking Atheromatous arteries Aging Male High alcohol levels Obesity Exercise lack Ethnicity Diabetes Poor diet (high in salt/fat)
What is the procedure for taking blood pressure?
1) Explain what and why (informed consent)
2) Wash/ decontaminate hands
3) Patient seated comfortably (sitting quietly 5 mins before), arm free of constrictive clothing and supported at heart level
4) Wrap cuff around upper arm with bladder centre over brachial arterty. Cuff must circle 80% of arm (can position cuff so tubing comes from top to avoid noise from the tubing bumping against the stethoscope being confused with arteroid sounds)
5) Palpitate brachial/radial pulse and inflate cuff until pulse disappears - note readings and + 30, remember, deflate
6) Position stethoscope over brachial artery, re-inflate cuff to level noted previously (if can hear tapping from brachial artery inflate cuff little more until it disappears)
7) Deflate cuff v. slowly and record reading when first hear pulse come back in = SYSTOLIC reading (Korotkoff I), record to nearest 2mm (NEVER ROUND UP/DOWN)
8) Keep deflating cuff slowly until tapping sound disappears/muffles = DIASTOLIC reading (Korotkoff IV or V)
9) Measure BP in both arms and record highest reading - always use this arm in future. If difference is 20mmHg or more report to nurse/doctor (may indicate subclavian stenosis)
10) Take second measurement from chosen arm (and 3rd if v. different). Record lower of last 2 as clinic reading
Why might elderly/diabetic patients need their BP checked again after 2 minutes of standing?
To check for postural hypotension (comman cause of falls in elderly). Still try and support arm at heart level so no muscular contractions in arm.
How do you use a digital/automatic monitor and what if ERROR is displayed?
Wrap cuff around upper arm and make sure no restrictive clothing and supported comfortably at heart level. Press record button and wait for cuff to inflate and deflate before recording. If ERROR (e.g. if patient has arrythmia) manual method must be used and doctor/nurse informed
