Lecture 4 - Blood Pressure, Pain Assessment, Nutrition, Violence Flashcards
Describe diastolic and systolic pressure/
Systolic
–> Max pressure on arterial wall during left ventricular contraction (120)
Diastolic
–> Constant pressure blood exerts on arterial walls between contraction (80)
What is Pulse Pressure?
aka Stroke Volume.
Difference between systole and diastolic pressure
What is MAP (Mean Arterial Pressure)?
The pressure propelling blood into tissues averaged over cardiac cycle
Which five factors impact BP?
- Peripheral vascular resistance (vasodilation)
- Cardiac output
- Blood volume
- Blood viscosity
- Elasticity of vessel walls
How does old age affect BP?
Blood pressure rises with age because older adults have less elasticity in BVs. However, if a patient exhibits higher than normal BP, you must assess to determine if it is a pathological issue or normal to aging.
How does sex/hormones affect BP?
Females have lower BP after puberty, and higher BP after menpause
Describe the fluctuation of BP throughout the day
BP is highest first thing in the morning and lowest in the evening
Which medications will increase BP?
Stimulants, nicotine, and some cough and cold medications
Which foods increase BP?
Black licorice, salty + sugary foods, fried foods (related to obesity)
What are the eight steps to taking someone’s BP?
- Correct positioning
- Choose the right cuff (should cover 80-100% of arm length)
- Palpate brachial artery
- Wrap cuff around the arm
- Inflate cuff an additional 30mmHg above where the brachial pulse is extinguished
- Place stethoscope over the brachial artery
- Slowly deflate the cuff
- Note the first sound (systolic) and the last sound (diastolic)
What do you do if one arm has a BP >10mmHg than the other?
Use the arm with the higher BP, as it is a more reliable measurement of circulation in the extremities
What is Orthostatic Hypotension?
Fluctuations (or drops) in blood pressure associated with changes in position or posture?
What BP fluctuations are interpreted as orthostatic hypotentsion?
–> A decrease of systolic pressure less than 20 mmHg
–> A decrease in diastolic pressure less than 10 mmHg
–> An increase in pulse of over 20 bpm
What should you verify is you suspect a patient has orthostatic hypotension?
–> if volume is depleted
–> is the patient has known HTN or any new anti-HTN meds
–> A history of presyncope of syncope
How do you assess for orthostatic hypotension?
Ask patient to remain supine for 2-3 minutes, take baseline HR and BP.
Repeat measurements while sitting and standing.
What is considered hypotension?
When pressure drops below 95/60.
What are signs and symptoms of hypotension?
Pallor, dizziness, confusion, tachycardia
What are some possible causes for hypotension?
Vasodilation, hemorrhage, acute myocardial infarction.
May indicate a state of shock - this is life threatening
What is considered hypertension?
130/80-89 (I)
140/90 (II)
Acutely high BP can lead to hemorrhagic stroke
What is considered elevated bp?
120-129/80
Where do spinothalamic pathways, such as nociception, decussate?
Within the spinal cord before heading towards medulla –> thalamus –> cortex
What are the four phases of nociception?
- Transduction
- Transmission
- Perception of Pain
- Modulation (pain is blocked by endogenous opioids, enkephalins, GABA, NE)
What are the three classes of pain?
- Nociceptive
–> Can be somatic or visceral - Neuropathic
- Both
At what point is pain considered chronic?
After it has been present for over 6 months
What is the difference between malignant and nonmalignant chronic pain?
Malignant - related to stretching or necrosis of tissue due to a growing tumor
Nonmalignant - related to an MSK condition
What is referred pain?
Visceral pain being perceived by the body as being elsewhere because they share a nerve group.
When can a fetus feel pain?
At 20 weeks of gestation
Which chronic pain disorders are women more likely to face?
–> Fibromyalgia
–> Migraines
–> IBS
Which chronic pain disorders are men more likely to experience?
–> Ulcers
–> Cluster headaches
–> Gout
Those in acute pain are more likely to be at risk of undertreatment. Why?
A nonverbal, but cognitively intact person in unable to communicate by word, but you must provide them with other options
Those with chronic pain are more likely to be at risk for underdetection of pain. How can this be combatted?
Ask about pain and coping mechanisms directly
Who is at risk of having their pain be underdetected and undertreated?
Those who are unconscious
What two additional questions should you ask someone with chronic pain on top of the PQRSTU?
O - Onset of pain
V - Value of pain to patient, as well as how it affects their daily living.
Which supplement should all Canadians be taking?
Vitamin D
What are the four comprehensive nurtitional assessments?
–> 24 hour Recall
–> Food Diary
–> Food Frequency Questionnaire
–> Direct Observation
What are the four steps to trauma and violence informed care?
- Assume the majority of patients have a history of abuse or might currently be experiencing abuse
- Know that all forms of abuse are abuses of power
- Anticipate what might be traumatizing
- Routine screening of impact of home and work on health
Which kind of impulses do Aδ and C Fibers carry to the CNS?
Aδ Fibers
–> Myelinated and large in diameter
–> Localized, rapid, short-term, sharp sensations
C Fibers
–> Unmyelinated and smaller in diameter
–> Diffuse and aching sensations
What kind of pain are men more likely to experience?
Cluster Headaches, gout, coronary artery disease, duodenal ulcers
