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24 Cards in this Set
- Front
- Back
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what is a HTN emergency
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1. Endo Organ damage
Brain- altered mental status Kidney- Heart- 2. Rapid elevation in BP 3. diastolic >115 |
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what is HTN urgency
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more common than an Emergency
NO end organ damage (kidney, brain, heart) diastolic >115 (same as emergency) |
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what are the CNS signs that indicate end organ damage in HTN
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1. ALTERED MENTAL STATUS
2. headache 3 vision change 4. nausea/vomit WIll find: 1. Blindness 2. CN dysfx 3. Aphasia |
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what are some signs/sx that indicate end organ damage of the heart (end organ damages caused by HTN)
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not as common end organ signs as the altered mental status
1. angina 2. MI 3. CHF 4. SOB 5. dyspnea 6. orthopena 7. peripheral edema 8. JVD 9. PND (Paroxysmal nocturnal dyspnea) 10. cardiac enzymes |
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what indicated end organ renal damage
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1. hematuria/protenuria
2. problems urinating 3. decreased output 4. flank pain 5. BUM/Creatinine in BMP (basic metabolic panel) 6. renal insufficiency 7. microalbumin |
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what are some good meds to give pretty much everyone, they wont really hurt ya
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1. O2
2. IV fluids |
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HTN can cause:
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1. stroke
2. CHF 3. Peripheral vascular disease 4. sudden death 5. MI |
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we know we cant just take BP once and call it HTN if its like 140/95, is there ever a time we can dx HTN after 1 reading
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if >180 >110 OR end organ damage
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why might you get a false + HTN reading
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wrong cuff, improper technique
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is there end organ damage in essential HTN? urgency?
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nope, end organ is only in HTN EMERGENCY
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what is MAP?
calc if BP is 200/120 what is normal limits |
Diastolic + (syst -diastolic)
______________ 3 200/120 is HTN, MAP is 120+ (200-120)/3 = 147, WNL Normal is 50-150 |
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HTN can be 2 to a disorger that what?
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increases CO or TPR
CO= HR x SV MAP= D+ (S-D)/3 |
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what systems are affected by HTN
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1. Brain
2. heart 3. Kidney 4. endocrine |
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why might someone with HTN have altered mental status. whats the physio behind it? what is the presentation
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Cerebral hyperperfusion leads to dilated arterioles, the brain cant hands the increase in pressure, the BBB breaks down, intracranial pressure increases and prevents new blood- decreased cerebral blood flow
Pt presents: headache, nasuea, comit, Doc Finds: focal neurlogic defects, blindness, CN dysfx, aphasia, hemiparesis (1 sided mm weakness) |
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If pt presents...
Altered mental status, headache, blindness and doc finds... CN dysfx, aphasia, 1 side of body weak whats the deal? what do you need to be cautios of |
CNS involvement of HTN
**dont bring MAP down too fast, it can decrease cerebral perfusion and your pt can stroke out (brain autoregulates when MAP changes) seen in: old ppl with carotid stenosis chronic HTN |
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why be careful to bring HTN down slow if its really high?
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bs of the brains autoregulation- pt may decrease cerebral BF and stroke out
**especially risky in 1. ppl with chronic HTN 2. old 3. ppl with severe carotid stenosis |
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if an EKG shows ischemia w/o injury (ischemia- T inversion, injury- ST change) and they have angina what can it be
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end organ cardio damage by HTN emergency
**pt may have CHF, MI SOB, dyspnea, orthopenia, PND (cant breath in middle of night), peripheral edema. PE: increase RR, rales, JVD, gallop heart |
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what are the changes in the fundus in acute HTN, chronic
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Acute: paplilledema, fundal hemmorage, vasospasm
Chronic: AV nicking, silver wiring, arterioler aneurysms, cotton wool exudates |
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if you see cotton wool and silver wire on fundus what are you thinking?
how would your thinking change if you saw papliedema and fundal hemmorage |
Chronic: also see AV nicking, arterioler aneurysm
Acute: also see vasospasm |
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if your pt has 200/120 and has serum creatinine >1.5 and protenuria 1+ what will you do
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HTN EMERGENCY
*these are signs of end organ damage of HTN (renal) **also will have hematuria and microalbumin |
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in the case what were the things that led us to believe it was urgency rather than emergency? why could we dx HTN even though we just took BP once
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No endo rogan damage
CNS: normal mentation, neuro exam normal. AV nicking CV: no angina, SOB, peripheral edema, pulse was equal, no EKG change. CXR- clear, no pulm edema, aneurysm, coarctation GU- no protein or blood **can make dx bc >115 is stage 3 so we can do it |
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what is essentail HTN
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no underlying cause, most ppl have essentail
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so if essential HTN is HTN w/o underlying cause, what are some underlying causes of HTN
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1. Chronic Renal Disease
2. Renal A stenosis 3. Pulmonary Aldosteronism 4. Coarctation of the Aorta 5. Cushingg's Syndrome (increase cortisol) 6. Pheochromocytoma 7. Drug induced |
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how should we treat HTN urgency
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decrease BP slowly
- monitor close for 2 weeks then can go 3 months |
