michigan hypertension core curriculum - State of Michigan

More documents

Recommendations

Info

10 Hypertension Core Curriculum Blood Pressure Measurement Rosalind Peters PhD, RN and Velma Theisen MSN, RN Objectives: At the end of this module, participants should be able to: 1. Describe the strengths and limitations of different methods of measuring BP. 2. Describe the steps necessary to ensure accurate measurement of BP in accordance with national guidelines. 3. Identify resources and references related to accurate home BP measurement. Pre-Test questions: 1. The point at which the diastolic BP is recorded is a. the point where the sounds become muffled b. the last regular sound you hear c. the point where no sound is heard d. two millimeters below the last sound heard 2. The point at which the SBP is recorded is a. the point where the sounds are loudest b. the first sound you hear c. the point where the first of two consecutive sounds are heard d. two millimeters after the first sound heard 3. The correct cuff size for an individual is determined by a. the individual’s age b. the size of the arm circumference c. the weight of the individual d. the body mass index of the individual 4. Evaluating the accuracy of the BP measurement device should be done a. every 3 years b. only when you suspect it might be inaccurate c. every 6 months d. every 12 months 5. Correct positioning the individual for BP measurement includes all of the following except a. seated with feet flat on floor and legs uncrossed b. back supported c. arm supported at heart level d. seated on the side of an exam table
Measurement Methods Early detection, treatment and control of hypertension require accurate blood pressure (BP) measurement. 1 This task, which too often is left to unlicensed assistive personnel, should be carefully done by the health care professional. Accuracy of measurement begins with understanding the three methods used to obtain a BP reading, and ensuring that the equipment to be used is accurate. The first method is auscultation with an approved and accurate BP device. The mercury sphygmomanometer is considered to provide the gold standard of BP measurement. However, due to concerns about environmental hazards these devices are being phased out, and in Michigan as of January 2009 mercury sphygmomanometers can only be used to check accuracy of other devices or used in a patient’s home. 2 As a result the mercury sphygmomanometers are being replaced with aneroid and/or oscillometric devices. Aneroid devices also use auscultation to detect blood flow through the artery. BP readings based on auscultation are subject to measurement error due to environmental factors (e.g., extraneous room noise), personnel factors (e.g., education, hearing ability, terminal digit preference), and device factors. Aneroid devices do not maintain stability over time and require frequent re-calibration (e.g., every 6 -12 months). The level of inaccuracy of BP measurements obtained with aneroid devices has been found to range from 1% to 44%. 3 To overcome the errors of auscultation, an ocillometric method may be used. The ocillometric method detects vibrations in the arterial wall that occur due to blood flow, and transforms the vibrations into an electrical signal which is displayed as a digital readout of BP. However, factors other than blood flow may affect the vibrations. Thus the oscillometric techniques will underestimate the true BP in patients with arterial stiffness or dysrrhythmias. 4 The ocillometric method has been used with a variety of measurement devices (e.g., upper arm, wrist, finger, and ambulatory devices). Automated upper arm devices that measure BP at the brachial artery have been shown to be reliable in clinical practice, and therefore their use is recommended over wrist or finger devices. Finger devices are not recommended due to inaccuracies related to peripheral vasoconstriction, alteration in BP at distal sites, and the error of limb position in relation to the heart during measurement. 4,3 Wrist devices are increasingly being used especially with obese people since the diameter of the wrist is usually not affected by obesity. However, wrist devices are subject to the same errors as finger devices, with the addition of altered readings due to the flexion/ hyperextension NKFM & MDCH 11
Page 1: MICHIGAN HYPERTENSION CORE CURRICUL
Page 4 and 5: April 2010 Dear Colleague: In 2005,
Page 6 and 7: Kevin L. Piggott, MD, MPH, FAAFP Pr
Page 8 and 9: Blood Pressure Measurement........
Page 12 and 13: of the wrist. Additionally, there i
Page 14 and 15: asis. National guidelines recommend
Page 16 and 17: Post-Test Questions: 1. High BP is
Page 18 and 19: 18 Hypertension Core Curriculum Ess
Page 20 and 21: Masked Hypertension is when the off
Page 22 and 23: TABLE 1. Prevalence of Awareness, T
Page 24 and 25: Blood Pressure, Circulatory Physiol
Page 26 and 27: side of the vascular tree. Arterial
Page 28 and 29: upon the other co-morbidities prese
Page 30 and 31: Table 3. Clinically Available Clues
Page 32 and 33: In the setting of chronic hypertens
Page 34 and 35: 34 Hypertension Core Curriculum Tab
Page 36 and 37: cause greater disruption of CBF aut
Page 38 and 39: References/Suggested Reading Agabit
Page 40 and 41: 40 Hypertension Core Curriculum Chr
Page 42 and 43: development of essential HTN can se
Page 44 and 45: Figures: Figure 1. Pie-chart with m
Page 46 and 47: Table 2 Table 3 Screening Test for
Page 48 and 49: References: 1. U.S. Renal Data Syst
Page 50 and 51: 50 Hypertension Core Curriculum Spe
Page 52 and 53: side effects particularly well. A h
Page 54 and 55: 14. Gaede P, Vedel P, Larsen N, Jen
Page 56 and 57: Learning Objectives: 56 Hypertensio
Page 58 and 59: glycemic risk factdors such as hype
Page 60 and 61:
. Weight loss c. Weight gain d. A a
Page 62 and 63:
References: 1. Association AD. All
Page 64 and 65:
64 Hypertension Core Curriculum Spe
Page 66 and 67:
foods and turn out of necessity to
Page 68 and 69:
Figure 1: Table 1. Metabolic Syndro
Page 70 and 71:
9. Singh GK, Kogan MD, Van Dyck PC,
Page 72 and 73:
Incidence and Prevalence The overal
Page 74 and 75:
access to healthy foods than their
Page 76 and 77:
As a part of the approach to managi
Page 78 and 79:
B Hypertensive Adults (rate, percen
Page 80 and 81:
References: 1. Lewington S, Clarke
Page 82 and 83:
82 Hypertension Core Curriculum
Page 84 and 85:
appear to be related to access to c
Page 86 and 87:
CDC MMWR Feb 24, 2006/55(07); 177-1
Page 88 and 89:
Figure 1; Clinical presentation and
Page 90 and 91:
90 Hypertension Core Curriculum Phe
Page 92 and 93:
ANY patient, who develops paroxysma
Page 94 and 95:
Figure 1: 94 Hypertension Core Curr
Page 96 and 97:
Objectives: 96 Hypertension Core Cu
Page 98 and 99:
Definition Prevalence Clinical Feat
Page 100 and 101:
intake. 4 Figure 1; Ion transport i
Page 102 and 103:
loading with 200 mmoles (4.6 grams)
Page 104 and 105:
Figure 3; Endocrine Society See tex
Page 106 and 107:
INTRODUCTION 106 Hypertension Core
Page 108 and 109:
Renal manifestations. Renal ischemi
Page 110 and 111:
to assess renal dimensions and dupl
Page 112 and 113:
stenosis severity. Patients with no
Page 114 and 115:
ARAS, ischemic nephropathy, and imp
Page 116 and 117:
the goals of minimizing injury to t
Page 118 and 119:
hemodynamically impaired renal arte
Page 120 and 121:
e classified as having “renovascu
Page 122 and 123:
disease of the abdominal aorta and
Page 124 and 125:
Table 1. Contemporary evaluation of
Page 126 and 127:
2. Screening tests for RAS RDU, MRA
Page 128 and 129:
Manifestations of vital organ injur
Page 130 and 131:
Table 6. Clinical evaluation of ren
Page 132 and 133:
Table 9. Assessment of worsening re
Page 134 and 135:
Table 11. New terminology for renal
Page 136 and 137:
References: 1. Murphy TP, Soares G,
Page 138 and 139:
2001;12(6):1235-1241. 40. Subramani
Page 140 and 141:
78. Tami LF, McElderry MW, al-Adli
Page 142 and 143:
142 Hypertension Core Curriculum Pr
Page 144 and 145:
monitored hypertension screening an
Page 146 and 147:
Policy Development: Public health p
Page 148 and 149:
Med Clin North Am. Jan 2004;88(1):2
Page 150 and 151:
mind they will have no problem iden
Page 152 and 153:
Role of Race in the Selection of An
Page 154 and 155:
individuals of any race or ethnicit
Page 156 and 157:
Older Patients Need Elevated Systol
Page 158 and 159:
sister, mother and father. A family
Page 160 and 161:
ecause pressure-related retinopathy
Page 162 and 163:
pulses (lower in the left arm). 4 C
Page 164 and 165:
Vital signs suggestive of OSAHS. 20
Page 166 and 167:
may shed light on underlying medica
Page 168 and 169:
References: patients. 8 However, th
Page 170 and 171:
Objectives: 170 Hypertension Core C
Page 172 and 173:
and evidence that anti-hypertensive
Page 174 and 175:
When subjects are given instruction
Page 176 and 177:
interestingly found only a 6.0/4.6
Page 178 and 179:
pressure: a meta-analysis of random
Page 180 and 181:
isolated systolic hypertension have
Page 182 and 183:
Compelling Indications for Specific
Page 184 and 185:
3.) Beta-blockers, ACE inhibitors,
Page 186 and 187:
treatment levels - albeit though at
Page 188 and 189:
Preparations and Dosage: Oral antih
Page 190 and 191:
Preparations and Dosages: The Oral
Page 192 and 193:
patients with tachy-brady syndrome
Page 194 and 195:
significant proteinuria. Pharmacolo
Page 196 and 197:
the effect found by the ACE inhibit
Page 198 and 199:
and nominally statistically signifi
Page 200 and 201:
sensitive K+-channels in vascular s
Page 202 and 203:
clonidine (Catapres†) 0.1-0.8 mg
Page 204 and 205:
Learning Objectives 204 Hypertensio
Page 206 and 207:
general, the response to beta-block
Page 208 and 209:
Table 2: (JNC VII, 2004) 208 Hypert
Page 210 and 211:
Learning objectives: 210 Hypertensi
Page 212 and 213:
ecently published RCT investigated
Page 214 and 215:
Post-test question: 35y/o male w/ h
Page 216 and 217:
Orthostatic Hypotension Pretest que
Page 218 and 219:
BP. It is important to note that la
Page 220 and 221:
1- Fludrocortisone : a mineralocort
Page 222 and 223:
References: 1. Hiitola P, Enlund H,
Page 224 and 225:
www.neuroanatomy.wisc.edu/.../Image
Page 226 and 227:
Learning objectives: 226 Hypertensi
Page 228 and 229:
controlled BP to have been victimiz
Page 230 and 231:
Treatment of Secondary Causes of Hy
Page 232 and 233:
4-Direct vasodilators (e.g.minoxidi
Page 234 and 235:
Hypertension. Aug 2003;42(2):161-16
Page 236 and 237:
emergency by virtue of the associat
Page 238 and 239:
PATHOPHYSIOLOGY The underlying mech
Page 240 and 241:
trials included a placebo arm. Seve
Page 242 and 243:
an indication for careful and modes
Page 244 and 245:
ACUTE KIDNEY INJURY (AKI) In additi
Page 246 and 247:
Blood Pressure Research Council, an
Page 248 and 249:
[ACE inhibitors (ACEIs), angiotensi
Page 250 and 251:
y sodium restriction or the use of
Page 252 and 253:
44 months 24 , and were also seen i
Page 254 and 255:
• Hypertension in dialysis patien
Page 256 and 257:
GISEN Group (Gruppo Italiano di Stu
Page 258 and 259:
258 Hypertension Core Curriculum
Page 260 and 261:
DEFINITION AND CLASSIFICATION Hyper
Page 262 and 263:
etween adult socioeconomic position
Page 264 and 265:
women treated with atenolol in earl
Page 266 and 267:
Obstet Gynecol. Dec 12 2008. 5. Vol
Page 268 and 269:
able to dissipate the pressure rise
Page 270 and 271:
Use of Dihydropyridine Calcium Anta
Page 272 and 273:
272 Hypertension Core Curriculum Ca
Page 274 and 275:
Case 4 Hypertensive patient with CK
Page 276 and 277:
Case 6 276 Hypertension Core Curric
Page 278 and 279:
year. Sodium restriction and weight
Page 280:
What may be causing these new sympt
show all

michigan hypertension core curriculum - State of Michigan

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?