a nurse in a providers office is assessing a client who has hypertension and takes propranolol This is a topic that many people are looking for. bluevelvetrestaurant.com is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, bluevelvetrestaurant.com would like to introduce to you A Focus Series on Hypertension: Patient Assessment. Following along are instructions in the video below:
Thank you for joining us today. My name is kristen watson. Im an associate associate professor at the university of maryland school of pharmacy as part of our under a focus series on hypertension.
I will be talking about the patient assessment piece in this program. We are going to be talking about what assessment strategy should be taking when determining the etiology of hypertension. As well as identifying a patients risk factors for hypertension and their cardiovascular risk factors.
So that we can appropriately manage the patient and select the appropriate treatment option as we know primary or essential hypertension is the most common cause of hypertension among our patients. This is and when there is no identical identifiable cause for the patients hypertension this primary or essential hypertension gradually occurs over time. We also have known secondary causes of hypertension.
Its important to evaluate our patients for these secondary causes. Especially. When we see patients who have treatment resistant hypertension these secondary causes by treating them can potentially improve.
The control of a patients blood pressure causes of secondary hypertension can include the white coat phenomenon as many of us are familiar with this is when a patient presents to a clinic visit and their blood pressure is higher than what it is in their home setting. And that is because the blood pressure gets elevated potentially due to stress being in the office visit. This is because of this white coat phenomenon.
This has been a focus of using ambulatory care blood pressure assessments. When managing and treating hypertension to evaluate what the patients blood pressure is in their home setting. When theyre in that more relaxed environment as opposed to coming in clinic.
The ambulatory care blood pressure monitoring also give you more values than those isolated values. When a patient presents the clinic all their causes a secondary hypertension include chronic kidney disease. Renal artery stenosis obstructive sleep.
Apnea primary aldosterone isms and then other causes more rare cause. This is cushing syndrome. A pheochromocytoma and a ortak y tation.
We also need to look for potential causes of drug induced hypertension. So as part of any assessment that were doing with a patient. We should be doing a complete medication history including the use of prescription medications.
Over the counter medications as well as herbal products and illicit substances. By doing this we could potentially identify medications that may be leading to an increase in the patients blood pressure. Its important to note as we will discuss some of these medications while they may lead to drug induced hypertension.
We may not be able to take those medications off of the patients profile and may need to treat through that hypertension. One example that well discuss is the use of immunosuppressive therapy. Such as cyclosporine and tacrolimus patient can be on those medications post.
A transplant and if that medication is that medication as part of their regimen. We would not necessarily want to change the patients immunosuppression regiment rather.
We would want to go about treating the hypertension. So we can think of medications. So going through their complete medication regimen have listed here.
Several medications that can lead to drug induced. Hypertension. This includes.
Things such as oral contraceptive pills. Women who are over 35 have a history of family. Members developing hypertension on oral contraceptive therapy or at increased risk for this thats why is important in women who are on oral contraceptive pills that they have their blood pressure checked routinely to evaluate for potential hypertension.
Our mineralocorticoids and our corticosteroids can also lead to increases in blood pressure as well as use of medications. Such as phenyl afrin and epinephrine antidepressant. We know that venlafaxine and our tricyclic antidepressants can increase the blood pressure again if that blood pressure increases occurs we need to take a look at their medications their psychiatric history before determining what the best course of action to take with those medications as i mentioned before immunosuppressant therapies.
Such as cyclosporine and tacrolimus can lead to elevations in blood pressure with this like medication such as this again you may not have to be able to remove the offending cause. But you may need to go ahead and treat through that hypertension. But identifying that as identified as a potential cause is important to do we also know that a list of substances.
Such as cocaine and amphetamines can lead to hypertension in patients. So making sure we have a clear sense of what our page substances. Our patients are using.
And then also some herbal products have been associated with the development of drug induced hypertension. So making sure we get a clear sense of supplements that our patients are using. I always think its important when asking a patient about herbal products is to give them a list of names of herbal products that they may potentially be using to find out so they have a sense of what youre doing so asking them do tastings of just nate johns wort or licorice.
So that they have a sense of what herbal products are and which ones may potentially be a problem part of our work up for the management of hypertension includes the assessment of cardiovascular risk factors. Its important to identify these risk factors as one some of them may be modifiable. So we can use this to manage and potentially treat these risk factors to lower and operations overall risk of cardiovascular disease in addition to managing their hypertension.
We can also identify by doing this we can also identify the appropriate blood pressure goal for a patient as well as the appropriate selection of treatment to manage their hypertension. Some of our non modifiable risk factors for patients include a patients age and a family history. We know that patient who has a family history of premature cardiovascular disease is going to be at higher risk of developing a cardiovascular event as opposed to somebody without that premature risk.
We know that obesity is a risk factor for the development of hypertension. As well as a risk factor for the development of cardiovascular disease. But we also do know that weight loss is a potential treatment option for hypertension in those patients who are obese.
So by addressing this with our patient and potentially setting weight loss goals. We can help lower their with the potentially help lower their cardiovascular risk and potentially also help lower their blood pressure over time. We also need to look at whats the patients level of physical activity.
Our patients who are physically inactive. We know that they are at a higher risk for cardiovascular disease.
So incorporating an exercise regimen as part of a patients management for hypertension. We could potentially help them lose weight and overall improve their health status tobacco use is also a known risk factor for cardiovascular disease regardless. If were seeing somebody for hypertension for any other condition.
We always want to ensure that we are assessing for the use of tobacco and making attempts to help to assist the patient and talking to them and how we can help them achieve smoking cessation renal disease is another risk factor. We know that renal disease can lead to the development of hypertension. We want to and identifying renal disease or risk factors can be very important as were identifying the selection of treatment regimens for patients.
And what their blood pressure. Goal is going to be identifying and reviewing a patients cholesterol panel may be of help looking at patients risk factors and identifying if they qualify for an hmg coa reductase inhibitor or statin therapy is also beneficial to be part of our workup patients who qualify based on risk factors for statin therapy. The addition of the use of that in addition to controlling their hypertension can help reduce their overall risk heart attack or stroke.
And then finally its important to also identify if a patient has diabetes. If they have not been screened for diabetes in the past depending on the patient criteria. It would be important to have to have this screening occur again the comorbid condition of diabetes is going to dictate.
Which a therapy that the patient may receive for the treatment of hypertension as well as their potential blood pressure goal when encountering a patient was diagnosed with hypertension. We want to assess that they have already had any complications as a result of their hypertension by doing this one again can help us in determining the appropriate blood pressure goal for the patient and can also help us in determining which type of therapies. We have available and would like to use for sub patients.
I think also identifying the presence of complications for hypertension. If one has been identified its important for us to use that as our counseling points. As we are talking about the benefits of treatment of hypertension and how by treating and adequately controlling their blood pressure.
We can lower the risk of recurrent events. So what are these complications that we think of so we think of a patient. Which had they had a stroke in the past or a transient ischemic attack patients have retinopathy ensuring that if the patients have not had an ocular exam recently that we are setting them up to have that assess from a cardiac perspective.
We want to assess patients to determine if they have known heart failure due to have they had a myocardial infarction or do they have established coronary artery disease. We want to make sure that patients especially before beginning therapy. What is their renal function so determining to 10 7.
On patients will be very helpful so determining what their baseline renal function is as we initiate therapy. Because as we know some of our therapies can have the potential to affect renal function. So its good to have that baseline early on and its discussed previously.
We know that identifying a patient has chronic kidney disease. Thats going to probably lead us to pick one medication over another as our first line therapy. And many patients for the treatment of hypertension and then do patients have peripheral vascular disease.
So again a peripheral vascular disease. Or prefer arterial disease being a complication of long standing hypertension. So we want to make sure that we assess for this as part of our overall assessment of patients with hypertension.
The following our credit for the images that you saw use in this presentation. Thank you for joining us today. .
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