Lecture 12: hypertensive urgency & emergency
What 4 other symptoms to hypertensive emergency
1. Altered consciousness 2. Visual loss 3. Seizure 4. Nausea/vomiting
What is an untreated HTN at risk for? list 3 conditions.
1. CVD 2. CVA 3. Kidney damage
List 3 ways degeneration of cerebral BV affects the BV.
1. Damages inner lining 2. Causes weakened walls 3. Weak areas trap lipids (cholesterol)
List the 3 symptoms of orthostatic hypotension
1. Dimming of vision 2. Decreased hearing 3. Lightheadedness
List 6 symptoms of hypertensive urgency
1. Headache (mod-sev) 2. Anxiety 3. Shortness of breath 4. Tinnitus 5. Edema 6. Epistaxis (bloody nose)
List the 2 types of hypertensive crisis
1. Hypertensive urgency 2. Hypertensive emergency
List the 3 steps to proceed if patients blood pressure remains at stage 2 and have been retaken.
1. New patient needs medical consult 2. Refer to MD 3. Non invasive procedures ONLY
List the 5 steps of protocol/treatment for orthostatic hypotension
1. Position supine with feet raised (trendelenburg) 2. Assess airway 3. Administer 4-6 L/min of O2 4. Monitor vital signs every 5 minutes 5. If no improvement, contact EMS
List 4 etiologies of orthostatic hypotension
1. Prolonged supine positioning 2. Illness 3. Medications (anti-hypertensives) 4. Normally hypotensive individuals
List the 3 steps to proceed if patients blood pressure returns to normal after stage 2 reading.
1. Recommend stress reduction protocols 2. Advise lifestyle changes 3. Caution with Epi
List the treatment protocol of hypertensive urgency in Dental office
1. Seat patient upright 2. Recheck BP in 5 mins 3. Immediate medical consultation 4. Refer to ER/urgent care 5. Contact EMS if needed 6. Monitor BP every 5 mins 7. Administer 4-6L/min of oxygen if pt complains of dyspnea 8. Document 9. NO future dental treatment without medical clearance
List 3 reason why orthostatic/postural hypotension might occur.
1. Sudden drop in BP due to change in body position 2. Usually from supine to upright/standing 3. Dizziness or loss of consciousness may occur
List 5 symptoms of hypertensive emergency
1. Sudden increase in BP 2. Dyspnea 3. Chest pain 4. Dysarthria - difficulty speaking 5. weakness
What is the treatment protocol for hypertensive emergency in dental office.
1. sit patient upright 2. contact EMS 3. Monitor vital signs 4. Administer 4-6 L/min of oxygen
What values are considered HTN?
130/80 or higher
How does HTN affect cerebral blood vessels?
Degenerates
Hypertension (HBP) (HTN)
Disorder characterized by blood pressure (BP)
True/False. you should dismiss a patient with stage 1 HTN.
False, just refer to MD
True/False. Stage 2 HTN is considered controlled HBP.
False, uncontrolled
What is the treatment protocol for hypertensive emergency in general?
Treat end organ damage BLS or CPR(if needed)
List the stages and values of all BP.
Normal- less than 120 AND less than 80 Elevated- 120-129 AND less than 80 Stage 1- 130-139 OR 80-89 Stage 2- 140< OR 90< Stage 3 (crisis)- 180< OR 120<
For each 10 mmHG increase in systolic BP above 160 is at greater risk for CVA by how much?
30%
How many Americans are affected by HTN?
60 million
What % of Americans are unaware that they have HBP?
70%
What can someone with elevated BP do to reduce?
Lifestyle changes
True/False. Elevated BP is at risk of progression to HBP
True
True/False. Hypertensive emergency symptoms are similar to MI or CVA
True
What do those lifestyle changes include? list 5
Weight reduction Sodium reduction Exercise Moderate alcohol consumption Diet rich in fruits, vegetables, and low diary products
