Possible Diagnostic Findings : Hypertension

  • Possible Diagnostic Findings
    • Abnormal serum electrolytes (especially potassium)
    • Increased BUN, creatinine, glucose, cholesterol, and triglyceride levels
    • Proteinuria, albuminuria, microscopic hematuria
    • Evidence of ischemic heart disease and left ventricular hypertrophy on ECG
    • Evidence of structural heart disease and left ventricular hypertrophy on echocardiogram; evidence of arteriovenous nicking, retinal hemorrhages, and papilledema on funduscopic examination
  • BP Measurement
    • Take in both arms initially
    • Proper size and placement of cuff
    • Can use forearm if needed
      • Document site
    • Assess for orthostatic hypotension
      • BP and HR supine, sitting, and standing
      • Measure within 1 to 2 minutes of position change
      • Positive if decrease of 20 mm Hg or more in SBP, decrease 10 mm Hg or more in DBP, or increased 20 beats/minute or more in heart rate
      • Teach patients about lifestyle management and drug use.
      • Evaluate the effectiveness of lifestyle management and drugs in decreasing BP to acceptable levels.
      • Teach about home BP monitoring, including the correct use of automatic BP monitors. Check that the device selected by the patient meets the Association for the Advancement of Medical
      • Instrumentation standards.
      • Make appropriate referrals to other HCPs, such as dietitians or stress management programs.
      • Monitor for complications of hypertension such as coronary artery disease, heart failure, cerebrovascular disease, peripheral vascular disease, and renal disease.
      • Assess the patient with hypertensive crisis for evidence of target organ disease (e.g., encephalopathy, renal insufficiency, cardiac decompensation).
      • Manage the patient with hypertensive urgency or emergency, including administration of drugs and evaluation for resolution of the crisis.