Transcript HIPERTENSIE IN HUISARTSPRAKTYK

Hypertension in Family
Practice
Dr T McD Kluyts
MB ChB, MPraxMed, DTO
PRE TEST
1. What is the range of diastolic
pressure in “moderate
hypertension?”
AUGUST 2003
T McD Kluyts
2
Choose a range
90 – 99
100 – 109
105 – 114
90 – 104
100 – 114
(100 – 109)
AUGUST 2003
T McD Kluyts
3
2.Which of the following drugs are
not recognised EDL drugs for
hypertension in PHC?
a.
b.
c.
d.
e.
Hydrochlorothiazide 25
Propranolol 40mg
Perindopril 4mg
Spironolactone 25mg
Reserpine 5mg
B, D, E
AUGUST 2003
T McD Kluyts
4
3.Which of the following
conditions in a Hypertensive
patient would indicate referral
to a higher level of care?
a.
b.
c.
d.
e.
AUGUST 2003
Diastolic pressure >114mmHg
Depression
Macroscopic haematuria
Poliuria
Visual accuity disturbance
T McD Kluyts
5
Wat is die rol van ABP monitor in
die diagnose en hantering van
hipertensie?
APB speel tans nie ‘n rol in die diagnose van hipertensie nie
en diagnostiese kriteria is nie hiervoor vasgelê nie. APB is
primêr ‘n navorsingsinstrument en word aangewend om die
graad van bloeddruk kontrole wat deur medikasie
gehandhaaf word, aan te dui. Dit mag nuttig gebruik word
om psigososiale invloede op bloeddruk aan te toon.
AUGUST 2003
T McD Kluyts
6
FOLLOW UP TREATMENT FOR
HYPERTENSION IN CLINICAL
PRACTICE
How to plan your
consultation
FREQUENCY
The frequency of follow up will be
dictated by several factors:
Clinical
Psychosocial
Demographic
AUGUST 2003
T McD Kluyts
8
CLINICAL FACTORS
Severity of the disease
Complications
Disease related
Concomitant conditions
Duration of treatment
Degree of control
AUGUST 2003
T McD Kluyts
9
PSYCHOSOCIAL
Dependency of patient
Age
Compliability
AUGUST 2003
T McD Kluyts
10
DEMOGRAPHIC
Transport
Geographical location
Communication facilities available
AUGUST 2003
T McD Kluyts
11
STOTT’S MODEL
PRESENTING
PROBLEM
HELP SEEKING
BEHAVIOUR
ASSOCIATED
CONDITIONS
HEALTH
EDUCATION
AUGUST 2003
T McD Kluyts
12
MAIN PROBLEM
HYPERTENSION
CONTROLLED
UNCONTROLLED
FLUCTUATING
CRITICAL
AUGUST 2003
T McD Kluyts
13
HELPSEEKING BEHAVIOUR
IS THIS CONSULTATION SCHEDULED?
IF NOT, WHAT IS THE REASON?
IF YES, IS THERE ANY ADDITIONAL ISSUES?
AUGUST 2003
T McD Kluyts
14
ASSOCIATED CONDITIONS
CARDIOVASCULAR
ANGINA
CHRONIC ULCERATIONS
COLD EXTREMITIES
RENAL
PROTEINURIA
HEMATURIA
UREMIA
POLI / OLIGURIA
AUGUST 2003
T McD Kluyts
15
ASSOCIATED CONDITIONS
VISUAL
Accuity
Peripheral vision
Fundoscopy
PERIPHERAL CIRCULATION
Cappillary filling
Aortic bruits
Peripheral pulses
Oedema
AUGUST 2003
T McD Kluyts
16
ASSOCIATED CONDITIONS
HEART
Cardiomegaly
Additional heart sounds
Basal crepitations
Altered pulse rate
Angina
ECG-changes
AUGUST 2003
T McD Kluyts
17
ASSOCIATED CONDITIONS
CEREBRAL
Change of Consciousness
Memory loss
Vertigo
AUGUST 2003
T McD Kluyts
18
ASSOCIATED CONDITIONS
VITAL SIGNS
RESPIRATORY RATE
TEMPERATURE
PULSE RATE
GENERAL SYSTEMIC EXAMINATION
AUGUST 2003
T McD Kluyts
19
ASSOCIATED CONDITIONS
LIFESTYLE MODIFICATION
EXERCISE RECORD
DIET RECORD
ADDICTION ISSSUES IF ANY
DRUG SIDE EFFECTS
ALLERGIES
AUGUST 2003
T McD Kluyts
20
HEALTH EDUCATION
Introduce a Q+A session where the patient
gets the opportunity to ask any questions
that has been bothering him/her.
Use this to clear up any misconceptions that
might be held by the patient.
Review and re-affirm the treatment plan with
the patient.
AUGUST 2003
T McD Kluyts
21
REFERENCES
1. Susic D, Frohlich ED. Nephroprotective effect o
antihypertensive drugs in essential hypertension.
Hypertension 8(3) 2000:14-27
2. Standard treatment guidelines and essential drug
list. Pretoria, National Department of Health.
1998.
AUGUST 2003
T McD Kluyts
22