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Hypertension in Family Practice

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? ”. Choose a range. 90 – 99 100 – 109 105 – 114 90 – 104 100 – 114 (100 – 109).

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Hypertension in Family Practice

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  1. Hypertension in Family Practice Dr T McD Kluyts MB ChB, MPraxMed, DTO

  2. PRE TEST1. What is the range of diastolic pressure in “moderate hypertension?” T McD Kluyts

  3. Choose a range 90 – 99 100 – 109 105 – 114 90 – 104 100 – 114 (100 – 109) T McD Kluyts

  4. 2.Which of the following drugs are not recognised EDL drugs for hypertension in PHC? • a. Hydrochlorothiazide 25b. Propranolol 40mgc. Perindopril 4mgd. Spironolactone 25mge. Reserpine 5mg B, D, E T McD Kluyts

  5. 3.Which of the following conditions in a Hypertensive patient would indicate referral to a higher level of care? a. Diastolic pressure >114mmHgb. Depressionc. Macroscopic haematuriad. Poliuriae. Visual accuity disturbance T McD Kluyts

  6. 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. T McD Kluyts

  7. FOLLOW UP TREATMENT FOR HYPERTENSION IN CLINICAL PRACTICE How to plan your consultation

  8. FREQUENCY • The frequency of follow up will be dictated by several factors: • Clinical • Psychosocial • Demographic T McD Kluyts

  9. CLINICAL FACTORS • Severity of the disease • Complications • Disease related • Concomitant conditions • Duration of treatment • Degree of control T McD Kluyts

  10. PSYCHOSOCIAL • Dependency of patient • Age • Compliability T McD Kluyts

  11. DEMOGRAPHIC • Transport • Geographical location • Communication facilities available T McD Kluyts

  12. STOTT’S MODEL PRESENTING PROBLEM HELP SEEKING BEHAVIOUR ASSOCIATED CONDITIONS HEALTH EDUCATION T McD Kluyts

  13. MAIN PROBLEM • HYPERTENSION • CONTROLLED • UNCONTROLLED • FLUCTUATING • CRITICAL T McD Kluyts

  14. HELPSEEKING BEHAVIOUR • IS THIS CONSULTATION SCHEDULED? • IF NOT, WHAT IS THE REASON? • IF YES, IS THERE ANY ADDITIONAL ISSUES? T McD Kluyts

  15. ASSOCIATED CONDITIONS • CARDIOVASCULAR • ANGINA • CHRONIC ULCERATIONS • COLD EXTREMITIES • RENAL • PROTEINURIA • HEMATURIA • UREMIA • POLI / OLIGURIA T McD Kluyts

  16. ASSOCIATED CONDITIONS • VISUAL • Accuity • Peripheral vision • Fundoscopy • PERIPHERAL CIRCULATION • Cappillary filling • Aortic bruits • Peripheral pulses • Oedema T McD Kluyts

  17. ASSOCIATED CONDITIONS • HEART • Cardiomegaly • Additional heart sounds • Basal crepitations • Altered pulse rate • Angina • ECG-changes T McD Kluyts

  18. ASSOCIATED CONDITIONS • CEREBRAL • Change of Consciousness • Memory loss • Vertigo T McD Kluyts

  19. ASSOCIATED CONDITIONS • VITAL SIGNS • RESPIRATORY RATE • TEMPERATURE • PULSE RATE GENERAL SYSTEMIC EXAMINATION T McD Kluyts

  20. ASSOCIATED CONDITIONS • LIFESTYLE MODIFICATION • EXERCISE RECORD • DIET RECORD • ADDICTION ISSSUES IF ANY • DRUG SIDE EFFECTS • ALLERGIES T McD Kluyts

  21. 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. T McD Kluyts

  22. REFERENCES • Susic D, Frohlich ED. Nephroprotective effect o antihypertensive drugs in essential hypertension. Hypertension 8(3) 2000:14-27 • Standard treatment guidelines and essential drug list. Pretoria, National Department of Health. 1998. T McD Kluyts

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