ppt krisis hipertensi
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Transcript of ppt krisis hipertensi
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CASE REPORTCrisis Hypertension
Preseptor : dr Ihsanil Husna, Sp.PD
Arranged by : Salan Saisar Hidayat !"#$$%#'()
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Patient*s identity
+ae : rs. -
Age : (thyears old
Edu/ation : Senior High s/hool
arital status: arried
O//upation : Seller
Religion : osle
Date o0 adission : April "#$1 R nuber : ##'&%'$%
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Ananesis
Chie0 /oplaint :
Patient /oplained o0 heade/he sin/e &days ago.
Another /oplaint :
Patient 0elt 2ea3ness
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History o0 present illness
Patient /ae 2ith /oplaint o0 her heade/he sin/e & days ago,and also 0elt 2ea3 i0 she 2anted to do the a/ti4ity. She 0elthea4y in the ba/3 o0 ne/3. She denied any heartbeat 0ast. Shedenied o0 de/rease appetite. Patient aditted to ha4ehypertension disease but she had ne4er /ontrolled her disease.
" 2ee3s ago, patient has been hospitali5ed be/ause o0hypertension and diabetes elitus. Her tension 2as "## at thattie and she didn*t 3no2 about the blood sugar Soeties she0elt it/hy and her sight 2as blurry
6e0ore she hospitali5ed, she also /oplains lots o0 urine andshe drin3s too u/h. She denied eat a lot. She 3ne2 about herdiabetes elitus disease but she had ne4er /ontrolled herdisease
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History o0 past illness
History o0 Hypertension
History o0 D
+o history o0 3idney disease +o history o0 astha
+o history o0 allergi/
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History o0 0aily
Her 0ather has sae proble inhypertension
+o history o0 D
+o history o0 allergi/ +o history o0 astha
+o history o0 3idney disease
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History o0 allergy
Patient has no allergy to 0ood, drugs and2eather.
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History o0 treatent
Patient had drin3ed the hypertensiondrugs
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Habits
So3ing habits : Denied
Drin3ing al/ohol : Denied
Doing e7er/ise : Denied
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Physi/al e7aination
8eneral /ondition: ildill
Con/iusness:
/oposentis
8eneralis
status
Blood pressure: 110/70 mmHg
Heart rate: 88x/minute Respiratory rate: 18x/minute Temperature : 36.9 !
9italsigns
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Head : noro/ephal, de0ority !) Eyes : anei/ /on;ungti4a !
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Inspe/tion: loo3ed ?at Aus/ultation: bo2el sounds !=) Palpation: tou/hing pain epigastri3 !) epigastri3
retra/tion !)
Per/ussion: tiphani
Abdoe
n
Superior: Edea ! < ), 2ar a3ral!= < =), RCT @"se/onds != < =)
In0erior: Edea ! < ), 2ar a3ral != < =), RCT @"se/onds != < =)
E7treities
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Resue
rs. -, (thyears old /ae to hospital 2ith
/oplained o0 her heade/he sin/e & days ago. Shealso /oplained the body 2as 0elt 2ea3. She 0elthea4y in the ba/3 o0 ne/3. She aditted to ha4e
hypertension disease and diabetes ellitus diseasebut she didn*t /ontrol her disease. " 2ee3s ago, hertension 2as "## Hg 2hen she /ae to thehospital. She 0elt it/hy and her sight 2as blurry. she
also /oplains lots o0 urine and she drin3s toou/h. She denied eat a lot.
History of past illness: hypertension and DM
History of treatment: she had consumed the
hypertension drugs and DM drugs
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Physical Examination:
TD: 110/70 mmHg
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Proble list
Crisis hypertension
Diabetes elitus
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Assesent
$. Crisis hypertension
S: s. -, (thyears old /ae to hospital 2ith/oplained o0 her heade/he sin/e & days ago.
She also /oplained the body 2as 0elt 2ea3.She 0elt hea4y in the ba/3 o0 ne/3. She adittedto ha4e hypertension disease. She didn*t
/ontroll her desease. " 2ee3s ago, her tension2as "##. History o0 past illness hypertension.History o0 treatent hypertension drugs.
O:TD: $$#
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A: Crisis hypertension
P:Controlled blood pressure
". Diabetes ellitus
S:She 0elt it/hy and her sight 2as blurry. History o0past illness D. She also /oplains lots o0 urineand she drin3s too u/h.
O:
A:diabetes ellitus
P: /he/3 blood glu/ose
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Case analysis
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Denition
Hypertensi4e /rises are dened as le4elso0 systoli/ blood pressure B$# Hgand< or le4els o0 diastoli/ blood pressure
B$"# Hg and are ainly 0ound inpatients 2ith essential arteryhypertension.
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Classi/ation
Hypertensive urgency is a situation2ith a se4ere in/rease in blood pressure2ithout progressi4e dys0un/tion o0 target
organs.
Hypertensive emergencies are li0e
threatening states be/ause theirout/oe is /opli/ated by a/utedaages o0 target organs.
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Epideiology
In an Italian ulti/enter study o0 $,(1 patients2ith hypertensi4e /rises, $& o0 en and '
o0 2oen reported not ta3ing antihypertensi4edrugs.
Hypertensi4e eergen/ies represented "( o0/rises. Appro7iately "( o0 adults 2ith/hroni/ hypertension 2ere una2are o0 theirdisease.
In the S parallels the distribution o0 essentialhypertension 2ith a t2o0old higher in/iden/e in
A0ri/anFAeri/ans than in 2hites.
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Etiology
ndiagnosed or untreated hypertensionis the ost iportant ris3 0a/tor to be/rises hypertension. 8eneti/ 0a/tor,
li0estyle, diet, a/ute physi/al stress,/hroni/ physiologi/al stress /an be the/auses o0 hypertension. So the priarytreatent is to /hange the ris3 0a/tor
that /an a3e hypertension.
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Patophysiology
Pathophysiology o0 hypertensi4e /risesis still un/lear. Gro the aspe/t o0pathophysiology, the disorder o0
systei/ blood o2 auto regulation onthe le4el o0 arterioles is /onsidered tobe a /ause 0or both 0ors o0hypertensi4e /risis.
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Clini/al ani0estation
Hypertensive urgency is a situation 2ith se4erein/rease in blood pressure 2ithout progressi4edys0un/tion o0 4ital organs. The ost /oonsyptos are heada/he, dyspnea, nausea,
4oiting, epista7is, and pronoun/ed an7iety. Hypertensive emergencies in/lude hypertensi4e
en/ephalopathy, hypertensi4e a/ute le0t 4entri/ularrela7ation asso/iated 2ith a/ute yo/ardial
in0ar/tion or unstable angina, aorti/ disse/tion,subarhnoi/ heorrhage, is/hei/ stro3e, andse4ere pree/lapsia or e/lapsia.
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Clini/al ani0estation
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Supporting e7ainations
Re/oended testing in/ludes the 0ollo2ing:
Heatologi/ routine
6lood glu/ose
Total /holesterol seru Seru uri/ a/id
Creatinin seru
-aliu seru rinalisis
Ele/tro/ardiogra
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Treatent
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Re0eren/es
onnet, a4ier, Paul E. ari3. "#$(. hat*s ne2 2ith hypertensi4e/risesJ. Intensi4e Care ed. $:$"%F$
Sal3i/, Sabina, Oli4era 6ati/u;ano4i/, Garid K;u/a, Selira 6r3i/."#$.Clini/al Presentation o0 Hypertensi4e Crises in Eergen/yedi/al Ser4i/es. ater So/ioed. "1!$): $"$1
Sal3i/, Sabina, Selira 6r3i/, Oli4era 6ati/u;ano4i/, Garid K;u/a,Aledina -arabasi/, Seh4eta usta/. "#$(. Eergen/y RooTreatent o0 Hypertensi4e Crises. ed Arh, 1'!()L "
Current edi/al Diagnosis > Treatent. Systei/ Hypertension.Sutters, i/hael.D. "#$1. &(1%
Aeri/an Mournal o0 Eergen/y ed/ine. The Relationship between
vascular infammation and target organ damage in hypertensivecrises. Karaback, Mustaa MD. "#$(L '%(##
Mose Roesa. -risis Hipertensi. Sudoyo, Idrus Al2i editor. 6u3u A;arIlu Penya3it Dala Milid II Edisi 9I. Pusat penerbitan departeenpenya3it dala G-I."#$
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Than3 Nou