《RN-ISPN学习》2021年05月12日总第773期
★ Vocabulary ★
ramification – n. 分枝，分歧
correlate – v. 互相有联系，相关联
isometric exercise – 等长运动
white coat hypertension -- 白衣高血压
American Heart Association – 美国心脏协会
put forth – 发出
stress-provoking – 诱发应激的
muffling – n. 闷声
absence of sound – 失声
BP machine – 血压计
captopril – n. 卡托普利
Capoten – n. 开博通
nadolol – n. 纳多洛尔
Corgard – n. 【奥】可佳得
注：带“【奥】”标记者为奥医临时用名，只为方便学员复习记忆，不得作为临床诊疗依据！
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★ RN/ISPN Review ★
“White Coat” Hypertension 白衣高血压
The diagnosis of hypertension is accompanied by the impact of serious ramifications, such as increased risk for numerous diseases and cardiovascular death, the potential need for significant lifestyle changes, and the potential need for drug therapy, which may include many unpleasant adverse effects. Consequently, it is important that a patient be correctly diagnosed before being labeled hypertensive.
高血压的诊断伴随多种严重分枝疾病的影响，如多种疾病和心血管死亡风险的增加、生活方式进行重大改变的潜在需要及药物疗法的潜在需要，包括很多另人讨厌的不良效应。因此，患者被贴上高血压标签之前的正确诊断极为重要。
Researchers in the 1990s discovered that some patients were hypertensive only when they were in their doctor’s office having their BP measured. This was correlated to a sympathetic stress reaction (which elevates systolic blood pressure) and a tendency to tighten the muscles (isometric exercise, which elevates diastolic blood pressure) while waiting to be seen and during BP measurement. The researchers labeled this phenomenon “white coat” hypertension.
20世纪90年代，研究人员发现，有些患者只有在医生认定测量血压时才高血压。人们将之与等医生看病及血压测量时的交感神经应激反应（升高收缩压）和肌肉绷紧倾向（等长运动，可升高舒张期血压）相关联。研究人员将这一现象贴上了“白衣”高血压的标签。
The American Heart Association has put forth new guidelines for the diagnosis of hypertension. A patient should have three consecutive BP readings above normal, when taken by a nurse, over a period of 2 to 3 weeks. (It was assumed that nurses were not as threatening or stress provoking as doctors.) These guidelines point out the importance of using the correct technique when taking a patient’s BP, especially because the results can have such a tremendous impact on a patient. It is good practice to periodically review the process for performing this routine task. For example, the nurse should:
美国心脏协会为高血压诊断推出了新的指南：护士2-3周测量患者血压，血压读数连续3次高于正常。（人们认为，护士不会象医生那样对患者构成威胁或诱发应激。）这些指南指出了测量患者血压时使用正确技术的重要性，特别是因为测量结果对患者所具有的巨大冲击。定期审查实施这一常规操作的程序不失为一种好的做法。例如，护士应当：
l Select a cuff that is the correct size for the patient’s arm (a cuff that is too small may give a high reading; a cuff that is too large may give a lower reading).
选择与患者手臂尺寸相当的血压计套袖（套袖太紧可能给出高读数；套袖太大可能给出低读数）。
l Try to put the patient at ease; remember that waiting alone in a cold room can be stressful to the body and mind and can increase the blood pressure.
尽量使患者感到舒适。记住，单独在一个冰冷的房间里等候可能使心、身充满压力，可能影响血压。
l Ensure that the arm that will be used for the cuff is supported.
确保带套袖手臂得到支撑。
l Make sure the rest of the patient’s muscles are not tensed while the BP is being taken.
确保患者其余肌肉在形如量血压时放松。
l Place both the cuff and the stethoscope directly on the patient instead of on clothing.
将套袖和听诊器直接接触患者，而不是通过衣服。
l Listen carefully and record the first sound heard, the muffling of sounds, and the absence of sound (the actual diastolic pressure is thought to be between these two sounds).
仔细倾听和记录听到的第一声、变闷和缺声（人们认为，实际的收缩压就界于这两种声音之间）。
BP machines found in grocery stores and pharmacies often give higher readings than the actual BP, so patients should not be encouraged to use these machines for follow-up readings. The American Heart Association offers many good guidelines for accurate BP measurement. Nurses are often the health care providers most likely to be taking and recording patient BP, so it is important to always use a proper technique and to make accurate records.
仪器商店和药房卖的血压计经常给出高于实际血压的读数，因此，不鼓励患者使用这些血压计来测量后续读数。美国心脏协会为血压正确测量提供了很多好的指南。护士是最可能替患者测量、记录血压的医疗保健人员，因此，始终采用适当的技术作出正确的记录，这一点很重要。
★ Video ★
“White Coat” Hypertension
★ Tests ★
1. A patient has just been diagnosed with hypertension and has a new prescription for captopril (Capoten). Which information is important to include when teaching the patient?
A. Check BP daily before taking the medication.
B. Increase fluid intake if dryness of the mouth is a problem.
C. Include high-potassium foods such as bananas in the diet.
D. Change position slowly to help prevent dizziness and falls.
2. A patient is diagnosed with hypertension and nadolol (Corgard) is prescribed. The nurse should consult with the health care provider before giving this medication upon finding a history of
A. Asthma.
B. Peptic ulcer disease.
C. Alcohol dependency.
D. Myocardial infarction (MI).
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答案 Answers
1. D. Change position slowly to help prevent dizziness and falls.
Rationale: The angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change. Increasing fluid intake may counteract the effect of the medication, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP does not need to be checked at home by the patient before taking the medication. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.
2. A. Asthma.
Rationale: Nonselective β-blockers block β1- and β2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. β-blockers will have no effect on the patient's peptic ulcer disease or alcohol dependency. β-blocker therapy is recommended after MI.
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