Blood pressure self monitoring

It is important to carefully document core ADHD symptoms at baseline to provide a reference point from which to evaluate effectiveness of treatment. Improvement in individualized patient outcomes are desired, such as (1) family and social relationships, (2) disruptive behavior, (3) completing required tasks, (4) self-motivation, (5) appearance, and (6) self-esteem. It is very important to elicit evaluations of the patient s behavior from family, school, and social environments in order to assess the preceding. Using standardized rating scales (e.g., Conners Rating Scales-Revised, Brown Attention-Deficit Disorder Scale, and IOWA Conners Scale) in both children and adults with ADHD helps to minimize variability in evaluation.29 After initiation of therapy, evaluations should be done every 2 to 4 weeks to determine efficacy of treatment, height, weight, pulse, and blood pressure. Physical examination or liver function tests may be used to monitor for adverse effects. 

With estrogen-based therapy, there should be yearly breast exams, monthly breast self-examinations, and periodic mammograms. Women on hormonal therapy should undergo annual monitoring, including pelvic examination, blood pressure checks, and routine endometrial cancer surveillance. 

Weight should be monitored monthly for 3 months, then quarterly. Body mass index, waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile should be monitored at the end of 3 months, then annually. The use of patient self-assessments are encouraged. 

Hypertensive crises are characterized initially by headache, but can evolve to include neck stiffness, chest discomfort, palpitations, confusion, and, ultimately, hemorrhage or stroke. Treatment of MAOI-associated hypertension may include a watch-and-wait stance by the patient if the symptoms are mild. Some patients have the ability to check and monitor their own blood pressure. Others may consult with a physician for blood pressure checks and observation, but if symptoms are severe, the patient may need to go to an emergency room or self-medicate. Standard emergency room treatment is intravenous phentolamine, an a-adrenergic blocker, continuous monitoring and management until blood pressure is normalized without medication. Some doctors will provide patients with small doses of chlorpromazine or nifedipine to treat hypertension if a problem arises. 

Well, I was in for my next surprise. My blood pressure was unbelievably high. Usually my pressure is around 110/70 and today it was at 180/90. My cool and calm nurse started to talk in clipped sentences and stuck me in a bed on my back with monitors wrapped all around me. I explained to her that this wasn t how my labor was supposed to go. She didn t care what I thought. She saw preeclampsia starting and was doing her job. I tried to lie on my side to get my blood pressure down, and my now panicky nurse yelled at me to stop self-treating and get back on my back. 

Pickering T. Recommendations for the use of home (self) and ambulatory blood pressure monitoring. American Society of Hypertension Ad Hoc Panel. Am J Hypertens 1996 9 1-11. 

Stergiou GS, Ntineri A (2015) The optimal schedule for self-home blood pressure monitoring. 

Gas-selective electrodes are a particularly important application of the glass electrode. For example, the carbon dioxide electrode is a self-contained system with a glass electrode and a concentric silver-silver chloride electrode enclosed by a C02 permeable membrane. The latter holds a thin film of bicarbonate solution in contact with the glass membrane, which provides a junction to the silver/silver chloride reference electrode. The electrode, which is illustrated schematically by Figure 2.2, has found extensive application in monitoring C02 levels in blood and probably will find increasing application in other systems that require continuous measurement of C02 partial pressures. The electrode response is based on the reaction... 

An important specialized type of voltammetric system is a self-contained cell for the determination of 02 in the gas or solution phases. This is the so-called Clark electrode,66,67 which consists of a platinum or gold electrode in the end of a support rod that is covered by an 02 permeable membrane (polyethylene or Teflon) such that a thin film of electrolyte is contained between the electrode surface and the membrane. A concentric tube provides the support for the membrane and the means to contain an electrolyte solution in contact with a silver-silver chloride reference electrode. The Clark device has found extensive application to monitor 02 partial pressure in blood, the atmosphere, and in sewage plants. By appropriate adjustment of the applied potential it gives a voltammetric current plateau that is directly proportional to the 02 partial pressure. The membrane material prevents interference from electroactive ions as well as from surface-contaminating biological materials. Figure 3.19 illustrates one configuration for this important device. 

---