Post on 05-Dec-2014
description
Lilith Hutchinson BSN, RN
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Determine factors regulating blood pressure
Classify the characteristics of hypertension Review current national recommendations
for treatment of hypertension Review classifications of hypertensive
medications Nursing Care Practices Identify treatment of hypertension in
specific populations2
There are intrinsic, neurological, hormonal, renal mechanisms to control the blood pressure.
Blood pressure (BP) is the forced exerted by the blood(cardiac output) against the walls of the blood vessel (vascular resistance)
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Hypertension (HTN) develops when any one or a combination of the systemic and local peripheral mechanisms are defective.
The blood flow can’t overcome the opposing forces of resistance to maintain cardiac output and over time the arterial pressure will fall. 4
Initial therapy is directed by:Blood Pressure Readings
Primary and secondary causes
The guidelines are based on the mean of two
or more properly measured seated B/P.
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Obesity( central) Insulin resistance or
overproduction is its own hypertensive risk factor
Dyslipidema is the metabolic dysfunction of the lipids
Maintaining B/P >130/80 6
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Intrinsic: tissue perfusion Coractation, SNS overacting
Neurological: vasomotor center Brain injuries, tumors
Hormonal: vasomotor tone and volume Aldosteronism
Renal mechanisms Cushing’ Disease, Polycystic Kidneys
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Blood Pressure
(B/P)Classificatio
n
Systolic DiastolicInitial Drug
Therapy
Normal <120 and< 80 None
Pre Hypertension
120-1 39 OR 80-89 Treat indicators
Stage 1 Hypertension
140-159 OR 90-99 Treat the pressure
Stage 2
Hypertension>160 OR > 100 Diuretic
Ace InhibitorB-Blocker
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Enhances Drug Regimens Affordable B/P Control~ Underused Slow demineralization in Osteoporosis
Side Effects:, decreased libido, glucose intolerance, potentiates digoxin toxicity
Contraindications: Gout and Low NA+ 10
Heart Failure Potent with short duration of action
Side Effects: Ototoxicity, lipid increase, Non-potassium sparing the K+
Nursing Implications Orthostatic changes Electrolyte abnormities Medicine Compliance
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Stable angina Asymptomatic ventricular dysfunction Arial tachyarrhythmia/ fibrillation Preoperative hypertension: direct arterial
vasodilatation
Contraindications: asthmatic, heart block, restrictive airway disease
Implications: monitor pulses, Check blood sugars due to its masking effect of hypoglycemia,
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Asymptomatic ventricular dysfunction Arrhythmias
Action: Block extracellular calcium in to cells Vasodilatation and decreases vascular resistance
Side effects: reflex tachycardia, hypotension
Contraindication: 2nd and 3rd heart block
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Peripheral: Prevent the release of norepinephrine or deplete the stores to cause vasodilatation Avoid with elderly and coronary or cerebral
compromise a Adrenergic Blockers: Block adrenergic receptors
causes vasodilatation and orthostatic hypotension Central: reduce sympathetic out from CNS to cause
vasodilatation Clonidine, Methyldopa
Daytime sedation. Dry mouth, Caution use with Bradycardia with conduction disorders
Sudden withdrawal: Rebound HTN, Tachycardia, HA, tremors and sweating
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ACE: ANGIOTENSION-CONVERTING ENZYME
ARB’S:ANGIOTENSION II RECEPTOR BLOCKERS
Prevents vasoconstriction
SE: loss of taste, cough, renal failure
Meds: (Ramipril, Vasotec) Not with CVVH
Produces vasodilatation Na and water retention
SE: Hyperkalemia, Decrease renal function
Meds: (Lorstan, Cozaar)
Ace and ARB’s Cause fetal morbidity and mortality
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Potassium-Sparing Diuretics End- Sage Heart Disease Combines with Ace inhibitors and BB
Decreased Renal excretion or filtration Inhibit bodies ability to retain NA and excrete K+
Hormonal SE: gynecomastia, impotence, decreased libido and menstrual irregularities
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The presence of a silent gap should be recorded
White Coat HTN is the elevation of the B/P without organ injury
Knowledge: Illness and Management
Physical Findings
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Documentation Goal directed Follow-up / Reinforcement Mechanisms Written: Medications /Reactions
Support Systems Include pharmacists, social services, and
dietitians Evaluate diuretic uses Cost and barriers to access medical care Eating to change health
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Ambulatory B/P monitoring EKG Chest Labs
CBC BMP Creatinine/BUN U/A Lipids
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Malignant hypertension related to noncompliance Degree of crisis is related to target organ damage
Vision Disturbances /level of consciousness (LOC)
Level 160/100: Manage the rate the B/P is rising
Clinical : Headache, N/V, Seizures, Changes in LOC Meds: IV Nipride (Nitroprusside) protect from light
Caution direct dilators with left ventricular hypertrophy
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Absence of target organ damage
No IV Medications to control B/P
Managed outpatient basis Rest Oral medications
Next day follow-up
Education 21
Support the need to expression of fears and any reactions to treatments
Hispanic and American Indians least controlled population
Understand cultural differences builds trust
Dispel cultural misunderstandings Lack of symptoms = no disease Medications = ill health
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Oral contraceptive increases risk of HTN
Watch for Creatinine levels of >1.3 for women 1.5 men
Women and lighter weight persons are caution to limit one drink per day
Pregnant and sexually active girls should not be on ARB’s or ACE inhibitors
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The use of anabolic steroids causes fluid retention and increase LDH
80 % of the children have an identifiable cause Kidney disease , coarctation of the aorta
Repeated B/P measurements at 95 percentile Diastolic determined by the fifth Korotkoff
sound
No restriction of physical activities Medications instituted when lifestyle changes
fail Adjusts doses for child's body makeup24
Isolated Systolic Hypertension: Sustain >160/90Difficult to get systolic control
Loss of tissue elasticity: stiff myocardium Decreased physiological response to sodium
and water depletion
Increased of orthostatic hypotension >10mmHg Dementia /Cognitive impairments related to
HTN
Decreased renal and liver function affects medication absorption ,metabolism, and, excretion 25
Degree of Participation Dietary Exercise B/P levels
Lipid management ~ Preventive
Smoking Drinking Cessation Efforts
Documented Reactions
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Chobanian, A., Bakris, G., Black, H., Cushman, W., Green, L., Izzo, J., Jones, D., Materson, B., Oparil, S., Wright, T., Roccella, E., and the National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on Prevent, Detection, Evaluation and Treatment of High Blood Pressure. Hypertension. 2003;42:1206-1252.
Hall, J., Granger, J., Reckelhoff, J. Sandberg, K. Hypertension and Cardiovascular Disease in Women. down loaded on February 11, 2008 www.ahajournals.org/cgi/reprint/HYPERTENSIONAHA.107.009813v1
Lewis, S., Heitkemper, M., and Dirksen, S., (6th ed). (2004). Medical-surgical nursing – Assessment and management of clinical problems. St. Louis: Mosby.
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