Michelle Gardner RN NUR-224. OBJECTIVES Define normal blood pressure and categories of abnormal...
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Transcript of Michelle Gardner RN NUR-224. OBJECTIVES Define normal blood pressure and categories of abnormal...
HYPERTENSION
Michelle Gardner RNNUR-224
HYPERTENSIONOBJECTIVES Define normal blood pressure and
categories of abnormal pressure Identify risk factors for hypertension Describe treatment approaches for
hypertension, including lifestyle and medication therapy
Use the nursing process as a framework for care of the patient with hypertension
Definition A systolic pressure greater than 140 mm
Hg and a diastolic pressure greater than 90 mm Hg, based on the average of two or more accurate blood pressure measurements taken during two or more contacts with a health care provider.
Classification
Incidence 28-31% of the adult population of the
U.S. have hypertension. 90-95% of this population with
hypertension have primary hypertension. The remaining 5%-10% have secondary
hypertension Incidence is greater in southeastern U.S.
and among African-Americans. Silent Killer
Hypertension BP = CO x peripheral resistance Normal circulation pressure transfers
from the heart muscle to blood each time the heart contracts, and then pressure is exerted by the blood as it flows through the vessels
Hypertension increases CO, and increases peripheral resistance
No precise cause can be identified for hypertension multifactorial condition
Etiology
Increased sympathetic nervous system activity
Increased reabsorption of sodium, chloride and water by the kidneys
Increased activity of the renin-angiotensin system
Decreased vasodilatation
Risk Factors Smoking Obesity Physical inactivity Dyslipidemia Diabetes mellitus Impaired renal function Older adult Family history
Clinical Manifestations Usually NO symptoms other than
elevated blood pressure Symptoms may be related to target
organ damage Retinal and other eye changes Renal damage Confusion N/V
Diagnostics History and Physical Laboratory tests
Urinalysis Blood chemistry Cholesterol levels
ECG
Treatment Lifestyle Modifications:
• Weight loss• Reduced alcohol intake• Smoking cessation• Regular physical activity• DASH Diet:
Medication Treatment Initial medication treatment diuretic, a
beta blocker, or both. Low doses are initiated and the
medication dosage is increased gradually if blood pressure does not reach target goal.
Additional medications may be added Multiple medications may be needed to
control blood pressure. Lifestyle changes initiated to control BP
must be maintained.
Medication Therapy for Hypertension
Diuretic and related drugs Beta blockers Alpha blockers Angiotensin-converting enzyme (ACE)
inhibitors Calcium channel blockers
Nursing History and Assessment
History and risk factors Assess potential symptoms of target
organ damage Personal, social, and financial factors that
will influence the condition or its treatment
Goals: Patient understanding of disease process. Patient understanding of treatment
regimen. Patient participation in self-care. Absence of complications.
Nursing Diagnoses Knowledge deficit regarding the relation
of the treatment regimen and control of the disease process.
Noncompliance with therapeutic regimen related to side effects of prescribed therapy.
Interventions Patient teaching- nutrition, excess fluid
volume Support groups Follow-up care Emphasize control rather than cure Rebound hypertension
Gerontologic Considerations
Noncompliance Understanding of therapeutic regimen
Reading instructions Monotherapy
Hypertensive Crises Hypertensive emergency
Blood pressure >180/120 and must be lowered immediately to prevent damage to target organs.
Hypertensive urgency Blood pressure is very high but no evidence of
immediate or progressive target organ damage.
Oral agents – beta-adrenergic blocking agents - labetalol(Trandate), ACE inhibitors-captopril (Capoten)
Hypertensive Emergency Reduce BP 25% in first hour Reduce to 160/100 over 6 hours Then gradual reduction to normal over a
period of days Exceptions are ischemic stroke and aortic
dissection Medications
IV vasodilators: sodium nitroprusside (Nitropress), nicardipine (Cardene), fenoldopam mesylate (Corlopam), enalaprilat, nitroglycerin
Need very frequent monitoring of BP and cardiovascular status
Hypertensive Urgency Blood pressure is very elevated no
evidence of target organ damage. Associated with: severe headaches,
nosebleeds, anxiety Normalize B/P within 24-48 hours Medications
Fast-acting oral agents: labetalol (Trandate), captopril (Capoten) or clonidine (Catapres)
THE END