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