Download - Kuliah Hipertensi 2013
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HYPERTENSION
Alfrina Hany
Do You Know?
The most common primary diagnosis in the United States, 50 million Americanaffected.
Only 70% are aware they have HTN, only 50% are being treated.
Only 25% of all hypertensive patients have their BP under control
Cardiovascular risk increases two-fold for each 20mm/Hg rise in systolic pressure oreach 10mm/Hg rise in diastolic pressure
Indonesiabest 3, 7% mortality
Topics
Definition
Etiology
Classification
Clinical Manifestation
Diagnostic Tests
Complication
What is Blood Pressure?
The force of blood against the wall of the
arteries.
Systolic- as the heart beats
Diastolic - as the heart relaxes
Written as systolic over diastolic in mm Hg
Williams & Hoppers, 2007
Hypertension
Hyperexcessive / highTensionPressure
HypertensionHigh blood pressure
Williams & Hopper, 2007
Why is High Blood Pressure Important?
Makes the Heart work too hard.Makes the walls of arteries hard.
Increases risk for heart disease and
stroke.
Can cause heart failure, kidney
disease, and blindness. Heart
disease and stroke are the 1stand 3rd
leading causes of death in the U.S.
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Hypertension (HTN)
is defined assustained abnormal
elevation of the
arterial blood
pressure (Brashers,
2006, p.1).
Hypertension Defined Hipertensi
keadaan bertahan dari kenaikan TD arterial
sistemik, ditandai dengan kenaikan curah
jantung /c.o dan tahanan periferal
vaskular/svrmelibatkan multifaktorial
Brunner & Suddarth, 2009
70 bpm 70 mls
4.9 L/min
Cardiac outputFactors Controlling BP
Etiology
tidak dapat dihindari (heriditer, etnik, jenis kelamin, usia)
dapat dihindari (gaya hidup, diet, alkohol, obesitas)
penyakit penyebab (DM; CKD)
Klasifikasi JNC VII (2003)
(Brashers, 2006, p.1)
Category Systol ic Diastol ic
Normal 100
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Klasifikasi berdasarkan tahapan
High Blood Pressure
Stage 1 140159 /9099
Stage 2 160179 /100109
Stage 3 180 /110
Klasifikasi berdasarkan penyebab (1)
Primary HypertensionIs usually of gradual onset
Usually develops between the ages of30 and 50
Tends to remain asymptomatic for 10to 20 years
Essential or Primary-Underlyingpathophysiologic alteration of unknowncause
95% of cases of HTN
Contributing factors for Primary HTN:
Psychological stress, high-sodium intake,and alcohol intake over 1 ounce per day
Increased activity of: sympathetic nervous system (SNS) Renin-angiotensin-aldosterone system (RAA)
Defects in natriuretic hormone function
Inflammation
Obesity
Endothelial dysfunction
Insulin resistance
Klasifikasi berdasarkan penyebab (2)
Secondary Hypertension
Secondary-Resulting from a
specific cause such as renal
or endocrine disorders;
Medications
5% of cases
Klasifikasi berdasarkan kegawatan
Hipertensi emergensi
TD diastolik>120 mmHg, kerusakan organ
target, keterlambatankematian
Hipertensi urgensi
TD Diastolik > 120 mmHg, tanpa kerusakan
organ, harus diturunkan 24 jam
Manifestasi Klinis
Silent killersymptoms freemild hypertension
Kelelahan, konfusi, nausea, vomit, ansietas, keringat
berlebihan, tremor, nyeri dada, epiktaksis,
pandangan kabur, nokturia, azotemiasevere
hypertension
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Diagnostic Tests
Laboratorium:
HBnilai viskositas dan indikator faktor risiko (anemia, hiperkoagulability)Leukosit infeksi/kegagalan sumsum tulang
BUN/Kreatininperfusi/faal ginjal
Glukosahiperglikemi
Kolesterolpredisposisi terbentuknya plak
Serum aldosteronaldosteronisme primer
Asam uratfaktor risiko
Elektrolitkalium, natrium, kalsium
Urineanalisa darah, protein, glukosa, identifikasi fungsi renal
Diagnostic Tests
Penunjang Lain:
CT Scanemboli pada otakRontgen dadaedema paru, kardiomegali
EKGkardiomegali, gangguan konduksi jantung
Phaechromecytoma kolesterol dalam darah dan urin
Echocardiogram: shows a graphic outline of the hearts movement
Web of CausationGenetik,
gerontologi,
obesitas
Perubahan
struktur & Fgs PD
Elastisitas PD
Pompa jantung
Aliran darah perifer
Nikotin
Merokok
Asetil kolin ke PD
Stress, cemas, takut
Norepineprin
Vasokonstriksi PD
Tekanan sistemik
epineprin
Katekolamin
DM
Pelepasan renin
Angiotensin I
Angiotensin II
Aldosteron
Retensi Na & K
Mediator nyeri
PD Otak
Hipertropi ventrikel
Tekanan darah sistemik
CO
Beban jtg
BUN & Cr
Iskemi
Nyeri kepala
Vol.intravaskuler
Ggn Perfusi Jar
Filtrasi ginjal Kelebihan Vol.Cairan
Penurunan CO
Kelelahan
Intoleransi
aktivitas
Nyeri akut/kronis
HypertensionComplication
Over long time, high bp damages arterial walls Sclerosis, decreased lumen
Wall may dilate, tear Aneurysm
Areas most frequently damaged: Kidneys, brain, retina
End result of poorly controlled hypertension: Chronic kidney disease
Stroke
Loss of vision
CHF
How Does It Effect the Body?
The Brain
High blood pressure is the most important riskfactor for stroke.
Can cause a break in a weakened blood vessel
which then bleeds in the brain.
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The Heart
High Blood Pressure is a major risk factor for
heart attack.Is the number one risk factor for Congestive
Heart Failure.
The Kidneys
Kidneys act as filters to rid the body of wastes.
High blood pressure can narrow and thicken theblood vessels.
Waste builds up in the blood, can result in kidney
damage.
The Role of the Kidney
Renin is made by the juxtaglomerular cells of the kidney
Renin transforms plasma angiotensinogen toangiotensin I which is converted to angiotensin II by
ACE
Angiotensin II alters BP by increasing both PVR andblood volume by causing vasoconstriction and bystimulating the secretion of aldosterone which increasesthe reabsorption of sodium
The Kidney cont.
Angiotensinogen
Renin
Angiotensin I
ACE vasoconstriction
Angiotensin II Inc. PVR
aldosterone (inc. reabsorp of Na)
Inc. blood volume
The Eyes
Can eventually cause blood vessels to breakand bleed in the eye.
Can result in blurred vision or even blindness.
The Arteries
Causes arteries to harden.
This in turn causes the kidneys and heart to work
harder.
Contributes to a number of problems.
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Life Style Changes
Following a healthy eating pattern.
Maintaining a healthy weight.
Being Physically Active.
Limiting Alcohol.
Quitting Smoking.
Penatalaksanaan non Farmakologi
Tips for Reducing Sodium
Buy fresh, plain frozen or canned no added salt
veggies.
Use fresh poultry, lean meat, and fish.
Use herbs, spices, and salt-free seasonings at
the table and while cooking.
Choose convenience foods low in salt.
Rinse canned foods to reduce sodium.
Maintain Healthy Weight
Blood pressure rises as weight rises.
Obesity is also a risk factor for heartdisease.
Even a 10# weight loss can reduceblood pressure.
35-55% higher risk compared tothose maintaining ideal weight
BMI > 30 kg / m2 or waist girth > 100cm (39.4 inches)
Be Physically Active
Helps lower blood pressure and lose/maintain weight.
30 minutes of moderate level activity on
most days of week. Can even break it
up into 10 minute sessions.
Use stairs instead of elevator, get off
bus 2 stops early, Park your car at the
far end of the lot and walk!
Limit Alcohol Intake
Alcohol raises blood pressure and canharm liver, brain, and heart
What counts as a drink?
12 oz beer
5 oz of wine
1.5 oz of 80 proof whiskey
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Quit Smoking
Injures blood vessel walls
Speeds up process of hardening of thearteries.
Current or quit within past 6 months
Stimulate E & NE => raise HR +
pheriperal vasoconstriction
Farmakologi
Vasodilator
Mengembangkan PD
arteri, kurangi
tahanan perifer
Diazoxide, Minoxidil,
Prozasin
Kalsium Antagonis
Hambat masukan ion
kalsium ke dalam sel
dan turunkan
afterload
Diltiazem, Nifedipin
Farmakologi
ACE Inhibitor
Hambat renin,
angiotensin,
vasodilatasi, turunkan
vol.darah
Captopril, Elanapril,
Ramipril
Diuretik
Turunkan volume
plasma, retensi
perifer
Furosemid, Thiazide
Farmakologi
Beta Bloker
Kurangi impuls ke
jantung dan PD
Nervous system
inhibitors
slow nerve impulses
to the heart.
=ASKEP=Pengkajian
Tn.K, Usia 55 thn
Sangat pusing sekali
Usaha harus tutup
3 bulan ini pusing,
jarang OR, sering
makan malam hari
TB 170cm, BB 93kg
(BBI 63 kg, BMI 39,8)
Pengusaha rumahmakan
Nadi 60x/mnt regular
TD190/110mmHg,T36,7
Tangan dan kaki pucat
terut.saat elevasi, kulit
dingin dan lembab
CRT ekstremitas 3 dtk
Kolesterol total 245
Askep=Analisa Data
Usia 55 tahun
Pengusaha RM
Sering makan di
malam hari
TB 170cm, BB 93 kg
BBI 63 kg, BMI
Total serum kolesterol
245 mg/dL.
KetidakseimbanganNutrisi lebih dari
kebutuhan tubuh
intake makanan
berlebihan akibat
kebutuhan metabolik
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Askep=Analisa Data
Sering makan di
malam hari
Jarang berolahraga
Sebelumnya merasa
penyakit belum parah
sehingga tidak perlu
periksa
Inefective health
maintenancekopingindividu yang tidak
efektif dengan gaya
hidup yang tidak sehat
Askep=Analisa Data
Mengatakan sakit kepala
Nadi 60x/mnt regular, TD(duduk): 190/110 mmHg
Tangan dan kaki pucat
terutama saat elevasi,
CRT ekstremitas 3 detik
Kulit teraba dingin dan
lembab
Ketidakefektifan perfusi
jaringan periferproses penyakit
(hipertensi)
Askep=Analisa Data
Sangat sibuk dengan
usahanya
Kadang pusing 3
bulan ini tapi tidak
pernah periksa
Klien suka makanan
berlemak dan merasahal tersebut biasa
dalam keluarganya
Kurang Pengetahuan
kurangnya paparan
informasi
Askep=Analisa Data
Kepala sangat pusing
sekali
Ketidaknyamanan
proses penyakit
DAFTAR DIAGNOSA KEP
KetidakseimbanganNutrisi lebih dari
kebutuhan tubuh
intake makanan
berlebihan
Inefective health
maintenance
(ketidakefektifan
pemeliharaan
kesehatan)gaya
hidup tidak sehat
Ketidakefektifan perfusijaringan perifer
hipertensi
Kurang pengetahuan
kurang informasi tentang
pengobatan
Risiko penurunan perfusi
jaringan jantung
Ketidaknyamanan
proses penyakit (HT)
Diagnosa 1 Nutrisi
Dalam 4 minggu,kelebihan nutrisi klien
dapat mencapai
indikator 3 pada
NOC : nutritional
status
Intake nutrient : diet seimbang : KH, Prot,Lemak, Mineralindikator 3
Food intake : DASH bertahap mulai diet
HT 1indikator 3
Energy : olahraga 30 menit sehari
indikator 3
Weight/height ratio : BBI dan BMI
menurun bertahapindikator 3
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Diagnosa 1 intervensi
Domain: Nutrition
support
Nutrition management
1.1 Identifikasi pilihan
makan klien
1.2 anjurkan intake
kalori yang sesuai
2.1 yakinkan perlunya
diet DASH
2.2 kolaborasi diet
DASHdiet HT
sesuai klien
Conclusion
Cardiovascular disease is the number one killer.Hypertension is a very controllable disease, withdrastic consequences if left uncontrolled.
It is highly preventable and controllable with dietand exercise.
Good resource: www.americanheart.org;www.nhlbi.nih.gov
Thanks
Good Luck and see you around
http://www.americanheart.org/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.americanheart.org/