hypertension power point for module
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Hypertension
Learning Outcome
Students will gain an understanding of hypertension, its disease process and management, and will apply that understanding to planned patient care.
Learning Objectives
By the end of this module students will• Compare and Contrast prehypertension, stage
I and stage II parameters according to JNC 7 Guidelines
• Differential between essential and secondary hypertension
• Describe effects of uncontrolled hypertension on body organs
Learning Objectives
• Name a minimum of four causes of secondary hypertension
• Define the term "silent killer“• Create a nursing care plan for a hypertensive
patient using the nursing process and following the provided rubric
Outline
• JNC guidelines for prehypertension and stage I & II Hypertension
• Types of hypertension• Risk factors• Organ damage• Treatment
Introduction
Introduction
• Nearly 60 million Americans, or 1 in 4 adults, have high blood pressure
• High blood pressure contributes to the deaths of almost 30 individuals every hour of every day
• An additional 45 million adults, or 22% of the population, have prehypertension
• Many individuals don’t even know they have hypertension
the JNC 7 report. JAMA. 2003;289:2560-72.
Manifestations of Hypertension
• Usually no symptoms other than elevated blood pressure
• Symptoms are related to organ damage and are seen late and are very serious
Parameters According to JNC 7
• Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)
http://www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf
U . S . D E PA RT M E N T O F H E A LT H A N D H U M A N S E RV I C E SN a t i o n a l I n s t i t u t e s o f H e a l t hN a t i o n a l H e a r t , L u n g , a n d B l o o d I n s t i t u t e
BP classification Systolic BP
(mmHg) Diastolic BP
(mmHg)
Normal <120 and <80
Prehypertension 120–139 or 80–89
Stage 1 hypertension 140–159 or 90–99
Stage 2 hypertension >160 or >100
JNC, Joint National Committee; DBP, diastolic blood pressure; HTN, hypertension; SBP, systolic blood pressure. http://www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf
What is High Blood Pressure? JNC 7 Guidelines for Patients Age ≥18 Years
JNC 7 Parameters
Key: SBP = systolic blood pressure DBP = diastolic blood pressure
Types of Hypertension• Essential 90% - 95%
– Cause is unknown• Secondary 5% - 10%
– High blood pressure that is caused by another medical condition or medication
Secondary Hypertension Causes
• Chronic kidney disease• Disorders of the adrenal gland
(pheochromocytoma or Cushing syndrome)• Pregnancy (preeclampsia)• Medications such as birth control pills, diet pills,
some cold medications, and migraine medications• Narrowed artery that supplies blood to the kidney
(renal artery stenosis)• Hyperparathyroidism
Risk Factors
• Factors that cannot be changed–Family history of high blood pressure–Family history of premature CVD–Diabetes–Race (African American)
Lifestyle Risk Factors
• Weight (body mass index > 30 kg/m2)• Stress• Sedentary lifestyle• Diet• Smoking• Alcohol (more than one drink per day for women
and more than two drinks per day for men)• Birth control pills
Blood Pressure >140/90 mm Hg Damages Target Organs
CHD, coronary heart disease.
HBP
Retinopathy
Peripheral vascular disease Renal failure
LVH, CHD, HFHemorrhage,stroke, dementia
Chobanian AV. JAMA. 2003;289:2560-2572.
Organ Damage
• Vascular Effects– Artery damage and narrowing– Aneurysm
• Cardiac Effects– Coronary artery disease– Enlarged left ventricle– Heart failure
High Blood Pressure Increases Risk of Ischemic Heart Disease Death
IHD
mor
talit
y(fl
oatin
g ab
solu
te ri
sks
& 9
5% C
I)
CI, confidence interval; SBP, systolic blood pressure. Prospective Studies Collaboration. Lancet. 2002;360(9349):1903-1913.
• Risk of IHD death increases with increasing age
• Risk of IHD death increases with increasing BP in each decade of life
• Increased risk begins at systolic BP >120 mmHg
• Trend begins at 40 years old
Usual SBP (mmHg)120 140 160 180
1
2
4
8
16
32
64
128
256
50-59 yrs
70-79 yrs
60-69 yrs
80-89 yrs
40-49 yrs
Organ Damage
• Cerebral Effects– Transient ischemic attack (TIA)– Stroke– Mild cognitive impairment– Dementia
• retinopathy – Vision impairment– blindness
High Blood Pressure Increases Risk of Stroke Death
Stro
ke m
orta
lity
(floa
ting
abso
lute
risk
s &
95%
CI)
CI, confidence interval; SBP, systolic blood pressure. Prospective Studies Collaboration. Lancet. 2002;360(9349):1903-1913.
120 140 160 180
1
2
4
8
16
32
64
128
256
Usual SBP (mmHg)
50-59 yrs
70-79 yrs
60-69 yrs
80-89 yrs• Risk of stroke death increases
with increasing BP in each decade of life
• Risk of stroke death increases with increasing age
• Increased risk begins at systolic BP >120 mmHg
Organ Damage
• Renal Effects– Kidney failure– Kidney scarring (glomerulosclerosis).– Kidney artery aneurysm
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Treatment
• Lifestyle changes– Weight– Exercise– Diet– Smoking– Alcohol use– Stress
• Medication
JNC 7
Recommended by JNC 7
Recommended by JNC 7
Medications
• See additional information on medication video in hypertension module
• Refer to Drug and Medication Textbook
• Review Medication Online Module
Nurses Help Patients Significantly Reduce Systolic BP
Denver E. Diabetes Care. 2003;26:2256-2260
130
135
140
145
150
155
160
165
Nurse-led program Standard care
Baseline BP
After treatment
Syst
olic
blo
od p
ress
ure
(mm
Hg)
160.7
141.1
157.6
151.1
P=0.02
P=0.28
Learning Activities
• Review module materials and videos• Form a group of 2-4• Create a nursing care plan for a hypertensive
patient using the nursing process and following the provided rubric as a guide
• Review the nursing process and nursing care plans as needed
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Discussion forum
• Review hypertension Case scenario• Using critical thinking answer questions in
discussion forum• Respond and reply to fellow students
concerning case scenario and nursing care
Hypertensive Crisis
This is discussed in the next module
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