Hypertension
NPN 200
Medical Surgical I
Description of
Hypertension
Intermittent or sustained elevation in the
diastolic or systolic blood pressure: systolic
>140mm Hg and diastolic > 90 mm Hg
Arterioles are primarily affected, resulting in a
rise of peripheral vascular resistence
Rise may be caused by responses of the
sympathetic nervous system and stimulation
of the renin angiotension mechanism
Damage occurs to major organs supplied by
these blood vessels over time
Called the “silent killer”
Types of Hypertension
Essential (primary or idiopathic) hypertension
(the most common)
Cause unknown
Secondary hypertension
Predisposing factors
Smoking, obesity, diet, stress, family history, race, birth
control pills, some drugs, pregnancy
Associations with disease
Renal disease, atherosclerosis, Cushing’s syndrome,
thyroid, parathyroid or pituitary disease, PVD, and
diabetes
Hypertension, cont.
Malignant hypertension is a severe form
of hypertension common to both types
Is a major cause of cardiac disease,
renal failure, and CVA
Prognosis is good if condition is
detected early and treatment begins
before complications occur
Hypertensive crisis may be fatal
Hypertension, cont.
Factors which determine B/P
B/P =CO X PVR
Cardiac output
Volume of blood pumped from the heart in 1 minute
Peripheral vascular resistance
Force in the blood vessels that the LV must overcome to
eject blood from the heart
^ PVR is the result of narrowing of the arteries and
arterioles or an ^ blood volume
The vasomotor center in the sympathetic nervous system
controls the release of epi and norepi. These are
vasoconstrictors.
Vasoconstriciton decreases blood flow to the kidneys
which starts the renin angiotension cycle
Hypertension, cont.
Data collection Data collection
Subjective
Asymptomatic or vague Objective
symptoms
B/P ^ 140/90
Chest pain
Fatigue Epistaxis
Blurred vision
Evidence of
Irritability
Dizziness
associated disease
Ringing in ears Hematuria
Tachycardia
N/V
Proteinuria
SOB and anxiety Restlessness
Hypertension, cont.
Diagnostic tests
H&P
Liver and kidney exams
Series of B/P readings
Chest x-ray
EKG
Urine, BUN, Creatinine
Serum K
Electrolytes
Blood glucose
Hypertension, cont.
Medical treatment
Lifestyle modifications
Weight reduction, exercise, stop smoking,
Drugs
Individualize
Start on any single drug to determine what will control -
Low dose thiazide diuretic, beta blocker, calcium channel
blocker or Ace inhibitor
Stepped approach – not used as much as in past
Low dose thiazide diuretic, beta blocker, calcium channel
blocker or Ace inhibitor
Increases dosages or add another drug
Change drugs and or increases dosages of previous meds
Hypertension, cont.
Nursing Care
Assess, report and record signs of progress
Record B/P in both arms as well as lying, sitting
and standing comparison
Inspect extremities and neurological function
Schedule rest periods
Quiet, calm environment
Emotional support
Give meds as ordered
I/O and weight daily
Dietary changes if necessary
Hypertension, cont.
Patient teaching
Must manage effectively to control
May need to check B/P at home
Teach importance of medication regimen
Low fat diet along with Na restriction may be
necessary
Watch K if on diuretic
Include exercise
Teach stress management
Some antihypertensives cause decreased libido
and erection problems
Always keep follow up appointments