HYPERTENSION by MikeJenny

VIEWS: 39 PAGES: 33

									     Hypertension

George Ann Daniels MS, RN
       What is Blood Pressure
• Components of B/P            • Systolic
                                  – Force while the heart pumps
  – Pressure of blood             – Pressure as the heart pushes
    against the walls of the        the blood out to the body
    arteries                      – Normal >130
  – The elasticity of the      • Diastolic
    artery walls                  – Force between heart pumps
                                  – Pressure as the heart begins
  – The volume and                  to fill with blood
    thickness of the blood        – Normal >85
                               • Systolic over diastolic
                               • 120/80
What is Hypertension
          • Is the result of persistent
            high arterial blood
            pressure which may cause
            damage to the vessels and
            arteries of the
             –   Heart
             –   Brain
             –   Kidneys
             –   Eyes
          • B/P > 140/90
           Damage to arteries
• HTN arterial walls thicken
  – Narrowing the opening inside the artery and
    reduces/block blood flow
• Persistent HTN arterial walls become rough
  – Easy for plaque is collect inside the artery
  – Decreased/blocked blood flow
  – Plaque can become mobile
     • Fatty emboli
 Classifications of Hypertension
• Primary
  – Essential HTN
    • Slow onset
    • Asymptomatic
  – Malignant
    • Sudden onset
    • Rapid development of symptoms
    • Accelerated progression
Risk Factors R/T Primary
      Hypertension
            •   Age/Heredity
            •   Sex
            •   Race
            •   Obesity
            •   Stimulants
            •   Sodium
            •   Alcohol
            •   Stress
            •   Hyperlipidemia
            •   Diabetes
            •   Socioeconomic Status
       Secondary Hypertension
• Underlying cause that impairs peripheral blood
  flow, alters cardiac output, or increases blood
  viscosity
• Most common
   – Renal failure
• Other causes
   – Endocrine, Coarctation, neurological, sleep apnea,
     medications/stimulants, PIH
• Treat cause and hypertension resolves
Clinical Manifestation
           • Persistent
             hypertension
           • Fatigue
           • Reduced activity
             tolerance,
           • Palpation
           • Angina
           • Dyspnea
Complications
       • Hypertensive Heart Disease
          – Coronary Artery Disease
              • Hypertension is a major risk
                factor for CAD
              • Left Ventricular Hypertrophy
                (LVH)
                  – Increased resistance in the
                    arteries
                       » Stiffness and
                          narrowing of vessels
                       » Left heart works
                          harder pumping
                          against higher
                          pressure
                       » Increases myocardial
                          work and 02
                          consumption
• Heart Failure
  – Heart can no longer pump enough blood to
    meet the metabolic needs of the body
  – Contractility depressed
  – Stroke volume and cardiac output decreases
  – C/O
     • SOB on exertion, paroxysmal nocturnal dyspnea and
       fatigue
Complications Con’t Disease
          • Cerebrovascular
             (CVA)
             – Most common cause
               Atherosclerosis
             – Portions of plaque or a blood
               clot (forms on plaque) breaks
               off
                 • Thromboembolism
                 • Travels to intracerebral
                   vessels
                      – Stops the flow of blood to
                        parts of the brain
                      – Aneurysms burst R/T
                        increased pressure
                           » Hemorrhage
                           » Brain tissue damage
• Peripheral Vascular
  Disease (PVD)
   – Hypertension speeds up
     Atherosclerosis in the
     peripheral blood vessels
       • Aortic aneurysm
       • Aortic dissection
       • PVD
   – C/O
       • Intermittent claudication
• Nephrosclerosis
   – End stage renal disease
   – Renal dysfunction
       • Ischemia
           – Narrowed intrarenal
             vessel
               » Atrophy of tubules
               » Destruction of
                  glomeruli
               » Death of nephron
   – Earliest symptom
       • nocturia
• Retinal Damage
  – Red flag
     • Damage to retinal
       vessels may indicate
       vessel damage in the
       heart, brain, and kidney
  – C/O
     • Blurred vision
     • Retinal hemorrhage
     • Loss of vision
       Nursing Assessment Data
• Subjective Data                         FHP 6
   – Past medical history/Family          Cognitive/perception
     history                                   Blurred vision
   – FHP 2 Nutrition
       • Alcohol use, salt and fat
                                               paresthesia
         intake, wt. gain/loss          FHP 9 Sexual/Repro
   – FHP 3 Elimination                    Impotence
       • Nocturia
   – FHP 4 Activity/Exercise
                                        FHP 10 Coping/stress
       • Fatigue, Dyspnea on              Stressful life events
         exertion, palpitation,           Noncompliance
         angina, chest pain,
         intermittent claudication,            knowledge deficit
         muscle cramps, smoking
         history, sedentary lifestyle          financial
                  Objective Data
• Cardiovascular                    • Musculoskeletal
   – Persisted elevated B/P           – Truncal obesity
   – Orthostatic change in B/P or     – Abnormal waist-hip
     pulse                              ratio
   – Retinal changes
   – Abnormal heart sounds
                                    • Neurologic
   – Diminished or absent             – Mental status changes,
     peripheral pulses                – Localized edema
   – Carotid, renal, ischial or
     femoral bruits
   – edema
    Abnormal Diagnostic Test
• Lab                              • ECG
  – UA, BUN, serum                   – Left Ventricular
    Creatinine                         hypertrophy
        • Renal involvement
  – Serum electrolytes             • EEG
        • Potassium                  – Ischemic heart disease
            – Hyperaldosteronism
  – Blood Glucose
  – Serum cholesterol and
    triglycerides
  – Uric acid
Medications
      • Diuretics
         – Suppresses renal tubular re-
           absorption of sodium
             • Diuril
         – Loop diuretics
             • Bumex, Lasix, Demadex
         – Potassium supplement
         – Potassium sparing diuretic
             • Aldactone
• Beta Blockers
   – Blocks sympathetic
                                     • Peripheral Inhibitors
     stimulation, decreases renin       – Relaxes smooth muscle,
     secretions, decreases cardiac        decreases peripheral
     output.                              resistance, decreases
       • Tenormin, Lopressor,             heart rate, and B/P
         Corgard, Inderal                  • Resperine
• Alpha Inhibitors                   • Vasodilators
   – Decreases peripheral vascular
                                        – Relaxation of arteriolar
     resistance,
                                          smooth muscle,
   – Vasodilator
                                          vasodilatation, decreases
       • Catapres
                                          cardiac output, decreases
• Central Inhibitors                      peripheral resistance
   – Decreases cardiac output,             • Apresolilne, Nipride
     peripheral resistance, and
     heart rate
       • Aldomet, Tenex
• Calcium Channel               • Angiotension-
  Blockers                        Converting Enzyme
  – Inhibits calcium into         Inhibitors
    smooth muscle cells,          – Decreases peripheral
    vasodilatation, decreases       vascular resistance
    peripheral resistance,           • Lotension, Captoen,
    increases cardiac output           Vasotec, Prinivil,
                                       Accupril
     • Norvasc, Cardizem,
       Plendil
         Expected Outcomes
• Patient will achieve and maintain desired
  B/P
• Patient will understand, accept, and
  implement the therapeutic plan for B/P
• Patient will experience minimal or no side
  effects from therapy
• Patient will exhibit a confident ability to
  manage and cope with hypertension.
                      Plan of Care
• Health Promotion                   • Teaching
   – Life style modifications          – Hypertension
       • Diet                              • Family/patient
       • Regular physical activity     – Correct technique for taking
                                         B/P
       • Avoid smoking and
         chewing                       – ID Risk factors and
       • Relaxation                      S& S
         techniques/stress             – Screening programs
         management                    – Drug therapy
       • Drug Therapy                • Recommendations for
                                       follow-up
                                       – Box 31-13
Hypertensive Crisis
          • Severe and abrupt
            elevation in B/P
             – Diastolic of 120-130
          • Non-compliant
            patients
          • Cocaine or crack users
          • PCP, LSD
          • Causes listed in table
            31-15
•
      Types of Hypertensive Crisis
    Hypertensive Emergency
    – Develops over hours to days
    – Evidence of damage to acute target organ
       • CNS
    – Hypertensive encephalopathy, intracranial or subarachnoid
      hemorrhage, acute left ventricular failure with pulmonary
      edema, myocardial infarction, renal failure, and dissecting
      aortic aneurysm
• Hypertensive Urgency
    – Develops over days to weeks
    – No evidence of target organ damage
                  Assessment data
• Sudden rise in arterial pressure seen in Hypertensive
  Encephalopathy
   – HA, Nausea, Vomiting, Seizures, Confusion, Stupor, Coma
   – Other common
      • Blurred vision and transient blindness
• Renal insufficiency
   – Minor to complete renal shut down
• Rapid cardiac decomposition
   – Unstable angina to MI
   – Pulmonary edema
      • Chest pain and dyspnea
• Neurological
   – Change in LOC
                 Diagnostic
• Mean arterial pressure (MAP)
  – DBP plus pulse pressure(SBP minus DBP)
  – MAP = DBP + 1/3 Pulse Pressure
  – Goal decrease MAP 10-20% in the first 1-2
    hours
  – Patients with aortic dissection, unstable angina,
    or sign of MI
     • Must have SBP lowered to l00-120 mm Hg asap
                   Medications
• IV Meds for Hypertensive Emergency
  – Vasodilators
     • Nipride (most effective), Nitroglycerin, Hyperstat, Apresoline
  – Alpha Inhibitors
     • Regitine, Normodyne, Brevibloc
  – Ace Inhibitors
     • Vasotec
• Meds for Hypertensive Urgency
  – Oral agents
     • Capoten, Catapres
                       Plan of Care
• Hypertensive Emergency
   – Administer IV meds with
     rapid onset of action
   – B/P Q 2-3 minutes
   – Medication is titrated
     according to B/P
   – Prevent hypotension
        • Stroke, MI, visual changes
   –   Monitor ECG
   –   Hourly output
   –   Bedrest
   –   Neurochecks
• Hypertensive Urgencies
  – Sit quietly for 20-30 minutes
  – Oral medications
  – Encourage patient to verbalize fears R/T
    hypertension
  – Follow up in 24 hours
Pediatric Considerations
            • Most common secondary
              to a structural abnormality
              or underlying pathologic
              process
            • Manifestations
               – Adolescents/older children
                   • Frequent HA, dizziness,
                     visual changes
               – Infants/young children
                   • Irritability, head
                     banging/head rubbing,
                     wake up screaming at
                     night
                      Treatment
• Diagnosis of underlying cause
• Surgery correction
• Life style changes
   – Low salt diet, wt loss, exercise, avoid stress, avoid
     smoking
   – Avoidance of BCP
• Education
   –   Orthostatic hypotension
   –   Take drug as prescribed
   –   Awarness of side effects and what to do
   –   Avoid alcohol
The End

								
To top