Michelle Gardner RN NUR-224

OBJECTIVES

  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

 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.

     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

    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

    Increased sympathetic nervous system activity Increased reabsorption of sodium, chloride and water by the kidneys Increased activity of the renin-angiotensin system Decreased vasodilatation

        Smoking Obesity Physical inactivity Dyslipidemia Diabetes mellitus Impaired renal function Older adult Family history

  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

   History and Physical Laboratory tests  Urinalysis   Blood chemistry Cholesterol levels ECG

 Lifestyle Modifications: •Weight loss •Reduced alcohol intake •Smoking cessation •Regular physical activity • DASH Diet:

     Initial medication treatment  blocker, or both.

diuretic, a beta 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.

     Diuretic and related drugs Beta blockers Alpha blockers Angiotensin-converting enzyme (ACE) inhibitors Calcium channel blockers

   History and risk factors Assess potential symptoms of target organ damage Personal, social, and financial factors that will influence the condition or its treatment

    Patient understanding of disease process.

Patient understanding of treatment regimen.

Patient participation in self-care.

Absence of complications.

  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.

     Patient teaching- nutrition, excess fluid volume Support groups Follow-up care Emphasize control rather than cure Rebound hypertension

  Noncompliance Understanding of therapeutic regimen  Reading instructions  Monotherapy

  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)

      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

    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