Hypertension

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Hypertension

• George Ann Daniels MS, RN

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What is Blood Pressure

• Components of B/P
• Pressure of blood against the walls of the
  arteries
• The elasticity of the artery walls
• The volume and thickness of the blood

• Systolic
• Force while the heart pumps
• Pressure as the heart pushes the blood out to the
  body
• Normal gt130
• Diastolic
• Force between heart pumps
• Pressure as the heart begins to fill with blood
• Normal gt85
• Systolic over diastolic
• 120/80

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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 gt 140/90

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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

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Classifications of Hypertension

• Primary
• Essential HTN
• Slow onset
• Asymptomatic
• Malignant
• Sudden onset
• Rapid development of symptoms
• Accelerated progression

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Risk Factors R/T Primary Hypertension

• Age/Heredity
• Sex
• Race
• Obesity
• Stimulants
• Sodium
• Alcohol
• Stress
• Hyperlipidemia
• Diabetes
• Socioeconomic Status

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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

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Clinical Manifestation

• Persistent hypertension
• Fatigue
• Reduced activity tolerance,
• Palpation
• Angina
• Dyspnea

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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

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• 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

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Complications Cont

• Cerebrovascular Disease (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

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• Peripheral Vascular Disease (PVD)
• Hypertension speeds up Atherosclerosis in the
  peripheral blood vessels
• Aortic aneurysm
• Aortic dissection
• PVD
• C/O
• Intermittent claudication

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• Nephrosclerosis
• End stage renal disease
• Renal dysfunction
• Ischemia
• Narrowed intrarenal vessel
• Atrophy of tubules
• Destruction of glomeruli
• Death of nephron
• Earliest symptom
• nocturia

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• 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

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Nursing Assessment Data

• Subjective Data
• Past medical history/Family history
• FHP 2 Nutrition
• Alcohol use, salt and fat intake, wt. gain/loss
• FHP 3 Elimination
• Nocturia
• FHP 4 Activity/Exercise
• Fatigue, Dyspnea on exertion, palpitation,
  angina, chest pain, intermittent claudication,
  muscle cramps, smoking history, sedentary
  lifestyle

• FHP 6 Cognitive/perception
• Blurred vision
• paresthesia
• FHP 9 Sexual/Repro
• Impotence
• FHP 10 Coping/stress
• Stressful life events
• Noncompliance
• knowledge deficit
• financial

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Objective Data

• Cardiovascular
• Persisted elevated B/P
• Orthostatic change in B/P or pulse
• Retinal changes
• Abnormal heart sounds
• Diminished or absent peripheral pulses
• Carotid, renal, ischial or femoral bruits
• edema

• Musculoskeletal
• Truncal obesity
• Abnormal waist-hip ratio
• Neurologic
• Mental status changes,
• Localized edema

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Abnormal Diagnostic Test

• Lab
• UA, BUN, serum Creatinine
• Renal involvement
• Serum electrolytes
• Potassium
• Hyperaldosteronism
• Blood Glucose
• Serum cholesterol and triglycerides
• Uric acid

• ECG
• Left Ventricular hypertrophy
• EEG
• Ischemic heart disease

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Medications

• Diuretics
• Suppresses renal tubular re-absorption of sodium
• Diuril
• Loop diuretics
• Bumex, Lasix, Demadex
• Potassium supplement
• Potassium sparing diuretic
• Aldactone

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• Beta Blockers
• Blocks sympathetic stimulation, decreases renin
  secretions, decreases cardiac output.
• Tenormin, Lopressor, Corgard, Inderal
• Alpha Inhibitors
• Decreases peripheral vascular resistance,
• Vasodilator
• Catapres
• Central Inhibitors
• Decreases cardiac output, peripheral resistance,
  and heart rate
• Aldomet, Tenex

• Peripheral Inhibitors
• Relaxes smooth muscle, decreases peripheral
  resistance, decreases heart rate, and B/P
• Resperine
• Vasodilators
• Relaxation of arteriolar smooth muscle,
  vasodilatation, decreases cardiac output,
  decreases peripheral resistance
• Apresolilne, Nipride

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• Angiotension-Converting Enzyme Inhibitors
• Decreases peripheral vascular resistance
• Lotension, Captoen, Vasotec, Prinivil, Accupril

• Calcium Channel Blockers
• Inhibits calcium into smooth muscle cells,
  vasodilatation, decreases peripheral resistance,
  increases cardiac output
• Norvasc, Cardizem, Plendil

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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.

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Plan of Care

• Health Promotion
• Life style modifications
• Diet
• Regular physical activity
• Avoid smoking and chewing
• Relaxation techniques/stress management
• Drug Therapy

• Teaching
• Hypertension
• Family/patient
• Correct technique for taking B/P
• ID Risk factors and
• S S
• Screening programs
• Drug therapy
• Recommendations for follow-up
• Box 31-13

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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

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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

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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

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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

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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

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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

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• Hypertensive Urgencies
• Sit quietly for 20-30 minutes
• Oral medications
• Encourage patient to verbalize fears R/T
  hypertension
• Follow up in 24 hours

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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

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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
• Stay on diet

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The End