Hypertension

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Hypertension

• NPN 200
• Medical Surgical I

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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

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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, Cushings
  syndrome, thyroid, parathyroid or pituitary
  disease, PVD, and diabetes

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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

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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

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Hypertension, cont.

• Data collection
• Subjective
• Asymptomatic or vague symptoms
• Chest pain
• Fatigue
• Blurred vision
• Irritability
• Dizziness
• Ringing in ears
• Tachycardia
• N/V
• SOB and anxiety

• Data collection
• Objective
• B/P 140/90
• Epistaxis
• Evidence of associated disease
• Hematuria
• Proteinuria
• Restlessness

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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

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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

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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

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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