MEDICAL SURGICAL NURSING CHAPTER 33

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MEDICAL SURGICAL NURSING CHAPTER 33

• CARING FOR CLIENTS WITH HYPERTENSION

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BLOOD PRESSURE

• Definition the force produced by the volume of
  blood within the walls of arteries
• BP Cardiac output x peripheral resistance
• Reflects the ability of the arteries to stretch
  fill with blood, the hearts efficiency volume
  of circulating blood.
• Affected by age, body size, diet, activity, time
  of day, emotions, pain, position, gender, and
  disease states

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BLOOD PRESSURE

• Normal range 100/60 119/79
• SYSTOLIC - force and volume of blood ejected from
  the left ventricle during systole or contraction
  and the ability of the arterial system to distend.

• DIASTOLIC - the arterial pressure during
  ventricular relaxation. It depends on the
  resistance of the arterioles and the diastolic
  filling times.

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HYPERTENSIVE DISEASE

• 1 in 4 adults in the US have high blood pressure
• Prehypertension systolic BP of 120-139 or a
  diastolic BP between 80-89
• HTN now divided into
• Stage I systolic BP of 140-150 or diastolic BP
  of 90-99
• Stage 2 systolic BP /gt 160 or diastolic /gt
  100

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HYPERTENSIVE DISEASE

• ESSENTIAL OR PRIMARY sustained elevation of BP
  no known cause - 95 of cases
• WHITE COAT HTN elevated BP that develops during
  assessment by medical personnel then goes back
  to normal

• SECONDARY results from some other disorder such
  as kidney dz, atherosclerosis, stimulant drug use
  such as cocaine or caffeine oral contraceptives

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Pathophysiology Etiology

• Exact cause unknown
• Affects African Americans more often
• Risk factors obesity, smoking, inactivity,
  excessive ETOH intake, high stress, heredity
• May be related to hypernatremia, impairment of
  the renin-angiotension-aldosterone mechanism
• May lead to organ damage

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Assessment Findings

• May be asymptomatic - known as the Silent
  Killer.
• Onset gradual
• Throbbing or pounding headache
• Dizziness
• Fatigue
• Insomnia

• Nervousness
• Nosebleeds
• Blurred vision
• FINDINGS
• elevated BP
• bounding pulse
• peripheral edema
• vascular changes

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Medical Mgmt

• LOWER THE BP
• PREVENT MAJOR COMPLICATIONS
• SEE FIGURE 35-1
• DECREASED NA INTAKE Box 33-1
• WT REDUCTION
• EXERCISE
• MEDICATIONS, SEE Drug Therapy Table 33-1
• Nursing Process- the client with HTN

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OTHER TYPES

• ACCELERATED HTN
• markedly elevated BP w/hemorrhages exudates in
  the eyes
• found in previously undiagnosed or noncompliant
  pts
• abrupt onset, if left untreated may lead to
  malignant HTN

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OTHER TYPES

• MALIGNANT HTN
• dangerously elevated BP with papilledema
  (swelling of the optic nerve at its point of
  entrance in the eye)
• if not treated can lead to severe organ damage,
  CVA, blindness, aortic aneurysm, and death

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Signs Symptoms

• Confusion, headache, visual disturbances,
  seizures possibly, coma
• Chest pain, dyspnea, moist lung sounds

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Medical Management

• lower the BP within 1-2 hrs with IV
  antihypertensive drugs such as Hyperstat,
  Nitropress, or NTG
• If clients condition is not as serious may give
  oral antihypertensives Procardia, Isoptin,
  Capoten, Minipress
• Oxygen therapy

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Nursing Care

• administer meds
• apply automatic BP cuff, cardiac monitor
• restrict activity
• have emergency equipment handy
• Report BP gt 160/115 immediately or per MD
  parameters