Nursing Care for patients with hypertension and heart failure Hypertension is define as a systolic blood pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg . based on the average of two or more the blood pressure measurements.

Classification of hypertension: 1- Primary Hypertension Primary or essential hypertension is the chronic elevation of blood pressure from an unknown cause. 2- Secondary Hypertension Secondary hypertension has a known cause. It is a sign of another problem, such as a kidney abnormality, a tumor of the adrenal gland, or a congenital defect of the aorta. Blood pressure usually returns to normal. (stone)

3- Gestational hypertension Sometimes it is called Pregnancy-Induced Hypertension (PIH). Women who develop high blood pressure after mid-pregnancy. the risk is higher if: -The first pregnancy. -Obesity. -Over 30 years of age. -If there is a personal or family history of gestational hypertension -Chronic renal failure or diabetes mellitus. -Carrying twins or higher multiple pregnancies.

Causes of hypertension Aging (older than 55 years for men, 65 years for women). Eating of excess salt. Obesity or . Sleep apnea. Sedentary lifestyle . Drug overdose stress. Hormonal conditions.

Guidelines of hypertension Blood pressure(Bp) Systolic BP(mmHg) Diastolic BP(mmHg) Normal <120 <80 Pre-hypertension 120-139 80-89 Hypertension stage 1 140-159 90-99 Hypertension stage 2 ≥160 ≥100

Major Risk Factors Smoking. Dyslipidemia (elevated LDL or total cholesterol and low HDL cholesterol). Drinking more than 2 alcoholic drinks a day for men or more than 1 alcoholic drink a day for women. Diabetes mellitus, impaired renal function Physical inactivity. Family history of cardiovascular disease.

Clinical manifestation (Signs and symptom) 1- Headache, Dizziness 2- Blurry of vision 3- Shortness of breathing 4- Palpitation 5- Chest pain 6- Nausea and vomiting 7-Epistaxia

Prevention Maintain normal body weight for adults Reduce dietary sodium intake physical activity Limit alcohol consumption. Consume a diet rich in fruit and vegetables. 6- Decreased smoking

Complication of hypertension 1- Cerebrovascular accident (CVA) 2- Angina, Myocardial infarction (MI ), congestive heart failure(CHF). 3-Retinal damage. 4- Renal failure

Nursing Interventions The patient and family should be allowed to maintain a sense of control, make informed decisions regarding care. Develop the skills necessary to make lifestyle modifications. Behavioral changes are the most difficult for the patient to initiate and maintain. Teach patient to take medications as prescribed and not to skip dosages. Teach patient to change positions slowly to prevent falls. Check the vital signs regularly ( BP& HR).

Heart Failure (HF) Is the inability of the heart to pump sufficient blood to meet tissues needs for oxygen and nutrients.

Causes of HF Any heart problem may potentially lead to HF Coronary artery disease (most often). Myocardial infarction. Cardiomyopathy. Heart valve problems. Hypertension. Anemia. In the elderly, the most common cause of HF is cardiac ischemia.  

ACUTE HEART FAILURE Pulmonary edema, also known as acute heart failure, is severe fluid congestion in the alveoli of the lungs. Pulmonary edema occurs in an acute event such as a myocardial infarction (MI) or when the heart is severely stressed, causing the left ventricle to fail.

Signs and Symptoms of AHF Rapid respirations with accessory Muscle use Crackles and wheezes Coughing Anxiety, restlessness Pale skin and mucous membranes Clammy, cold skin

Diagnostic Tests of AHF Chest x-ray examination Arterial blood gases Electrocardiogram Hemodynamic monitoring

Therapeutic Interventions of AHF Oxygen via cannula, mask, or mechanical ventilation. Positioning in high or semi-Fowler’s position. Bed rest. IV Drugs: morphine, diuretics. Vasodilators Frequent vital signs, urine output. Daily weight. Treatment of underlying cause  

CHRONIC HEART FAILURE Signs and Symptoms Right-Sided Heart Failure Left-Sided Heart Failure Jugular vein distention Dyspnea on exertion peripheral edema Dry cough Ascites Crackles, wheezing Weight gain Orthopnea Spleenomegaly Paroxysmal nocturnal dyspnea Hepatomegally GI pain, anorexia, nausea Cyanosis Fatigue, weakness Tachypnea, tachycardia Tachycardia Nocturia Nocturia  

Diagnostic Tests of CHF History and physical examination Electrocardiogram Chest x-ray examination Exercise stress test, Echocardiography Coronary angiography Cardiac catheterization Serum laboratory tests: ABGs, CBC, electrolytes, liver enzymes, BUN, creatinine,

Complications of CHF Hepatomegally Spleenomegaly Pleural effusion Left ventricular thrombus and emboli Cardiogenic shock

Therapeutic Interventions Noninvasive Treat underlying cause Oxygen by cannula or mask Drug therapy Individualized activity plan Dietary sodium restriction Fluid restriction Daily weights

Invasive Mechanical assistive devices Intra-aortic balloon pump Left ventricular assist device Heart valve replacement Cardiac transplant

Nursing Intervention Provide rest, space activities, and conserve energy. Teach use of assistive devices and lifestyle changes Monitor for edema, weight gain, jugular vein distention (JVD), lung crackles. Decrease sodium intake as ordered. Administer diuretics as ordered. Monitor intake and output. Identify barriers to sleep. Assist patient in identifying positions of comfort for sleeping.

4- Isolated Systolic Hypertension Isolated systolic hypertension (ISH) is a systolic pressure of 160 mm Hg or greater and a normal diastolic pressure of 90 mm Hg or less. This type of hypertension occurs mainly in elderly people, although it can occur at any age.