1. Nursing Care of Patients with Hypertension
Chapter 22
Nursing Care of Patients with Hypertension

2. Hypertension Incidence
2005–2006:
29% U.S. Adults > 18 Years of Age
Increases with Age
Non-Hispanic Blacks: 41%
Non-Hispanic Whites: 28%
Mexican Americans: 22%

3. Safety: Clean Stethoscope
Contaminated with Bacteria, Even MRSA
Clean at Start of Shift
Clean Between Every Patient Use
Clean with Each Hand Hygiene
Use Ethanol-based Cleanser or Isopropyl Alcohol Pads

4. Taking Blood Pressure (BP)
Use Calibrated Instrument
Have Patient Sit Quietly for 5 Minutes in Chair (Not Exam Table) with Feet on Floor, Arm Supported at Heart Level
Use Cuff Bladder Encircling at Least 80% of Arm
Take Two BP Measurements (Wait In-between)
Tell Patient BP Reading

5. Hypertension Normal BP is Below 120/80 mm Hg
Average of Two or More Readings on Different Dates
Highest Reading Determines Category

6. Classification of Hypertension
Systolic Diastolic
Pre-hypertension –139 or 80–89 mm Hg
Stage 1 Hypertension 140–159 or 90–99 mm Hg
Stage 2 Hypertension >160 or >100 mm Hg

7. Follow-Up Care Normal BP: 2 Years Pre-hypertension: 1 Year
Stage 1 Hypertension: 2 Months
Stage 2 Hypertension: 1 Month
>180/110 mm Hg: Immediate Treatment

8. Blood Pressure Pressure Exerted by Blood on Walls of Blood Vessels
Determined by Cardiac Output, Peripheral Vascular Resistance, Vessel Stretch, Blood Viscosity, Blood Volume

9. Pathophysiology Primary Hypertension Secondary Hypertension
Unknown Cause
Secondary Hypertension
Known Cause
Isolated Systolic Hypertension
SBP >140 mm Hg

10. Hypertension Signs/Symptoms
None
“Silent Killer”
Rare
Headache, Bloody Nose, Anxiety, Dyspnea
Target Organ Disease
Damage to Blood Vessels of Heart, Kidney, Brain, Eyes

11. Diagnosis of Hypertension
History
Signs and Symptoms
Kidney or Heart Disease
Medications
Blood Pressure Readings
Home Blood Pressure Measurements

12. Diagnostic Tests ECG Blood Glucose Hematocrit Potassium Calcium
Lipoprotein, Cholesterol, Triglyceride

13. Hypertension Risk Factors
Nonmodifiable: Unable to be Changed
Modifiable: Changeable

14. Nonmodifiable Risk Factors
Family History of Hypertension
Age
Ethnicity
Diabetes Mellitus

15. Modifiable Risk Factors
Weight
Diet
DASH
Limit Sodium
Limit Caffeine
Alcohol Use
Exercise
Smoking
Stress Management
Adequate Sleep

16. Hypertension Treatment
No/Low Risk Hypertensive
Lifestyle Changes
BP >140/90 mm Hg Over 6 Months
Goal of Treatment
<140/90 mm Hg
<130/80 mm Hg Diabetes/Kidney Disease/
Proteinuria

17. Hypertension Treatment (cont’d)
Lifestyle Changes
and
Antihypertensive Medications
Initial Therapy: Thiazide-type Diuretics
Combination Medications

18. Medications for Hypertension
Diuretics
Alpha Blockers
Beta Blockers
Calcium Channel Blockers

19. Medications for Hypertension (cont’d)
Angiotensin-converting Enzyme Inhibitors
Central Agents
Peripheral Agents
Vasodilators
Aspirin 100 mg at Bedtime

20. Complications of Hypertension
Atherosclerosis
Coronary Artery Disease
Myocardial Infarction
Left Ventricular Hypertrophy
Stroke
Kidney/Eye Damage

21. Hypertensive Emergency
SBP >180 mm Hg Systolic
DBP >120 mm Hg Systolic
Risk for/Progression for Target Organ Dysfunction
Immediate Gradual Reduction of BP to Protect Target Organs
Treatment: Nitroprusside (Nipride) IV

22. Hypertensive Urgency
Severe BP Elevation Without Target Organ Dysfunction Progression
Severe Headaches, Nosebleeds, Shortness of Breath, and Severe Anxiety
Oral Medication

23. Nursing Process Deficient Knowledge
Ineffective Therapeutic Regimen Management

24. Patient Education Lifelong BP Control Self-care Measures
Prescribed Medical Regimen