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HYPERTENSION
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Definition HTN is a persistent elevation of the SBP above 140mmHg and DBP above 90mmHg. Over sustained period of time Based on 2 or more reading at different intervals
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Patho *multifactoral condition Sign – used to monitor clinical status
Risk factor- involves atherosclerotic plaques within arterial walls Disease- major contributor to death from cadiac, renal, and peripheral vascular disease
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Types Primary (essential) – elevated BP of unknown cause; can not identify Secondary – elevated BP of known cause. Ex: renal Dz, DM, dyslipidemia
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Factors that affect BP *Age *Exercise *Stress *Race
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Factors that affect BP *Age *Gender *Exercise *Medication
*Stress *Obesity *Race *Diurnal variation *Disease process About 30% of the adult population within the U. S. has HTN. Highest prevalence in African Americans and Hispanics
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Risk Factors Risk positive risk factors Obesity Stress
Cigarette smoking Hypercholesteremia Increased Na intake
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Risk Factors Risk positive risk factors Obesity Stress
Cigarette smoking Hypercholesteremia Increased Na intake At risk for Heart attack Heart failure Stroke Cardiac Dz Renal failure Impaired vision
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Signs & Symptoms Subjective H/A (occipital) Lightheadedness Tinnitis
Easy fatigue Visual disturbances Palpitations Brief lapses in memory
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Signs & Symptoms Subjective Objective Elevated BP readings
H/A (occipital) Lightheadedness Tinnitis Easy fatigue Visual disturbances Palpitations Brief lapses in memory Objective Elevated BP readings Retinal chenges Possible hematuria Epistaxis Cardiac hypertrophy
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Classification Type SBP DBP Follow-up Normal <120 <80 1-2 yr
Pre-HTN 805-89 1 yr Stage 1 (mild) 90-99 1 months Stage 2 (Moderate) >160 >100 1 week
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Assessment *Obtain complete history (check for organ damage)
Pain- angina, intermittent claudation, occipital H/A,
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Assessment Polyuria, nocturia, fatigue, dizziness, epistaxis, dyspnea on exertion *Alteration in speech, vision or balance Labs- U/A, Blood chemistry, EKG cholesterol level
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Nsg Dx Knowledge Deficit Disease process * Diet Exercise *Medication
Noncompliance Treatment regimen *Diet Exercise
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Plan/Goal Client will: understand the disease process & its treatment.
Participate in self- care programs Absence of complications
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Medical Management * Diet & Wt. reduction – (restrict Na, Kcal, cholesterol) *Lifestyle changes – alcohol moderation, exercise regimen, cessation of smoking *Antihypertensive drug therapy Use home work med classification sheet as a guide when studying Med therapy includes—diuretics, beta-blockers, alpha 1 blockers, vasodilators, ACE inhibitors, ARB’s, CCB, renin inhibitors
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Nurse’s Role Patient/Family teaching
*med, usage, S/E, no abrupt stopping, when to take (no hot baths, alcohol, or strenuous exercise within 3 hrs of taking meds)
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Nurse’s Role Cont’ Early detection & screening
home or drug store Risk modification programs *develop gradual exercise program
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Nurse’s Role Cont’ Refer for medical treatment
Encourage/Facilitate client in complying with treatment regimen Administer meds as ordered Monitor I/O Daily Wt. Inform of importance of follow-up care
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Evaluation *Maintain adequate tissue perfusion
*Complies with self-care program *Has no complications
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HTN Crises HTN emergency (crisis)- acute, life-threatening BP elevations >180/120mm Hg *BP must be lowered immediately *halt/prevent damage to target organs *requires ICU monitoring with IV meds HTN urgency- BP must be lowered within a few hours * managed with oral meds Both requires close monitoring of BP & cardiovascular status.
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Orthostatic Hypotension
BP that is below normal BP falls when pt. sits or stands *Caused by peripheral vasodilation – (blood leaves the central organs and moves to the periphery). Pt. c/o feeling faint
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Nurse’s Role Place in supine position for 2-3 minutes
Check & record BP & pulse Encourage to sit or stand slowly Recheck BP & P after 1 minute Compare results : rise>40 or drop<30, indicate abnormalities
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