1. Hypertension NPN 200 Medical Surgical I

2. 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”

3. 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, Cushing’s syndrome, thyroid, parathyroid or pituitary disease, PVD, and diabetes

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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