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PN 131

PN 131. Hypertension. Objectives. Define hypertension (HTN) Name 2 classifications of HTN Explain the pathophysiology of HTN Describe nursing interventions in caring for clients with HTN. Hypertension. Normal SBP <120 and DBP<80 HTN  sustained SBP >140mmHg &/or DBP >90mmHg

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PN 131

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  1. PN 131 Hypertension

  2. Objectives • Define hypertension (HTN) • Name 2 classifications of HTN • Explain the pathophysiology of HTN • Describe nursing interventions in caring for clients with HTN

  3. Hypertension • Normal SBP <120 and DBP<80 • HTNsustainedSBP >140mmHg &/or DBP >90mmHg • Pre-hypertension is SBP 121-139 or DBP 81-89

  4. Hypertension • Stage 1 = • Systolic pressure 140-159 mm Hg, or • Diastolic pressure 90-99 mm Hg • Stage 2 = • Systolic pressure of 160 mm Hg or ↑; or • Diastolic pressure of 100 mm Hg or ↑

  5. Hypertension • 2 main types: • Essential (primary) • Secondary • Incidence ↑ with age and other risk factors

  6. Primary Hypertension • Also known as Essential Hypertension • Most people with HTN have primary HTN • Unknown cause, but several known risk factors

  7. Essential HTN Risk Factors

  8. Essential Hypertension • Historically, it was believed that ↑ systolic pressure was a normal part of aging: • 100 mm HG + pt. age = normal systolic BP! • Treatment for hypertension was based on diastolic readings • Isolated Systolic Hypertension (ISH) often not treated

  9. Essential Hypertension • ISH ↑ risk of cardiovascular disease and stroke • ISH is a better predictor of cardiovascular morbidity and mortality than diastolic pressure • Diastolic pressure remains a better predictor of CAD in people < 45 years old • ISH = Systolic BP = or > 140mm Hg + Diastolic pressure < 90 mm Hg.

  10. Secondary Hypertension • Attributed to an identifiable medical dx. • Renal Vascular Disease – affects renin and sodium  HTN • Renal artery stenosis, • Parenchymal disease like polycystic kidney disease

  11. Secondary Hypertension • Adrenal cortex diseases: • Atherosclerotic changes ↑ peripheral vascular resistance • Increase in aldosterone retention Na+ & H2O  ↑blood volume • Excess catacholemines ↑ peripheral resistance • Disease of the Adrenal Cortex: • Cushing’s Syndrome • Primary Aldosteronism • Pheochromocytoma

  12. Secondary Hypertension • Coarctation of the aorta (narrowing of the aorta) ↑BP UE, ↓ perfusion LE • Traumatic brain injury, brain tumor, or quadriplegia  ICP  medulla oblongata to ↑ BP • Pregnancy Induced HTN (PIH)

  13. Coarctation of the Aorta

  14. Secondary Hypertension • Other causes • Arteriosclerosis • Genetic arteriolar thickening, leading to increased systemic vascular resistance • Hypernatremia • Increased blood volume • Prolonged stress • Physical or emotional • Abnormally increased sympathetic stimulation, which increases systemic vascular resistance • Abnormal renin release by kidneys  which causes formation of angiotensin II arteriolar constriction and increased blood volume

  15. Effects of Hypertension • Prolonged hypertension increases the workload on the heart by increasing the systemic vascular resistance. • The heart initially compensates by making the myocardium thicker (hypertrophy) • When hypertrophy can no longer maintain a sufficient cardiac output, the heart will dilate. This results in left ventricular dysfunction and CHF (dilated cardiomyopathy).

  16. Effects of Hypertension • Prolonged HTN damages the endothelium in the arteries, promoting and accelerating atherosclerosis, leading to decreased blood flow and tissue perfusion • Coronary Artery Disease, Stroke, and Peripheral Artery Disease risks are elevated for those with HTN • Coronary atherosclerosis decreases blood flow to the myocardium which could lead to ischemia of the myocardium and left ventricular dysfunction (Ischemic Cardiomyopathy)

  17. Atherosclerosis

  18. Malignant Hypertension • Severe hypertension (SBP well over 200mmHg; DBP >120mmHg). • Runs a rapid course  necrosis of arteriolar walls in kidney and retina, hemorrhages and death • Most common causes of death from Malignant HTN are MI, stroke, and renal failure • Unknown exactly what causes it, but risk factors are: • African American male under 40 • Pregnancy • Hx of renal disease

  19. Hypertension • Clinical Manifestations: • A disease without symptoms until vascular changes in the heart, brain, eyes, or kidneys • S/sx usually occur because advanced HTN • Include: • Awakening with a headache • Blurred vision • Nosebleed

  20. Objective Data Collection • Blood pressure in both arms ; supine and standing • Full set VS • Blood pressure readings from past if available • Height and weight • Health history (includes Risk Factors) • Head to toe assessment • Client’s knowledge level of hypertension • Edema • Nocturia • Heart sounds

  21. Subjective Data Collection Most people do not complain of any symptoms, but this does not mean they don’t have signs and symptoms! Assessment: C/O: • Occipital headache (HA) • Blurred vision • Risk Factors • Dizziness, confusion, fatigue Are they able to verbalize: • Understanding of HTN • Understanding of TX

  22. Objective Data Collection • Diagnostic Tests • Chest x-ray (check for coarctation of aorta, cardiomegaly, pulmonary edema) • Serum metabolic panel (check for electrolyte imbalances, kidney function) • EKG (check for left ventricular hypertrophy and/or ischemia) • Echocardiogram (check for left ventricular dysfunction) • Urinalysis (check for proteinuria)

  23. Management of HTN • Modifying risk factors is first line therapy • Weight loss • Diet change • Exercise • Smoking cessation • Stress management • Management of causative diseases • 2nd Step • Beta Blocker and/or Diuretics • “olol’s” - Metoprolol, Propanolol • Potassium-sparing diuretics: • Spironolactone • Thiazides: Diuril, HCTZ

  24. Management of HTN • Step 3 • Increase dosage, • try another drug, or add a second drug • 4th Step • Add 3rddrug – eg. ACE Inhibitor: Captopril, Enalapril, Lisinopril

  25. Nursing Diagnosis • Knowledge Deficient related to disease process and therapeutic management • Assess their understanding of HTN • Assess their understanding of managing HTN

  26. Nursing Interventions • Focus on patient and family education • Disease processes • Compliance with appointments, even if no symptoms • Diagnostic testing • Lifestyle changes (exercise, using support systems, stress reduction, etc.) • Diet changes • Medications (importance, action and side effects) • Prevention of heart disease

  27. Misc.

  28. Hypertension Stats • There are over 72 million adults with HTN (1 in 3) • 78% of those with HTN are aware of their condition • 69% of all those with HTN are under current treatment • 45% are controlled • 55% are not controlled • In 2005: HTN killed ~57,000 people in the U.S. • In 2005: The death rate was ~ 3 times higher for African-Americans than Caucasians

  29. Hormones and Steroid Hormones Increase BP The adrenal gland secretes hormones: Catecholamines Epinephrine Norepinephrine Dopamine As well as steroid hormones: Corticosteroids Cortisol Aldosterone

  30. Renin Angiotensin System

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