Nursing Management of Clients with Stressors of
Circulatory FunctionHYPERTENSION
NUR133LECTURE # 10K. Burger MSEd,MSN, RN, CNE
Incidence and Prevalence
Hypertension affects about __________
people in the United StatesHypertension affects about __________
people worldwide___________ of the population are
unaware they have hypertensionAwareness, treatment, and control=goals
Target Organ Damage (TOD)Associated with Hypertension
Heart Disease- Left ventricular hypertrophy (LVH)- Congestive heart failure (CHF)- Myocardial infarction (MI)
Cerebrovascular accident (CVA)NephropathyRetinopathy
Definition and Classification
SBP => 120 mm Hg DBP => 80 mm Hg
Prehypertension 120-139/80-89Stage I Hypertension 140-159/90-99Stage II Hypertension >160/100
*Primary Hypertension (essential, idiopathic) 90% of casesSpecific cause unknown
Components of Blood Pressure
Blood pressure = CO X SVRCO = cardiac outputSVR = systemic vascular resistance
Risk Factors
Age greater than 60 yrs old Family history Obesity Sedentary lifestyle Hyperlipidemia Diabetes mellitus Increased intake of Na, ETOH, caffeine Smoking Stress African American ethnicity Metabolic Syndrome
Metabolic Syndrome
A group of metabolic risk factors that greatly increase risk for:CADDM type 2CVA
Complications Associated with Hypertension
Coronary Artery Disease (CAD )
Complications Associated with Hypertension
Thrombolytic CVA Hemorrhagic CVA
Complications Associated with Hypertension
NephropathyChronic hypertension
causes thickening of nephron blood vessels(nephrosclerosis) which decreases renal blood flow.
Result = chronically hypoxic renal tissue and permanent tissue damage
Complications Associated with Hypertension
Retinopathy
Complications Associated with Hypertension
Malignant Hypertension
Condition of severely elevated B/PSBP > 200mm Hg and/or DBP > 120mm Hg Acute, life-threatening emergency Creates hi-risk for target organ damage: Cardiac, Renal, CNSRequires swift intervention to lower B/P Also may be termed: Accelerated –malignant hypertensionIncidence generally low: (1-2% of hypertensive client population)Most commonly an unexplained occurrence in clients w/chronic HTN Higher incidences found in:-middle-aged-male-African-American
HTN ASSESSMENT
History- dietary, alcohol, smoking habits- stress and physical activity - other health stressors: DM- family hx of heart disease, HTN- ethnic origin or race- symptoms: ha, dizziness, OR NONE
Physical- BP both arms: lying, sitting, standing- Fundoscopic exam
HTN Assessment
Diagnostics- Anthropometric measures- EKG, Echocardiogram- Lipid Profile- HgAIC- C-reactive protein- homocysteine- Renal studies: BUN, Creat, Renin- Blood chemistries: Na, K, Glucose
Lipid Profiles
Desirable Levels
LDL < 100 HDL > 40 Total Cholesterol<200 Triglycerides <150
HTN Nursing Diagnosis
Deficient knowledgeRisk for ineffective therapeutic mgmtAltered nutrition; more than body reqIneffective tissue perfusionPotential for injury:
CVA, MI, Retinal Hemorrhage
+++++++++++++++++++++++++++++more
HTN Planning
Client will:Have BP readings 120/80 or <Be knowledgeable about disease process
and potential complicationsUndertake lifestyle modifications: weight
control, dietary/alcohol/smoking habits, stress reduction, exercise etc.
Comply with medication regimen
Interventions for Hypertension
Patient Education
Pharmacological TherapyLifestyle Modifications
DASH DIET
DIETARY APPROACH TO STOP HYPERTENSION
Reduce intake of: saturated fatcholesterolred meatsrefined carbohydrates (sugars)sodium
Increase intake of:complex carbohydrates (fiber)fruits & vegetables ( increases K )low-fat dairy products (increases Ca )
nuts and legumesDASH diet plan www.nhlbi.nih.gov
Pharmacological Interventions
DiureticsACE InhibitorsCalcium Channel BlockersAngiotensin II Receptor BlockersAdrenergics: Alpha & Beta BlockersVasodilatorsAntihyperlipemics ( CAD therapy )