HYPERTENSION

• THEORETICAL CONCEPTS

• NURSING PRACTISE

Mónica Roque

Adult Nurse

February 2014

DEFINITION OF HYPERTENSION

• High blood pressure

The pressure exercised by blood on the walls of the

blood vessels

• Cardiac outputdetermined by:

• Peripheral vascular resistance

• Viscosity (Thickness)

The product of the heartrate multiplied by the

stroke volume.

The ability of the vessels to stretch.

• The amount of circulating blood

volume 2

MEASURING BLOOD PRESSURE

Universal advices

Measurement should be done in both arms at first visit

The patient should be seated for at least 5 minutes, relaxed and not moving or speaking

Remove tight clothing, support arm at heart level, ensure arm relaxed and avoid talking

during the measurement

Thepatient should not have exercised, eaten or smoked for at least half na hour prior to taking

blood pressure. 3

MEASURING BLOOD PRESSURE

Manual measurement CHOOSE THE CORRECT CUFF

SIZE!

4

Indication Width (cm) Length (cm)

Child/Small adult 10-12 18-24

Standard Adult 12-13 23-35

Large Adult 12-16 35-40

Adult Tight Cuff 20 42

Bladder too large:Underestimation of BPBladder too

small:Overestimation of BP

5

Measuring blood pressure

Manual measurement

Palpate the brachial pulse along the inner upper arm.Explanation: Where the stethoscope will be placed when listening Korotkoff sounds.

Choose the correct cuff and apply it to the upper arm. The centre of the bladder must be in line with the brachial artery.Explanation: the cuff needs to be positioned to allow the stethoscope diaphragm clear access to the brachial artery.

Place the diaphragm of the stethoscope over the brachial artery, near to cubital fossa.

Close the control valve on the sphygmomanometer Inflate the cuff, so that the dial reads 30mmHg above your earlier estimated Systolic pressure (150mmHg, approximately).

Open the air valve fully, to rapidly deflate the cuff. Release the patient from the equipment.

The last sound that listen is the Diastolic pressure (measures the pressure in the arteries between beats).

The Korotkoff sounds are quite faint, but distinctive, when recognized. Listen carefully for the first ‘Bump’, note the associated dial reading. This is the real

Systolic pressure (measures the pressure in the arteries when the heart beats).

Gently open the valve for a slow controlled release of air from the cuff.

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MEASURING BLOOD PRESSURE

Manual measurement

CLASSIFICATION OF BLOOD PRESSURE

CATEGORY SYSTOLIC (MMHG)

DIASTOLIC (MMHG)

Optimal <120 <80

Normal 120-129 80-84

High normal 130-139 85-89

Stage 1 Hypertension 140-159 90-99

Stage 2 Hypertension 160-179 100-109

Stage 3 Hypertension ≥180 ≥110

CAUTION: The systolic and diastolic pressures are measured in millimetre of mercury (mmHg).

7

RISK FACTORSNon-modificable

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Family history

Age

Gender

Race and Ethnicity

Diabetes Mellitus disease

Other chronic diseases

• Two third of adults who have diabetes also have hypertension.

• The risk of developing hypertension when someone has a familiar background of diabetes and obesity is 2 to 6 times great than a person without this family history.

The probability to have hypertension increases with age.

• More common in men than women.

• Women are more likely to develop hypertension after menopause.

More common in

black.

• High cholesterol;• Kidney diseases;• Sleep apnea.

RISK FACTORSModificable

9

Weight

Stress

Unhealthy Diet

Addictions

Sedentary life

Overweight or obesity (If we have higher body mass index, our body need more blood to supply nutrients and oxygen to the tissues. As the blood volume in circulation increases, it will increase the pressure in artery walls.)

• Tobacco (chemicals in tobacco can damage the lining of the artery walls)

• Alcohol (the regular consumption of 3-4 alcoholic drinks per day, increases the risk of hypertension and reduce the action of antihypertensive therapy.)

• Sodium intake;• Low potassium

intake (Potassium helps to balance the amount of sodium in cells.);

• High-fat diet.

TYPES OF HYPERTENSION

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Primary Hypertension• Chronic elevation of blood pressure from an

unknown cause.• 90%-95% of all cases

Secondary Hypertension• Signify high blood pressure from an identified cause

(e.g. kidney disease)• 5%-10% of all cases

Systolic Isolated Hypertension• It’s a high value of systolic pressure, and a normal

value of diastolic pressure.• It’s rare.

SIGNS AND SYMPTOMS

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NORMALLY, HYPERTENSION IS A SILENT KILLER – CAUSES NO SIGNS OR SYMPTOMS!

• Headache

• Bloody nose

• Blurred vision

• Dizziness

• Fatigue, activity

intolerance

• Palpitations

• Blood spots in the

eyes

• Facial flushing

Target organ

diseases

Heart

Kidney Brain

Eyes

NURSING PRACTISETHE BEST CARE

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Individual Assessment:

Medical background:

• Food habits (alcohol use, salt and fat intake, weight gain/loss)

• Elimination (nocturia)

• Activity (fatigue, activity intolerance, dyspnoea on exertion, palpitation, angina, chest

pain, intermittent claudication, muscle cramps, )

• Addictions

• Cognitive/perception (blurred vision, paresthesia)

• Coping/stress (stressful life events, noncompliance)

NURSING INTERVENTIONS

13

Teaching

Therapy Adherence

Health Promotio

n

MAIN GOALS:

• Maintain or enhance

cardiovascular functioning.

• Prevent complications.

• Provide information about disease

process, prognosis, and therapy.

• Support active client control of

condition.

Regular blood pressure measurement is ESSENTIAL!

OBJECTIVE OF NURSING CARE:

Decrease and control the blood pressure

NURSING INTERVENTIONS

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Teaching

Therapy Adherence

Health Promotio

n

Life style modifications

• DIET:

reduce salt and sodium intake;

diet rich in fruits, vegetables, proteins,

potassium and calcium;

• REGULAR PHYSICAL ACTIVITY – 20 to 30

minutes of moderate activity 4/5 days a week

• WEIGHT REDUTION (in cases of overweight

or obesity)

• SMOKING CESSATION

• STRESS MANAGEMENT – use non-

pharmacologic strategies, like yoga or relaxing

training

• LIMIT ALCOHOL CONSUMPTION – for men,

no more than 2 drinks per day, and for women,

no more than 1 drink per day

NURSING INTERVENTIONS

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Teaching

Therapy Adherence

Health Promotio

n • Hypertension’s pathology

• Correct blood pressure

measurement

• Drug therapy

• Inform about support groups

and Community support

Patient/Family

NURSING INTERVENTIONS

16

Teaching

Therapy Adherence

Health Promotio

n

• Explain the importance

about therapy adherence.

• In case of Non-adherence:

Understand the patient’s

reasons;

Adjust clinical treatment

according to the patients’

cultural beliefs and individual

attitudes

REFERENCES:

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• Blood pressure measurements devices. V. 2.1. MHRA. (2013)

• Brunner, Standard. Textbook of Medical-Surgical Nursing. Lippincott Williams

& Wilkins; Twelfth, North American Edition (November 24, 2009)

• Marilynn E. Doenges, Mary Frances Moorhouse, Alice C. Murr. Nursing care

plans : guidelines for individualizing client care across the life span. Ed. 8.

David Plus (2010)

• NICE clinical guideline 127 Hypertension: clinical management of primary

hypertension in adults. NHS. (2011)

• WHO – A global brief on hypertension. (2013)

• Williams, S., Hopper, P. – Understanding medical-surgical nursing. Ed. 2. F. A.

David Company – Philadelphia (2003)