This document discusses hypertension (high blood pressure) including:
1. It defines hypertension as persistent high blood pressure that can damage vessels and organs like the heart, brain, kidneys, and eyes.
2. It identifies risk factors for primary (essential) hypertension such as age, heredity, sex, race, obesity, sodium intake, alcohol, stress, and other conditions.
3. It describes potential complications of uncontrolled hypertension like heart disease, heart failure, stroke, kidney damage, and retinal damage.
4. It provides an overview of hypertension diagnosis, treatment including lifestyle changes and medications, management, and nursing considerations.
2. What is Blood Pressure
• Components of B/P • Systolic
– Force while the heart
– Pressure of blood pumps
against the walls of the – Pressure as the heart pushes
arteries the blood out to the body
– Normal >130
– The elasticity of the
artery walls • Diastolic
– Force between heart pumps
– The volume and – Pressure as the heart begins
thickness of the blood to fill with blood
– Normal >85
• Systolic over diastolic
• 120/80
3. What is Hypertension
• Is the result of persistent
high arterial blood
pressure which may cause
damage to the vessels and
arteries of the
– Heart
– Brain
– Kidneys
– Eyes
• B/P > 140/90
4. Damage to arteries
• HTN arterial walls thicken
– Narrowing the opening inside the artery and
reduces/block blood flow
• Persistent HTN arterial walls become rough
– Easy for plaque is collect inside the artery
– Decreased/blocked blood flow
– Plaque can become mobile
• Fatty emboli
5.
6. Classifications of Hypertension
• Primary
– Essential HTN
• Slow onset
• Asymptomatic
– Malignant
• Sudden onset
• Rapid development of symptoms
• Accelerated progression
10. Complications
• Hypertensive Heart Disease
– Coronary Artery Disease
• Hypertension is a major risk
factor for CAD
• Left Ventricular Hypertrophy
(LVH)
– Increased resistance in the
arteries
» Stiffness and
narrowing of vessels
» Left heart works
harder pumping
against higher
pressure
» Increases myocardial
work and 02
consumption
11. • Heart Failure
– Heart can no longer pump enough blood to
meet the metabolic needs of the body
– Contractility depressed
– Stroke volume and cardiac output decreases
– C/O
• SOB on exertion, paroxysmal nocturnal dyspnea
and fatigue
12. Complications Con’t
• Cerebrovascular Disease
(CVA)
– Most common cause
Atherosclerosis
– Portions of plaque or a blood
clot (forms on plaque) breaks
off
• Thromboembolism
• Travels to intracerebral
vessels
– Stops the flow of blood to
parts of the brain
– Aneurysms burst R/T
increased pressure
» Hemorrhage
» Brain tissue damage
13. • Peripheral Vascular
Disease (PVD)
– Hypertension speeds up
Atherosclerosis in the
peripheral blood vessels
• Aortic aneurysm
• Aortic dissection
• PVD
– C/O
• Intermittent claudication
14. • Nephrosclerosis
– End stage renal disease
– Renal dysfunction
• Ischemia
– Narrowed intrarenal
vessel
» Atrophy of tubules
» Destruction of
glomeruli
» Death of nephron
– Earliest symptom
• nocturia
15. • Retinal Damage
– Red flag
• Damage to retinal
vessels may indicate
vessel damage in the
heart, brain, and kidney
– C/O
• Blurred vision
• Retinal hemorrhage
• Loss of vision
16. Nursing Assessment Data
• Subjective Data FHP 6
– Past medical history/Family Cognitive/perception
history Blurred vision
– FHP 2 Nutrition
• Alcohol use, salt and fat paresthesia
intake, wt. gain/loss FHP 9 Sexual/Repro
– FHP 3 Elimination Impotence
• Nocturia
– FHP 4 Activity/Exercise FHP 10 Coping/stress
• Fatigue, Dyspnea on Stressful life events
exertion, palpitation,
angina, chest pain,
Noncompliance
intermittent claudication, knowledge deficit
muscle cramps, smoking
history, sedentary lifestyle financial
17. Objective Data
• Cardiovascular • Musculoskeletal
– Persisted elevated B/P – Truncal obesity
– Orthostatic change in B/P – Abnormal waist-hip
or pulse ratio
– Retinal changes
• Neurologic
– Abnormal heart sounds
– Diminished or absent – Mental status changes,
peripheral pulses – Localized edema
– Carotid, renal, ischial or
femoral bruits
– edema
22. Expected Outcomes
• Patient will achieve and maintain desired B/
P
• Patient will understand, accept, and
implement the therapeutic plan for B/P
• Patient will experience minimal or no side
effects from therapy
• Patient will exhibit a confident ability to
manage and cope with hypertension.
23. Plan of Care
• Health Promotion • Teaching
– Life style modifications – Hypertension
• Diet • Family/patient
• Regular physical activity – Correct technique for taking
B/P
• Avoid smoking and
chewing – ID Risk factors and
• Relaxation S& S
techniques/stress – Screening programs
management – Drug therapy
• Drug Therapy • Recommendations for
follow-up
– Box 31-13
24. Hypertensive Crisis
• Severe and abrupt
elevation in B/P
– Diastolic of 120-130
• Non-compliant
patients
• Cocaine or crack users
• PCP, LSD
• Causes listed in table
31-15
25. Types of Hypertensive Crisis
• Hypertensive Emergency
– Develops over hours to days
– Evidence of damage to acute target organ
• CNS
– Hypertensive encephalopathy, intracranial or subarachnoid
hemorrhage, acute left ventricular failure with pulmonary
edema, myocardial infarction, renal failure, and dissecting
aortic aneurysm
• Hypertensive Urgency
– Develops over days to weeks
– No evidence of target organ damage
26. Assessment data
• Sudden rise in arterial pressure seen in Hypertensive
Encephalopathy
– HA, Nausea, Vomiting, Seizures, Confusion, Stupor, Coma
– Other common
• Blurred vision and transient blindness
• Renal insufficiency
– Minor to complete renal shut down
• Rapid cardiac decomposition
– Unstable angina to MI
– Pulmonary edema
• Chest pain and dyspnea
• Neurological
– Change in LOC
27. Diagnostic
• Mean arterial pressure (MAP)
– DBP plus pulse pressure(SBP minus DBP)
– MAP = DBP + 1/3 Pulse Pressure
– Goal decrease MAP 10-20% in the first 1-2
hours
– Patients with aortic dissection, unstable angina,
or sign of MI
• Must have SBP lowered to l00-120 mm Hg asap
29. Plan of Care
• Hypertensive Emergency
– Administer IV meds with
rapid onset of action
– B/P Q 2-3 minutes
– Medication is titrated
according to B/P
– Prevent hypotension
• Stroke, MI, visual changes
– Monitor ECG
– Hourly output
– Bedrest
– Neurochecks
30. • Hypertensive Urgencies
– Sit quietly for 20-30 minutes
– Oral medications
– Encourage patient to verbalize fears R/T
hypertension
– Follow up in 24 hours
31. Pediatric Considerations
• Most common secondary
to a structural abnormality
or underlying pathologic
process
• Manifestations
– Adolescents/older children
• Frequent HA, dizziness,
visual changes
– Infants/young children
• Irritability, head
banging/head rubbing,
wake up screaming at
night
32. Treatment
• Diagnosis of underlying cause
• Surgery correction
• Life style changes
– Low salt diet, wt loss, exercise, avoid stress, avoid
smoking
– Avoidance of BCP
• Education
– Orthostatic hypotension
– Take drug as prescribed
– Awarness of side effects and what to do
– Avoid alcohol
– Stay on diet
Heart- works harder, damage the heart muscle- Heart failure-muscle is overused and loses its elascitity and the heart expands like a out of shape rubber band Heart arteries become blocked leading to MI Brain- arteries in the brain become blocked or the pressure will burst blood vessels in the brain=stroke Kidneys- tiny vessels in the kidneys become blocked. Kidney can no longer remove wastes, kidney failure body becomes toxic Eyes- blindness of impaired vision- tiny blood vessels rupture or become blocked, damaging the surrounding eye tissue
Atherosclerosis- fatty deposits become hard with age Hardening of the arteries
Age/ Loss of arterial elasticity, >65 years, increased collagen content, increased vascular resistance heredity-, Close relatives Sex/Race- men (female >55 yrs), African-Americans Obesity- central abdominal obesity- increases cardiac workload and strains the vessels Stimulants- Smoking/caffeine-vasoconstrictors Sodium- water retention causes volume expansion/ decreases effects of certain B/P meds Hyperlipidemia- plaque in the vessels Diabetes- elevated glucose, insulin, and lipoprotein metabolism Socioeconomic-lower and less educated
Coarctation- narrowing of aorta congential Endocrine-Cushing’s, Phenochromocytoma (deficiency in an enzyme essential to fat metabolism-lipoprotein, Hyperaldosteronism Neurological-brain tumors, quadriplegia, head injury
Past thinking: epitaxis, vertigo, lightheadedness, occipital headache, are not increased in hypertension than in the general population. White Coat syndrome- elevated blood pressure. Rest 20-30 minutes then retake
Left ventricle becomes enlarged Inability to meet demands Heart Failure Left ventricle becomes enlarged When unable to meet demands =heart failure
Intermittent claudiation- Ischemic muscle pain precipitated by activity and relived with rest. Aortic Aneurysm pulsating mass