Hypertension, NCP, drug therapy, management

1. Understanding HYPERTENSION Reynel Dan L. Galicinao

2. Introduction

3. HYPERTENSION high BP intermittent or sustained elevation of diastolic or systolic blood pressure a disease of vascular regulation in which the mechanisms that control arterial pressure within the normal range are altered

5. renal pressor system (renin-angiotensin-aldosterone system)

6. extracellular fluid volumeThe basic explanation is that BP is elevated when there is increased cardiac output plus increased peripheral vascular resistance.

7. Classification

11. Secondary hypertension - results from renal disease or another identifiable cause

15. Race

16. Stress

17. Obesity

18. Diet high in sodium or saturated fat

19. Use of tobacco or hormonal contraceptives

20. Excess alcohol intake

21. Sedentary lifestyle

23. Renal parenchymal disease

24. Pheochromocytoma

25. Primary hyperaldosteronism

26. Cushing's syndrome

27. Diabetes mellitus

28. Dysfunction of the thyroid, pituitary, or parathyroid gland

29. Coarctation of the aorta

30. Pregnancy

32. Mineralocorticoids

33. Sympathomimetics

34. Cyclosporine

35. Cocaine

38. Cardiac disease

40. Angina

41. Myocardial infarction

42. Heart failure

43. Arrhythmias

45. hypertensive encephalopathyHypertensive retinopathy can cause blindness Renovascular hypertension can lead to renal failure

46. Clinical Manifestations

47. In many cases, the hypertensive patient has no symptoms The disorder is revealed incidentally during evaluation for another disorder or during a routine BP screening program When symptoms do occur, they reflect the effect of hypertension on the organ systems May cause headache, dizziness, blurred vision when greatly elevated

48. Diagnostic Evaluation

51. elevated in Cushing's syndrome

53. MANAGEMENT

55. Lose weight if body mass index is greater than or equal to 25 Limit alcohol - no more than 1 oz ethanol daily for men, 0.5 oz for women Get regular aerobic exercise equivalent to 30 to 45 minutes of brisk walking most days Cut sodium intake to 2.4 g or less per day

56. Lifestyle Modifications

60. Drug therapy

63. relax smooth muscle, which causes vasodilation

65. If the patient has had adverse effects, another class of drugs can be substituted

67. Nursing diagnoses

68. Deficient knowledge (lifestyle modifications) Fatigue Ineffective coping Ineffective tissue perfusion: Cardiopulmonary Noncompliance: Therapeutic regimen Risk for injury

69. Key outcomes

70. The patient will identify appropriate food choices. The patient will express that he has more energy. The patient will demonstrate adaptive coping behaviors. The patient will maintain adequate cardiac output and hemodynamic stability. The patient will comply with his therapy regimen. The patient will remain free from complications.

71. Nursing interventions

74. To help identify hypertension and prevent untreated hypertension, participate in public education programs dealing with hypertension and ways to reduce risk factors. Encourage public participation in blood pressure screening programs. Routinely screen all patients, especially those at risk (blacks and those with family histories of hypertension, stroke, or heart attack).

75. Patient teaching

79. table salt