Hypertension

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Author:
sdelap
ID:
116183
Filename:
Hypertension
Updated:
2011-11-12 16:50:14
Tags:
Hypertension HTN Nursing
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Description:
Nursing ssessment and treatment of HTN
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  1. Cardiac Output X Peripheral Resistance =
    Blood Pressure
  2. Heart Rate X Stroke Volume =
    Cardiac Output
  3. Blood Pressure Classifications:

    Normal syst/diast
    PreHtn syst/diast
    Stage I Htn syst/diast
    Stage II Htn syst/diast
    • Syst / Diast
    • Normal < 120 /&/ < 80
    • PreHtn 120-139 /or/ 80-89
    • Stage I Htn 140-159 /or/ 90-99
    • Stage II Htn 159+ /or/ 100+
  4. Primary Htn
    Don't know the cause
  5. Factors that influence development of HTN
    • Incr SNS activity
    • Incr reabsorption NaCl and H20 by kidneys
    • Incr RAAS activity
    • Insulin resistance
    • Aging
    • Other diseases (Cushings, DM, Renal Stenosis)
  6. Early S/S HTN
    • Headache
    • Vision changes
  7. Major Risk Factors for HTN
    • Atherosclerosis
    • Smoking
    • Obesity
    • Physical inactivity
    • Dyslipedemia
    • Diabetes mellitus
    • Microalbuminuria or GFR <60
    • Older age
    • Family history
  8. Dietary approach to manage HTN
    • D.A.S.H. Eating Plan
    • Dietary Approach to Stop Hypertension
  9. Lifestyle modifications to reduce blood pressure
    • Wt loss
    • Reduce alcohol intake
    • Reduced Na intake
    • Regular physical activity
    • Diet: high in fiber, fruits, vegetables, low-fat dairy
    • DASH diet
  10. Initial med prescribed to pt w/uncomplicated htn and no specific indications for another medication?
    • Thiazide diuretic
    • Lowers preload, increases CO
  11. Medications to manage HTN
    • Diuretics: Thiazides, Loops, K-sparing diuretics, Aldosterone receptors blockers
    • Beta-blockers
    • Alpha agonists/blockers
    • Vasodilators
    • ACE inhibitors
    • AngII antagonists
    • Calcium channel blockers
  12. Situation in which BP is severely elevated, evidence of actual or probable target organ damabe
    Hypertensive Crisis; BP >180/120

    (Hypertensive urgency=no evidence of actual/probably organ damage)
  13. Mgt of HTN Crisis
    • (BP >180/120)
    • ICU care, if possible
    • Intra-arterial monitoring
    • Reduce BP 25% first hour, 160/100 in 6 hr
    • Gradually reduce more over several days
  14. Meds to treat HTN Crisis
    • IV vasodilators
    • sodium nitroprusside
    • nicardipine
    • fenodopam mesylate
    • enalaprilat
    • nitroglycerine
  15. Meds to treat HTN Urgency
    • Fast-acting oragl agents: beta adrenergic blockers (labetalol)
    • ACE inhibitors: captopril
    • Alpha2 agonist: clonidine
  16. Thiazide Diuretics
    • chlorthalidone
    • chlorothiazide (Diuril)
    • hydrochlorothiazide (Hctz)
    • indapamide
    • methoclothiazide
    • metolazone (Zaroxolyn)
  17. Thiozides - Major Actions
    • Decrease blood volume, renal blood flow, CO
    • Depletion of extracellular fluid
    • Natriuresis - excrete Na in urine
    • Directly affects vascular smooth muscle
    • Mild hypokalemia - excrete K
  18. Thiozides - Contraindications
    • Gout
    • Known sensitivity to sulfonamide medications
    • Severely impaired kidny fcn
    • Hx hyponatremia
  19. Thiazides - SE/AE
    • Dry mouth
    • Thirst
    • Weakness
    • Drowsiness
    • Lethargy
    • Muscle aches/fatigue
    • Tachycardia
    • GI disturbances
    • Possible EE imbalances
    • R/F post hypotension r/t volume depletion
  20. Loop Diuretics
    • furosemide (Lasix)
    • bumetanide (Bumex)
    • torsemide (Demadex)
  21. Loop Diuretics - Major Action
    • Volume depletion
    • Blocks reabsorption Na & Cl, H2O in kidney
  22. Loops - Advantages/Contra
    • Rapid action
    • Potent
    • When thiozides fail or need rapid diuresis

    Same contras as thiozides: gout, sensitivity to sulfas, imp kidney fcn, hx hyponatremia
  23. Loops - SE/AE
    • R/F volume/EE depletion
    • Fluid & EE replacement may be required

    Gero: like thios - R/F post hypotension significant r/t volume depletion, rise slowly
  24. K-sparing Diuretics
    • amiloride (Midamor)
    • triamterene (Dyrenium)

    • (Aldosterone Receptor Blockers)
    • spirolactone (Aldactone)
  25. K-Sparing Diuretics - Major Actions
    Excrete Na, keeps K
  26. K-Sparing Diuretics - Adv/Contra
    • Keeps K
    • For Pts w/Hx MI

    Contra: Hyperkalemai, impaired kidney function, hepatic disease
  27. K-Sparing Diuretics - SE/AE
    • Hyperkalemia (>w/ACE or ARB)
    • Drowsy, lethargic
    • Ha, GI
    • Spirolactone may cause gynocomastia
  28. Beta Blockers (olols)-major actions
    • block SNS stimulation of the heart (lowers heart rate and contraction force thus lowering BP)
    • slows conduction- antiarrhythmic actiivity
  29. Advantages/Contraindications of Beta Blockers
    Advantages: dec HR, contract force, and conduct rate

    Contraindications: asthmatics, depression, DM, liver disease, PVD and heart failure, bradycardia
  30. Alpha-1 blockers (zosin) Major actions
    dialations of peripheral blood vessels
  31. Advantages and contraindications of Alpha-1 blockers
    Act directly on blood vessels

    Contraindications: Angina, could induce tachycardia if not given with BB and diuretic
  32. SE/AE of Alpha-1 blockers
    urinary frequency, vomiting, cardio collapse, drowsiness, lack of energy and weakness
  33. Combined alpha and beta blockers
    • carvedilol (Coreg)
    • labetalol hydrochoride (Trandate)
  34. Vasodialators
    • fenoldopam mesylate (Corlopam)
    • hydralazine (Apresoline)
    • minoxidil (Loniten)
    • sodium nitroprusside (Nitropress)
    • nitroglycerin
  35. ACE (prils)
    • mtr for hyperkalemia
    • lowers peripheral resistance
    • inhibiting RAAS
  36. ARBs (sartans)
    • Inhibits RAAS
    • lowers peripheral resistance
    • mtr for hyperkalemia
  37. Calcium channel blockers
    • diltaizem (Cardizem)
    • verapamil
  38. CCB actions
    • inhibits Ca influx
    • reduce cardiac afterload
    • slows conduction
    • antiarrythmic
    • blocks SA and AV node channels
    • DO NOT d/c abruptly
    • risk for hypotension
    • mtr electrolytes

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