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  1. Hypertension
    occurs when the systolic blood pressure is above 140 mm Hg or the diastolic blood pressure is above 90 mm Hg
  2. Essential Hypertension (primary hypertension)
    No known cause. Accounts for 90-95% of all cases. No identified cause.
  3. Secondary Hypertension
    related to other identified causes. Some of these include:

    • -renal disease
    • -hyperaldosterone, cushings disease,thyroid/parathyroid disorder
    • -sleep apnea
    • -pregnancy
    • -medications
  4. Hypertension Contributes to Cardiovascular disease
    • Obesity
    • Diabetes
    • Elevated cholesterol and triglycerides
    • smoking
    • sedentary lifestyle
    • family history
    • age
  5. Pathophysiology of Hypertension
    Each time the heart contracts pressure is exerted by the blood vessels

    Hypertension can result from an increase in cardiac output, an increase in peripheral or both
  6. Vasoconstriction and Vasodilation
    Arterial opening is an important determinant of peripheral vascular resistance

    Vessels have the ability to widen or narrow quickly in response to body needs (such as oxygen demands of nearby tissues, temperature regulation,fluid loss NS response)
  7. Progression of cardiovascular disease
    Elevated blood pressure roughs up the normally smooth lining

    Sets the stage for fat streaks, blood cells, or calcium to adhere
  8. ASHD (Ateriosclerotic Heart Disease)
    Thickening and buildup reduces blood flow and increases resistance.
  9. Consistantly elevated BP can have the following negative outcomes
    1. Damage to the endothelial lining of the arteries

    2. Increased workload of the heart causes heart failure

    3. Rupture of hemorrhage of arterioles
  10. Target organs of hypertension
    Brain, Heart, Kidneys, Blood Vessels, Eyes
  11. Regulatory Mechanisms of hypertension
    Sympathetic Nervous System and RAAS (Renin-agiotensin-aldosterone-system)
  12. Sympathetic Nervous System
    activity in response to feedback mechanisms signals

    • -vessels to constrict or to relax and open
    • -fluid retention
    • -heart rate and contractility
  13. RAAS (renin-angiotension-aldosterone-system)
    Important pathway causing vasoconstriction and sodium/fluid retension
  14. Safe, Effective Care of hypertension
    • -Hypertension is under diagnosed 
    • -No visible symptoms
    • -Often called the "silent killer"
  15. Risk Factors for Development of Primary HTN
    age-related to ↓ elasticity of blood vessels

    • family history
    • ethnicity
    • obesity
    • diabetes, sleep apnea
    • Diet
    • alcohol consumption
    • oral contraceptives in women
    • smoking
  16. Clinical Manifestations (signs and symptoms)
    Elevated blood pressure readings

    Most people have no outward symptoms


    • Sometimes (infrequently) reported by patients:
    •   -Dull headache, Nosebleeds,Dizziness, Blurred Vision
  17. Pharmacologic Therapy

    (Drugs used to treat hypertension have two main factors)
    1.They decrease the volume of circulating blood

    2. They reduce peripheral vascular resistance
  18. When administering antihypertensive medication drugs to patients always determine
    Blood pressure and heart rate
  19. (Drug Class)
    Diuretics
    • Mechanism of Action
    • ↑ urine output ↓ Blood volume

    Inhibits sodium reabsorption in kidneys

    • Side Effect & Adverse Effects
    • Volume depletion/dehydration
    • ↓ K (hypokalemia)
    • ↓ sodium (hyponantremia)

    • Headache
    • Weakness
    • Vertigo
    • Orthostatic hypotension
    • Dry mouth
  20. (Drug Class)
    Angiotensin-Converting Enzyme (ACE) Inhibitors
    -castopril(Capoten)
    -lisinopril(Zestril)
    -enalapril(Vasotec)
    • Inhibits conversion of angiotensin 1 to angiotensin 2 resulting in vasodilation lower peripheral resistance
    • ↓ blood volume


    • Side Effects & Adverse Effects
    • Persistent, dry cough
    • Hyperkalemia (high K)-especially in patients with kidney disease 
    • First dose hypotension
    • Angioedema(usually stridor) (potentially fatal)
  21. Treatment Goals for Patients with Hypertension

    Lowering and controlling blood pressure
    • -Maintain 140/90 or lower
    • -Maintian 130/80 or lower in patients with diabetes or chronic kidney disease
  22. Nursing Care of Patients with Hypertension

    (Assessment)
    • Pain-where, how often,how severe
    • Dizziness
    • Vision
    • Breathing, SOB
    • Fatigue
    • Urinating
    • Sexual dysfunction
  23. (Physical) Assessment Of Hypertension
    • -Blood pressure
    • -Heart rate, rhythm
    • -Peripheral pulses
    • -Peripheral edema
  24. Patient Teaching
    • -Emphasize concept of controlling rather than curing hypertension
    • -For most will be a lifelong, chronic illness.
    • -Treatment will Greatly decrease associated cardiovascular risks.
  25. Hypertensive crisis
    • -A Hypertensive crisis exists when blood pressure is severely elevated.
    • -Acute situation that requires prompt treatment to halt or prevent serious damage to target organs
    • -Severity of situation is determined by evidence of organ damage. (cerebral hemorrhage,MI,heart failure, Kidney failure)
  26. How High is TOO High
    • -No clear guidelines
    • -200/120 requires immediate treatment
    • -180-199 systolic or 110-119 may require immediate treatment or evaluation within 24-48 hrs
    • Hypertensive EMERGENCY there is evidence of target organ damage.
    • -Hypertensive URGENCY no organ damage is evident (Sometimes called asymptomatic severely elevated blood pressure)
  27. Oxygenation
    Occurs when O2 molecules enter the tissues of the body

            -Blood is oxygenated in the lungs where oxygen molecules travel from the air and into the blood
  28. Vital Signs
    A persons temp,pulse,respiration, blood pressure and pain assessment

    -ex: 98.5-72-18-120/80. pt denies pain 0/10
  29. Prevalence of Conditions related to Oxygenation
    • Respiratory infectious diseases 
    •       -Flu
    •       -Pneumonia
    • Hypertension
    • Coronary Artery Disease (CAD)
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Anemia
  30. Multiple systems involved in regulating oxygenation
    • -Nervous system
    • -Cardiovascular system
    • -Respiratory system
    • -Metabolic processes
    • -Hormones
    • -Electrolytes
  31. (Reciprocal Relationship of Vital Signs)

    They have a relationship to each other and together they are indicators of a persons health status.
    -They refect how the circulatory,respiratory,nervous,and endocrine systems are functioning.

    -Many things can affect VS

    -An alternation in one VS often affects others and needs to be seen in context with other health care assessments
  32. Physical Assessment
    • Technique
    •   -Inspection
    •   -Palpation
    •   -Percussion 
    •   -Auscultation
    •   
    • Stethoscope
  33. Temperature
    • Balance of heat produced and lost from the body
    •           normal temperature range:
    •            36-38 C    96.8-100 F
    • Heat produced-heat lost=body temp

    Core temp-temp of the deep tissues, relatively constant

    Surface temp-fluctuates
  34. Heat
  35. Heat production
    • -Is a by product of metabolism 
    • -Food is the main fuel for metabolism
    • -Increase metabolism increase heat
  36. Heat loss
    is lost mainly through the skin by

    • radiation           convection
    • conduction         evaporation
  37. (Thermoregulation)

    Nervous System
    Hypothalamus (set point)-is the thermo-regulatory center controlling body temperature.

    •         Anterior-controls heat production
    •         Posterior-controls heat loss
  38. (Thermoregulation)

    Cardiovascular Vascular System 

    Vasodilation
    Body becomes too warm superficial vessels dilate and leads to heat loss
  39. (Thermoregulation)

    Cardiovascular System

    Vasoconstriction
    Body becomes too cold and superficial vessels constrict leads to heat conservation
  40. (Thermoregulation)

    Hormones/Respiratory System
    • -Thyroxin
    • -Progesterone
    • -Testosterone


      -Increased temperature-see increased metabolism,fluid loss,R, & tissue O2 demands.
  41. Factors Influencing Temperature
    -Stress-physical/emotional

    -Gender-female greater fluctuation

    -Circadian rhythm- (24 hour cycle) 1-2 F change, lowest 1-4 am and highest 4-7pm

    -Age
  42. Factors Influencing Temp

    Environment
    very young and very old are more sensitive to environment changes
  43. Heat Stroke
    Overexposure to heat T-↑ 105 F


    • Signs and Symptoms
    •     Giddiness,confusion,delirium,hot dry skin
  44. Heat exhaustion
    Heat exposure that leads to diaphoresis(profuse sweating) and fluid and electrolyte imbalance
  45. Hypothermia
    • from heat loss as a result of exposure to cold
    •     -Temp below 95 F, shivering,poor judgment and memory, depression
    •     -usually develops slowly-person thinks "Im Ok"
  46. Fever(Pyrexia)
    • Results of:
    •  -Pyrogens(bacteria & viruses)
    • which trigger the immune response

    •   -Hypothalamus 
    •      raises the set point so the bosy produces & conserves more heat
  47. Three phases of a fever
    1) chills,shivers,feel cold- new set point

    2) feel warm & dry-at set point

    3) feel warm, flushed, diaphoretic-set point drops
  48. Febrile
    Temperature above normal 100.4
  49. types of fevers
    • Constant        Intermittent
    • Crisis             Remittent
    • Relapsing       Lysis
  50. Health Promotion and Maintenance


    Aging Process
    • -Narrower range of body temp
    • -Reduced metabolism
    • -Reduced sweat gland activity
    • -Less subcutaneous tissue
    • -Poor vasomotor control
  51. Health Promotion and Maintenance

    Self Care
    • -Immunizations
    • -Annual Physical
    • -Documentation regarding illness,treatment,response
  52. Physiology Integrity

    Basic Care and Comfort
    • -Non-pharmacological comfort interventions
    •       -Provide rest,dry linens/clothes
    •       -Offer well balanced meals
    •       -Frequent oral hygiene
    • -Cooling techniques
    •       -Tepid sponge baths, room temp 70-80
    •       -decrease clothing, cooling blanket
  53. Physiological Integrity

    Pharmacological therapiesds
    • Antipyretics
    •    -Expected effects-reduce fever and pain with action therapists in 30-60 min

    •    -Acetaminophen
    •    -ASA
    •    -NSAIDS
  54. Pulse
    Contraction of the left ventricle sends a wave of blood into the arteries causing their walls to distend-felt as a beat then walls relax until next beat.

    Apical pulse is more accurate than a peripheral
  55. Cardiac Output
    • Pulse rate- heart rate- BPM (beats per minute)
    • Stroke Volume-amount of blood amount of blood ejected from the heart with each beat 
    • Stroke Volume×Heart Rate=Cardiac Output
  56. (Physiology of Pulse Regulation)

    Cardiovascular System

    • -Automaticity
    • -SA node
    • -Blood volume
    • -Stroke volume
  57. Autonomic Nervous System






    Sympathetic Nervous System-stimulation of the SA node increases heart rate and force of contraction

    Parasympathetic- stimulation of SA node via vagus nerve decreases heart rate.
  58. (physiology Of Pulse Regulation)

    Respiratory System
    • -Cardiovascular and respiratory systems are closely related
    • -Chief function-supplies O2 to the blood and removes CO2 from the blood
    • -Circulatory System-brings O2 to the cells and removes CO2
  59. (Physiology Of Pulse Regulation)

    Hormones
    • -ADH-regulates vascular volume
    • -Aldosterone-affects vascular volume
    • -Epinephrine & norepinephrine-affect rate
    • -Renin-causes vasoconstriction
  60. Electrolytes
    Maintain rhythmicity of the heart

    •   -K-potassium:3.5 mEq/L
    •   -Na-Sodium:135-145 mEq/L
    •   -Ca-Calcium: 9-10.5 mg/dL
  61. Arterial Blood Gases (ABG's)
    Blood drawn from radial or femoral artery to assess patients oxygen status and acid base balance

    •        -pH 7.35-7.45
    •        -PaCO2 35-45 mmHg
    •        -PaO2 70-100mm Hg
    •        -HCO3 19-25 mEq/L
    •        -O2 saturation 95-100%
  62. Normal Adult Values
    • Rate
    •     60-100 bpm
    •       Bradycardia<60 bpm
    •       Tachycardia >100 bpm
    • Rhythm
    •       Regular
    • Equality
    •        Equal in both extremities
    • Amplitude
    •        +3
  63. Normal Values Cont'd
    • Amplitude                 Strength 
    •        0                         Absent
    •       +1                        Thready 
    •       +2                        Weak
    •       +3                        Normal
    •       +4                        Bounding
  64. Peripheral Vascular (CSM Signs)
  65.     -Circulation
    •         Color
    •         Temperature
    •         Pulse
    •         Capillary Refill-less than 3 seconds
    •      -Sensation
    •         Paresthesia
    •         Absence of feeling
    •      -Motion
    •         -Weakness,Paralysis
  66. Factors Affecting the Pulse
    • -Medications              -Exercise
    • -Hemorrhage             -Gender
    • -Postural changes       -Temp
    • -Pulmonary                -Environment
    • disease                      -Psychosocial state-pain, 
    • -age                             anxiety,relaxation
  67. Respiration
    The process of transporting O2 from the atmosphere to body cells and transporting CO2 from body cells to the atmosphere
  68. External respiration
    Involves ventilating lungs & exchange of gases at alveoli
  69. Internal Respiration
    Involves exchange of gases from blood to cells and cells to blood
  70. Ventilation
    Movement of gases in & out of the lungs
  71. Diffusion
    Exchange of O2 & CO2 between alveoli & circulating blood-assess O2 saturation
  72. Perfusion
    Exchange of O2 & between circulating blood & tissue cells-assess O2 saturation
  73. Nervous System
    Maintains rhythm & depth of respiration & balance between inspiration & expiration
  74. Respiratory Center

    medulla oblongata
    Automatic control of breathing
  75. Cerebral Cortex
    Voluntary control of breathing
  76. Cardiovascular System
    Controls the oxygenation and delivery of blood to cells

    • Factors to consider
    •  
    • Quality of blood 
    •      -Hgb 12-18 g/dL
    •  
    • Quality of blood-Hct
    •      -F 37-48%
    •      -M 42-52%
  77. Physiology Of Respiratory Function

    Metabolic process
    Anything that increases metabolism increases respirations
  78. Physiology of Respiratory Function

    Blood Gases
    CO2, O2 & H+ affect blood pH- most important factor is CO2 level
  79. Physiology Of Respiratory Function

    Chemoreceptors
    Stimulate respirations to maintain normal blood gases
  80. Assessment Of Diffusion and Perfusion

    Oxygen Saturation(SaO2)
    the percentage of Hgb bound with O2 in the arterial circulation
  81. Assessment of Diffusion/Perfusion

    Normal value
    SaO2-95-100%

    Anything that alters perfusion/diffusion will affect this anemia-insufficient respiratory status
  82. Assessment of Lung Sounds
    -Assess over trachea,bronchi,and peripheral lung fields

    -Normal lung sounds are quiet and heard only through the stethoscope

    -Abnormal sounds(adventitious) caused by narrowing, moisture, inflammation or consolidation
  83. O2 Assessment

    Skin Color
    -Normal 

    • -Abnormal
    •     Ruddiness
    •     Cyanosis-blue
    •     Pallor-pale
  84. O2 Assessment

    Clubbing of the nails
    • result of chronic O2 deficiency
    •      Normal-angle between nail & skin=160  degrees

    • Abnormal(clubbing)
    •      180 degree-flat to > 180 degree
    •      Nail base is spongy & swollen
  85. O2 Assessment
    • -Cough
    • -Body position
    • -Shape of chest cavity
    • -History of smoking
    • -Activity tolerance
    • -Shortness of breath
  86. Patient Centered Care Health Promotion and Maintenance
    • -Variations through life span 
    • -Changes associated with aging
    •    ↓ elasticity

       ↓ maximum capacity

       ↓ thoracic and abdominal muscle strength


       -These changes increases the risk for disease like pneumonia
  87. Patient-Centered Care

    Basic care and comfort
    •  Positioning
    •    -fowlers
    •  O2 administration
    •    -O2 via nasal cannula
    •  Fluid intake
    •    -2-3L daily if medically able
  88. Patient Centered Care

    Pharmacological therapies
    • Expected effects/outcomes/contradictions
    •    Nicotine supplements
    •       Gum
    •       Patch
    •   Bronchodilators
    • Reduction of risk potential
    •     Assessment of VS before administering meds affecting respirations
  89. Pulse Pressure
    systolic-diastolic=PP
  90. Cardiovascular system
    SVxHR=CO

    • Increased CO=Increased BP
    • Increased HR=Increased BP up to a point

    • Blood Volume-(5-6L)
    •  increased-elevated BP,decreased=lower BP

    Viscosity(amount RBC in plasma), increased=increased BP
  91. Cardiovascular system (cont)
    • Elasticity of vessels-decreased leads to increased BP
    • Peripheral resistance-increase see increased BP,decrease see decreased BP
  92. Physiology Of BP Regulation

    Nervous System
    • Cardiac reflex center-In Medulla-ANS
    •       -Stimulate parasympathetic branch impulses to heart via vagus nerve, decrease rate

    • Vasomotor reflex center-In Medulla
    •      -Regulates vasoconstriction/vasodilation of vessels
  93. Baroreceptors
    • -Pressure sensitive receptors (pressure receptors)
    • -Located in aortic arch and walls of arteries
    • -Respond to changes in diameter of vessels
    • -Send impulses to cardiovascular center
  94. Physiology of BP Regulation
    • Hormones
    •    -ADH-recall
    •    -Aldosterone-recall
    •    -Renin-recall
    • Electrolytes
    •    -Role in normal heart rhythm so influence BP
    • Blood gases
    •     -↓O2-Vasoconstriction

        -↑ CO2-Vasodilation
  95. Assessment Of BP
    • Normal Values
    •   -Systolic <120mmHg
    •   -Diastolic <80 mmHg
    • Consider 
    •   -Baseline
    •   -Position changes
    •   -Cuff size
  96. Assessment Of BP

    Korotkoff sounds
    • Phase 1-faint tapping sounds
    • Phase 2-muffled or swishing sounds-may disappear up to 40 mmHg
    • Phase 3-loud sounds
    • Phase 4-softer fading muffled sounds
    • Phase 5-last sound heard(diastolic pressure)
  97. Hypotension
    • -Below normal BP-systolic <90 -normal for some
    • Other S&S-tachycardia,pallor,confusion,clammy skin,mottled skin (Report Immediately)
    • Causes
    •   -Dilation of arteries
    •   -Decreased blood volume
    •   -Failure of heart's pumping ability
  98. Assessment Of BP

    Orthostatic(postural) hypotension
    -Systolic drop of at least 20 mmHg or diastolic by at least 10 mmHg after position change supine to sitting, sitting to standing or supine to standing assess BP and pulse 1-3 minutes after each position change

    -Causes; dehydration, blood loss, prolonged bed rest, older, surgery

    -Other S&S-weak, dizzy,faint
  99. Patient-Centered Care

    Aging Process
    • Resistance to blood flow increases yearly
    •   -↓ elasticity of arteries and the size of the lumen

      -Resulting in ↑ systolic and diastolic pressure
  100. Physiological Integrity

    Pharmacological Therapies
    • Expected effects/outcomes
    • Adverse effects-contradictions 
    •     -Orthostatic hypotension
    •     -Electrolyte imbalance
  101. Peripheral Arteries

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