Chapter 22 Nursing Care of Patients with Hypertension

• less than 120 / less than 80
• follow up: 2 years

• 120-139 / 80-89
• follow up: 1 year

• 140-159 / 90-99
• Follow up: 2 months

• 160+ / 100+
• follow up: 1 month

Blood pressure is determined by cardiac output, peripheral vascular resistance (the ability of the vessels to stretch), the viscosity of the blood, and the amount of circulating blood pressure.

These processes include nervous system regulation, arterial baroreceptors and chemoreceptors, the renin-angiotensin-aldosterone mechanism, and the balance of body fluids.

Increased arteriolar peripheral vascular resistance

Primary, or essential, hypertension is the chronic elevation of blood pressure from an unknown cause.

Secondary hypertenstion has a known cause. In other words, it is a sigh of another problem, such as kidney abnormality, a tumor of the adrenal gland, or a congenital defect of the aorta.

Isolated systolic hypertension is a systolic pressure of 140 mm Hg or greater and a diastolic pressure of 90 mm Hg or less. In other words the systolic pressure rises while the diastolic pressure stays within normal ranges. Treatment of ISH is recommended to decreased cardiovascular disease, especially heart failure episodes and risk of stroke.

Usually there are no visible signs or symptoms other than elevated bp readings. AKA "silent killer" In a small number of cases, a patient with hypertension may report a headache, bloody nose, severe anxiety, or shortness of breath.

ECG, blood glucose level, hematocrit, serum potassium and calcium levels, lipoprotein profile, high density and low density lipoprotein cholesterol , and triglyceride level. These tests help determine if target-organ damage has been caused by elevated blood pressure.

those that cannot be changed --- include a family history of hypertension, age, ethnicity, and diabetes mellitus

blood glucose level, activity level, smoking, salt and alcohol intake, and newly added insufficient sleep (less than 5 hours per night). Smoking cessation; reduced consumption of salt, caffeine, and alcohol; weight reduction; improved meal planning; increased physical activity; managing stress; and getting adequate sleep can all help to decrease blood pressure.

• people with a family history have almost twice the risk
• as a person ages, plaque builds up in the arteries, and blood vessels become stiffer and less elastic, causing the heart to work harder to force blood through the vessels
• the risk of developing hypertension with a family history of diabetes and obesity is greater than when there is no family history.

these modifications include weight; adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan; moderation of dietary sodium, caffeine, and alcohol intake; increased physical activity; and smoking cessation.

Weight reduction

Salt : High blood pressure is associated with a diet high in salt. Patients whose blood pressure can be lowered by restricting dietary sodium are called salt sensitive. Patients with hypertension should be instructed no to add salt while cooking and/or table salt to their food. Processed foods and foods in which salt can be easily tasted (canned soups, ham, bacon, salted nuts) should also be avoided.


Caffeine : Intake of caffeine should be limited because it can increase aortic stiffness. This raises the risk of cardiovascular disease for those with high blood pressure.


Potassium, Magnesium, and Calcium : The JNC7 recommends a balanced diet that ensures that adequate intake of potassium, magnesium, and calcium.

oranges, bananas, and broccoli

Green vegetables such as spinach, nuts, seeds, and some whole grains

Milk , yogurt, and spinach

helps prevent and control hypertension by reducing weight, decreasing peripheral resistance, and decreasing body fat. Anyone who is able should participate in regular aerobic physical activity, such as brisk walking, for at least 30 min. daily on most days of the week.

Smoking. Nicotine constricts the blood vessels.

The goal of therapeutic intervention is a bp lower than 140/90 mm Hg (lower than 130/80 mm Hg for those with diabetes, chronic kidney disease, or proteinuria of more than 1 g/day). For most patients with hypertension, initial drug therapy often involves thiazide-type diuretics.

coronary artery disease, atherosclerosis, myocardial infarction, heart failure, stroke and kidney or eye damage

.

strokes, MI, HF, kidney failure, and pulmonary edema

A severe type of hypertension characterized by elevations in systolic bp greater than  180 mm Hg and diastolic bp greater than 120 mm Hg that are complicated by a risk for or progression of target organ dysfunction.

,the blood pressure may need to be reduced by 25% within 1 hour to prevent organ damage. Gradual reduction of bp is desired to prevent decreased blood flow to the kidneys, heart, and/or brain. An intravenous medication such as nitroprusside (Nipride) may be given to quickly reduce blood pressure during the crisis.

hypertension urgency occurs in situations when blood pressure is as elevated as in a hypertensive emergency but without progression of target- organ dysfunction. A patient with hypertensive urgency may have severe headaches, nosebleeds, shortness of breath, and severe anxiety.

Data collection for a patient with hypertension includes the patient's health history, blood pressure measurements, medications, and physical assessment.