Chapter 22 Nursing Care of Patients with Hypertension
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- less than 120 / less than 80
- follow up: 2 years
- 120-139 / 80-89
- follow up: 1 year
Stage 1 Hypertension
- 140-159 / 90-99
- Follow up: 2 months
Stage 2 Hypertension
- 160+ / 100+
- follow up: 1 month
What is BP determined by ?
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.
Processes that influence BP?
These processes include nervous system regulation, arterial baroreceptors and chemoreceptors, the renin-angiotensin-aldosterone mechanism, and the balance of body fluids.
What is the main mechanism that elevates blood pressure in hypertension?
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
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.
Signs and Symptoms of Hypertension
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.
Test recommended by JNC 7 for diagnosis of Hypertension
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.
Nonmodifiable risk factors for hypertension
those that cannot be changed --- include a family history of hypertension, age, ethnicity, and diabetes mellitus
Modifiable risk factors for hypertension
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.
Nonmodifiable Risk Factors
- 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.
Modifiable Risk Factors
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.
One of the most important lifestyle modifications to lower blood pressure.
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.
Foods rich in potassium?
oranges, bananas, and broccoli
Magnesium is found in ?
Green vegetables such as spinach, nuts, seeds, and some whole grains
Foods rich in calcium?
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.
Major risk factor for cardiovascular disease?
Smoking. Nicotine constricts the blood vessels.
Therapeutic Measures for Hypertension
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.
Complications of Hypertension
coronary artery disease, atherosclerosis, myocardial infarction, heart failure, stroke and kidney or eye damage
High blood pressure levels may also increase the size of the left ventricle, referred to as hypertrophy. Over time elevated blood pressure damages the small vessels of the heart, kidneys, and retina.
Hypertensive patients are at greater risk of ?
strokes, MI, HF, kidney failure, and pulmonary edema
What is hypertensive emergency?
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.
What is Hypertension urgency?
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.
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