Nursing Management of Clients with Stressors of

Circulatory FunctionHYPERTENSION

NUR133LECTURE # 10K. Burger MSEd,MSN, RN, CNE

Incidence and Prevalence

Hypertension affects about __________

people in the United StatesHypertension affects about __________

people worldwide___________ of the population are

unaware they have hypertensionAwareness, treatment, and control=goals

Target Organ Damage (TOD)Associated with Hypertension

Heart Disease- Left ventricular hypertrophy (LVH)- Congestive heart failure (CHF)- Myocardial infarction (MI)

Cerebrovascular accident (CVA)NephropathyRetinopathy

Definition and Classification

SBP => 120 mm Hg DBP => 80 mm Hg

Prehypertension 120-139/80-89Stage I Hypertension 140-159/90-99Stage II Hypertension >160/100

*Primary Hypertension (essential, idiopathic) 90% of casesSpecific cause unknown

Components of Blood Pressure

Blood pressure = CO X SVRCO = cardiac outputSVR = systemic vascular resistance

Risk Factors

Age greater than 60 yrs old Family history Obesity Sedentary lifestyle Hyperlipidemia Diabetes mellitus Increased intake of Na, ETOH, caffeine Smoking Stress African American ethnicity Metabolic Syndrome

Metabolic Syndrome

A group of metabolic risk factors that greatly increase risk for:CADDM type 2CVA

Complications Associated with Hypertension

Coronary Artery Disease (CAD )

Complications Associated with Hypertension

Thrombolytic CVA Hemorrhagic CVA

Complications Associated with Hypertension

NephropathyChronic hypertension

causes thickening of nephron blood vessels(nephrosclerosis) which decreases renal blood flow.

Result = chronically hypoxic renal tissue and permanent tissue damage

Complications Associated with Hypertension

Retinopathy

Complications Associated with Hypertension

Malignant Hypertension

Condition of severely elevated B/PSBP > 200mm Hg and/or DBP > 120mm Hg Acute, life-threatening emergency Creates hi-risk for target organ damage: Cardiac, Renal, CNSRequires swift intervention to lower B/P Also may be termed: Accelerated –malignant hypertensionIncidence generally low: (1-2% of hypertensive client population)Most commonly an unexplained occurrence in clients w/chronic HTN Higher incidences found in:-middle-aged-male-African-American

HTN ASSESSMENT

History- dietary, alcohol, smoking habits- stress and physical activity - other health stressors: DM- family hx of heart disease, HTN- ethnic origin or race- symptoms: ha, dizziness, OR NONE

Physical- BP both arms: lying, sitting, standing- Fundoscopic exam

HTN Assessment

Diagnostics- Anthropometric measures- EKG, Echocardiogram- Lipid Profile- HgAIC- C-reactive protein- homocysteine- Renal studies: BUN, Creat, Renin- Blood chemistries: Na, K, Glucose

Lipid Profiles

Desirable Levels

LDL < 100 HDL > 40 Total Cholesterol<200 Triglycerides <150

HTN Nursing Diagnosis

Deficient knowledgeRisk for ineffective therapeutic mgmtAltered nutrition; more than body reqIneffective tissue perfusionPotential for injury:

CVA, MI, Retinal Hemorrhage

+++++++++++++++++++++++++++++more

HTN Planning

Client will:Have BP readings 120/80 or <Be knowledgeable about disease process

and potential complicationsUndertake lifestyle modifications: weight

control, dietary/alcohol/smoking habits, stress reduction, exercise etc.

Comply with medication regimen

Interventions for Hypertension

Patient Education

Pharmacological TherapyLifestyle Modifications

DASH DIET

DIETARY APPROACH TO STOP HYPERTENSION

Reduce intake of: saturated fatcholesterolred meatsrefined carbohydrates (sugars)sodium

Increase intake of:complex carbohydrates (fiber)fruits & vegetables ( increases K )low-fat dairy products (increases Ca )

nuts and legumesDASH diet plan www.nhlbi.nih.gov

Pharmacological Interventions

DiureticsACE InhibitorsCalcium Channel BlockersAngiotensin II Receptor BlockersAdrenergics: Alpha & Beta BlockersVasodilatorsAntihyperlipemics ( CAD therapy )