HYPERTENSION Definition HTN is a persistent elevation of

HYPERTENSION

Definition • HTN is a persistent elevation of the SBP above 140 mm. Hg and DBP above 90 mm. Hg. • Over sustained period of time • Based on 2 or more reading at different intervals

Patho • *multifactoral condition • Sign – used to monitor clinical status • Risk factor- involves atherosclerotic plaques within arterial walls • Disease- major contributor to death from cadiac, renal, and peripheral vascular disease

Types • Primary (essential) – elevated BP of unknown cause; can not identify • Secondary – elevated BP of known cause. Ex: renal Dz, DM, dyslipidemia

Factors that affect BP • *Age • *Exercise • *Stress • • *Race •

Factors that affect BP • *Age *Gender • *Exercise *Medication • *Stress *Obesity • *Race *Diurnal variation • *Disease process

Risk Factors • Risk • positive risk factors • Obesity • Stress • Cigarette smoking • Hypercholestere mia • Increased Na

Risk Factors • Risk • positive risk factors • Obesity • Stress • Cigarette smoking • Hypercholestere mia • Increased Na • • At risk for Heart attack Heart failure Stroke Cardiac Dz Renal failure Impaired vision

Signs & Symptoms • Subjective • • H/A (occipital) Lightheadedness Tinnitis Easy fatigue Visual disturbances Palpitations Brief lapses in memory

Signs & Symptoms • Subjective • • Objective H/A (occipital) • Elevated BP Lightheadedness readings Tinnitis • Retinal chenges Easy fatigue • Possible Visual disturbances hematuria Palpitations • Epistaxis Brief lapses in • Cardiac memory hypertrophy

Classification Type SBP DBP Follow-up Normal <120 <80 1 -2 yr Pre-HTN 120 -139 805 -89 1 yr Stage 1 (mild) 140 -159 90 -99 1 months Stage 2 (Moderate) >100 1 week >160

Assessment • *Obtain complete history (check for organ damage) • Pain- angina, intermittent claudation, occipital H/A, •

Assessment • Polyuria, nocturia, fatigue, dizziness, epistaxis, dyspnea on exertion • *Alteration in speech, vision or balance • Labs- U/A, Blood chemistry, EKG • cholesterol level

Nsg Dx • Knowledge Deficit • Disease process • Exercise *Medication • Noncompliance • Treatment regimen • Exercise * Diet *Diet

Plan/Goal • Client will: understand the disease process & its treatment. • Participate in self- care programs • Absence of complications

Medical Management • * Diet & Wt. reduction – (restrict Na, Kcal, cholesterol) • *Lifestyle changes – alcohol moderation, exercise regimen, cessation of smoking • *Antihypertensive drug therapy

Nurse’s Role • Patient/Family teaching • *med, usage, S/E, no abrupt stopping, when to take (no hot baths, alcohol, or strenuous exercise within 3 hrs of taking meds)

Nurse’s Role Cont’ • Early detection & screening • *self-monitoring @ home or drug store • Risk modification programs • *develop gradual exercise program

Nurse’s Role Cont’ • Refer for medical treatment • Encourage/Facilitate client in complying with treatment regimen • • Administer meds as ordered Monitor I/O Daily Wt. Inform of importance of follow-up care

Evaluation • *Maintain adequate tissue perfusion • *Complies with self-care program • *Has no complications

HTN Crises • HTN emergency (crisis)- acute, lifethreatening BP elevations • >180/120 mm Hg • *BP must be lowered immediately • *halt/prevent damage to target organs • *requires ICU monitoring with IV meds • HTN urgency- BP must be lowered within a few hours • * managed with oral meds • Both requires close monitoring of BP & cardiovascular status.

Orthostatic Hypotension • BP that is below normal • BP falls when pt. sits or stands • *Caused by peripheral vasodilation – (blood leaves the central organs and moves to the periphery). • Pt. c/o feeling faint

Nurse’s Role • Place in supine position for 2 -3 minutes • Check & record BP & pulse • Encourage to sit or stand slowly • Recheck BP & P after 1 minute • Compare results : rise>40 or drop<30, indicate abnormalities