Hypertension the silent killer Regulation of Blood Pressure

Hypertension “the silent killer”

Regulation of Blood Pressure Arterial baroreceptor system Regulation of body fluid volume Renin-angiotensin-aldosterone system Vascular autoregulation

Essential Hypertension No known cause Associated risk factors 1. Age >60, family history 2. Excessive calorie consumption, physical inactivity 3. Excessive alcohol intake 4. Hyperlipidemia 5. African ethnicity 6. High intake salt/caffeine 7. Reduced intake of potassium/calcium/magnesium 8. Obesity, smoking, stress

Risk Factors Modifiable & Non-modifiable

Vessel Wall Build-up

Complications of Hypertension Myocardial infarction Cerebrovascular accident Peripheral vascular disease Renal failure

Lifestyle Interventions Hypertension Sodium restriction Heart healthy diet Moderation of alcohol intake Exercise Relaxation techniques Smoke cessation Drug therapy

Sodium Restriction

Heart Dealthy Diet

Moderation of Alcohol

Exercise

Relaxation Techniques

Quit smoking

Supporting Smokers Who Want to Quit • • 70% of smokers want to quit 1/3 make a serious quit attempt each year There are effective treatments Nurses play a significant role in smoke cessation support

Nicotine Addiction • Smokers are rapidly addicted to nicotine • 7 of 10 adults regret smoking and would like to stop (70%) • 98% relapse in one year in not “program” • It takes 14 -20 seconds for heroin to reach addiction centers when given IV • It takes 7 -10 seconds for nicotine to reach addiction centers when smoked

Immediate and long term benefits of quitting > 20 mins > 8 hrs BP and P go down to normal Body temp returns to normal Carbon monoxide drops, O 2 increases >24 hrs Chance of MI goes down > 48 hrs Food tastes and smells better > 2 weeks Coughing, congestion, tiredness, SOB Overall energy > 1 year Risk of heart disease by 50% > 10 -15 yr Risk of dying prematurely = non smoker

Pharmacological Methods • Nicotine replacement therapy (NRT) – Gum – Patch – Inhaler • Bupropion (Zyban) • Varenicline (Champix)

A slip is not a fall! Advise to the client: • Treat it like an emergency – get away from the trigger, get rid of the smokes • Think about what happened, what went wrong and identify the triggers • Remember the signs next time • Feel good about how far you have come, picture yourself a non-smoker

Drug Therapy Hypertension • Diuretics Beta-adrenergic blocking agents Calcium channelblocking agents Angiotensinconverting enzyme inhibitors (ACE inhibitors) Angiotensin II receptor antagonists (ARB) Central alpha agonists Vasodilators Alpha-adrenergic receptor agonists

Drug Therapy (related) • Statins • Anticoagulants

Classification Diruretic Generic/Trade Name Loop Diuretic Thiazide and Thiazide-like diuretics Spironolactone (Aldactone) Effect on K+ Side/adverse effects Nrsg Response

Secondary Hypertension Related to specific disease states and medications Diseases: Medications:

Secondary Hypertension Clinical manifestations 1. Symptomless 2. Headaches, dizziness, fatigue 3. Vascular changes in the retina 4. Abdominal bruits 5. Tachycardia 6. Sweating/pallor 7. Delayed/absent femoral pulses Nursing diagnosis 1. Deficient knowledge 2. Risk for ineffective therapeutic regimen management 3. Ineffective tissue perfusion

Malignant Hypertension Severe elevated B/P Rapidly progressive Symptoms: 1. Morning headaches 2. Blurred vision 3. Dyspnea/uremia 4. Diastolic B/P >150 mm Hg (130 mm Hg) 5. Untreated = renal failure, left ventricular failure, stroke

Hypotension/Shock • Stages of shock

Type of shock hypovolemic cardiogenic Distributive • neurogenic • septic • chemical Obstructive Anaphylactic Cause Patho S&S