Case Study #3 Hypertension

Question 1

Differentiate between the two major types of hypertension

Answer 1

-Primary hypertension is unknown but related to a complex interaction between genes and the environment, 90 to 95% of cases

• Secondary hypertension is a elevated BP with a specific cause that can be recognized and corrected. This type of HTN accounts for 5 to 10% in adults and over 80% in children
• Causes: congential narrowing of aorta, renal disease, edocrine disorders (cushings), neurological disorders (brain tumor), sleep apnea, medications (cocaine, NSAIDS), pregnancy induced HTN

Question 2

Relate the pathophysiology of hypertension to the complications of hypertension

Answer 2

Pathogenesis of hypertension is thought to include consititutional and environmental factors involving the kidney and its role in regulating extracellular fluid volume through sale and water elimination, sympathetic nervous system hyperreacticity, renin-angiotensin system activity, or intracellular sodium and calcium levels.

-Therefore, uncontrolled hypertension produces increased demands on the heart, resulting in left ventricular hypertrophy and heart failure, atherosclerosis, kidney disease, retinopathy and stroke

Question 3

Describe the non-pharmacologic treatment of hypertension

Answer 3

-weight reduction, regular physical activity, reduction of salt, limit alcohol intake, and smoking

Question 4

Describe the pharmacological classifications prescribed for the treatment of hypertension

Answer 4

Diuretics lower blood pressure initially by decreasing vascular volume (by suppressing renal re absorption of sodium and increasing sodium and water excretion) and cardiac output.

B-adrenergic blockers are effective in treating hypertension because they decrease heart rate, cardiac output, and renin release by the kidney.

ACE inhibitors act by inhibiting the conversion of angiotensin 1 to angiotensin 2, decreasing angiotensin 2 levels and reducing tits effect on vasoconstriction, aldosterone levels, intrarenal blood flow, and glomerular filtration rate.

Calcium Channel Blockers decrease peripheral vascular resistance by inhibiting the movement of calcium into arterial smooth muscle cells.

A2-adrenergic agonist act in a negative-feedback manner to decrease sympathetic outflow from the central nervous system. It blocks the A1 receptors on the vascular smooth muscle, causing vasodilation and a reduction in peripheral vascular resistance

Question 5

Identify the diagnostic assessment for the complications of hypertension

Answer 5

• Routined urinalysis and serum creatinine are done to screen for kidney involvement and to get a baseline status on the kidney and liver damage
• Serum electrolytes, especially potassium, is important to monitor especially to detect hyperaldoseronism, cause of secondary HTN, also to check sodium and colesteral
• Blood glucose should be monitored to assist in diagnosis of diabetes
• Serum cholesterol and triglyceride levels provide information about additional risk factors that predispose to atherosclerosis
• ECG provides baseline info about cardiac status, helpful in identifying left ventrical hypertrophy and myocardial ischemia
• Routine blood pressure check to keep track of blood pressure

Question 6

Nursing management of a person with hypertension

Answer 6

-education on diet and exercise to control BP