Exam 2 HTN Flashcards
Errors in Blood Pressure
Arm too low blow heart
Arm too high above heart
Arm not supported raise blood pressure
Changes in elderly
Arm too low blow heart
Arm too high above heart
Arm not supported raise blood pressure
Changes in elderly
Errors in Blood Pressure
Feet flat on floor don’t cross legs will raise bp
Elderly needs to take more than once during a visits – might want to take there blood pressure standing take a tilt blood pressure for orthostatic
Possible errors in blood pressure
Assessment/Diagnostic Tests
One high does not mean high blood pressure
Need more than one time at different times
Don’t worry about the stages 120 over 80 is consider pre hypertension
When screening and test are looking for causes but it does not diagnose blood pressure
One high does not mean high blood pressure
Need more than one time at different times
Don’t worry about the stages 120 over 80 is consider pre hypertension
When screening and test are looking for causes but it does not diagnose blood pressure
Assessment/Diagnostic Tests
what are the goals for patients with hypertension?
Goal is to keep blood pressure to keep under 140 over 90 is dx with hypertension
Co morbidly 130 over 80 kidney and diabetes
Goal is to keep blood pressure to keep under 140 over 90 is dx with hypertension
Co morbidly 130 over 80 kidney and diabetes
what are the goals for patients with hypertension?
31% of adults have hypertension
Highest in Hispanics and African American
Most have primary (essential) hypertension
Statistics
t/f patient with primary (essential) does not have a know cause
TRUE
Risk factors for primary (essential) hypertension
Family hx
Increased sodium
Inactivity
Stress
Hyperlipidemia
Smoking
African American
High alcohol consumption
Obesity
Diabetes
Family hx
Increased ______
Inactivity
Stress
_____________
Smoking
African American
High alcohol consumption
Obesity
Diabetes
Risk factors for primary (essential) hypertension
sodium
Hyperlipidemia
Risk for secondary HTN
Renal disease
Several endocrine related disorders
Brain tumors, encephalitis
Medications-estrogen, steroids, sympathomimetics
Renal disease
Several endocrine related disorders
Brain tumors, encephalitis
Medications-estrogen, steroids, sympathomimetics
Risk for secondary HTN
t/f secondary htn is not cause by another disease
FALSE; it is caused
s/s of htn
May have few or no sx
Headache
Dizziness
Fainting
Changes in vision
May have few or no sx
Headache
Dizziness
Fainting
Changes in vision
s/s of htn
t/f sometimes when there is No compliance when it comes to drug regiment because drug make them feel worse compared to not taking meds for hypertension
TRUE
Changes related to the elderly
Elderly are at a higher risk
Will not have flexible artery
Have palpable buildup
Sometimes bottom number in pt in elder will have an okay systolic isolated systolic hypertension
Elderly are at a higher risk
Will not have flexible artery
Have palpable buildup
Sometimes bottom number in pt in elder will have an okay systolic isolated systolic hypertension
Changes related to the elderly
Damages blood vessels particularly heart, kidneys, brain and eyes.
Predispose to cognitive decline
Some outcomes of uncontrolled bp are MI, heart failure, renal failure, strokes, and impaired vision, Left Ventricular hypertrophy
prolonged htn
proplonged htn
Damages blood vessels particularly heart, kidneys, brain and eyes.
Predispose to cognitive decline
Some outcomes of uncontrolled bp are MI, heart failure, renal failure, strokes, and impaired vision, Left Ventricular hypertrophy
t/f the more damage to blood vessels the longer you don’t treat it
TRUE
Clinical manifestations
May be none other than elevated bp
Retinal changes (hemorrhages)
Papilledema
Left ventricular hypertrophy
Heart failure may occur if damage is severe
Pathologic changes in kidneys (increased bun, nocturia)
Stroke, TIA
May be none other than elevated bp
Retinal changes (hemorrhages)
Papilledema
Left ventricular hypertrophy
Heart failure may occur if damage is severe
Pathologic changes in kidneys (increased bun, nocturia)
Stroke, TIA
Clinical manifestations
t/f Heart can enlarge because it working hard to circulate blood
TRUE
_________________ Might see at the eye doctor edema of the optic never
Papilledema
Treatment
Lifestyle modifications:
Weight reduction
DASH diet
Reduce sodium intake
Increase physical activity
Only moderate alcohol consumption
Lifestyle modifications:
Weight reduction
DASH diet
Reduce sodium intake
Increase physical activity
Only moderate alcohol consumption
Treatment
more treatment
Ideal below 130 over 80 renal or diabetes
Hypertension below 140 over 90
Thiazide diuretic is the first line of defense
After they will try
Beta blocker
Under 140 over 90 is achieved they want to decrease the dose
Could also used loop diuretic
Elderly may start at half does for any medication dealing with hypertension
Change diet and increase exercise need low sodium
Ideal below 130 over 80 renal or diabetes
Hypertension below 140 over 90
Thiazide diuretic is the first line of defense
After they will try
Beta blocker
Under 140 over 90 is achieved they want to decrease the dose
Could also used loop diuretic
Elderly may start at half does for any medication dealing with hypertension
Change diet and increase exercise need low sodium
more treatment
patient teaching
Patient needs to be aware:
No decongestants that has in sudfedran
Watch sodium on OTC meds
Patient needs to be aware:
No decongestants that has in sudfedran
Watch sodium on OTC meds
patient teaching
what should pt watch for?
Watch for chest pain shob nose bleeds
assesment
Carefully monitor bp at frequent intervals
Hx to assess for s/s of organ damage rt bp
Pay specific attention to apical and peripheral pulses
Able to afford medications
Are they taking their meds (knowledge deficit, noncompliance)
Carefully monitor bp at frequent intervals
Hx to assess for s/s of organ damage rt bp
Pay specific attention to apical and peripheral pulses
Able to afford medications
Are they taking their meds (knowledge deficit, noncompliance)
assessment
patient teaching
Beta blockers may cause sexual dysfunction
Need to teach them how to take bp
Want to teach change position slowly
1.5 to 2 gram a day
Teach to reduce stress
50 % will stop taking it in the first year because of side affect and noncomplaice and not feel better while one the meds
Only can control not cure
Beta blockers may cause sexual dysfunction
Need to teach them how to take bp
Want to teach change position slowly
1.5 to 2 gram a day
Teach to reduce stress
50 % will stop taking it in the first year because of side affect and noncomplaice and not feel better while one the meds
Only can control not cure
patient teaching
DASH DIET
Dietary approaches to stop hypertension
NA
Whole grains
Vegetables
Dairy
Lean meat, poultry, fish
Nuts, seeds, legumes
Fats
Sweets
Alcohol
Limit sodium and have a good healthy diet
Limit sweet
Limit caffeine if it is having an affect
Dietary approaches to stop hypertension
NA
Whole grains
Vegetables
Dairy
Lean meat, poultry, fish
Nuts, seeds, legumes
Fats
Sweets
Alcohol
Limit sodium and have a good healthy diet
Limit sweet
Limit caffeine if it is having an affect
DASH DIET
t/f Rebound hypertension may occur is they suddenly stop the meds
TRUE
Tell them not to abruptly stop medications
Make sure they don’t run out.
Rebound hypertension
History and risk factors
Assess potential symptoms of target organ damage
Personal, social, and financial factors that will influence the condition or its treatment
nursing history and assessment
Do they have chest pain or blurry vision or alerted speech do they have nose bleeds nocturia
Let your pt know that they are at a higher risk for strokes this may help with compliance
Assessment
Deficient knowledge regarding the relation between the treatment regimen and control of the disease process
Noncompliance with therapeutic regimen related to side effects of prescribed therapy
Nursing Diagnosis
Understanding of the disease process and its treatment
Participation in a self-care program
Absence of complications
Planning and Goals
Patient education
Support adherence to the treatment regimen
Consultation and collaboration
Follow-up care
Emphasize control rather than cure
Reinforce and support lifestyle changes
A lifelong process
Interventions
Reports knowledge of disease management sufficient to maintain adequate tissue perfusion
Maintains blood pressure at less than 140/90 mm Hg with no symptoms of angina, palpitations, or vision changes; stable BUN and serum creatinine levels; and palpable peripheral pulses
Adheres to the self-care program
Reduces calorie, Na, and fat intake; exercises regularly; takes medications as prescribed and reports side effects; measures BP; abstains from tobacco and excessive alcohol intake; keeps appointments
evaluation
Has no complications
Reports no changes in vision; exhibits no retinal damage on vision testing
Maintains pulse rate and rhythm and respiratory rate within normal ranges; reports no dyspnea or edema
Maintains urine output consistent with intake; has renal function test results within normal range
Demonstrates no motor, speech, or sensory deficits
Reports no headaches, dizziness, weakness, changes in gait, or falls
evaluation
Medication regimen can be difficult to remember
Expense can be a challenge
Monotherapy, if appropriate, may simplify the medication regimen and make it less expensive
Ensure that older adult patients understand the regimen and can see and read instructions, open medication containers, and get prescriptions refilled.
Include family and caregivers in educational program
Gerontologic considerations
Hypertensive emergency
Hypertensive urgency
Poorly controlled or undx hypertension or stopped their meds
Over 180 or 200
Will start seeing target organ damage kidney vision problems
Will need IV medication PO will not help and will not do it fast enough
Emergency
bp is extremely elevated (more than 180/120) and must be lowered immediately (generally not less than 140/90) must be done to prevent damage to target organs.
Reduce mean bp by up to 25% in first hour and to about 160/100 in up to 6 hours and then gradually decline.
Hypertensive Emergency
things to know during a hypertensive emergency?
To kidney heart brain might have a stroke
Don’t want to bring it down below 140 over 90
Will not need to know percent or numbers
Just know you need to however it quickly
Will need to give vasodilators
BP very elevated but no evidence of progressive target organ damage.
Elevated blood pressure associated with severe headache, nosebleeds, or anxiety are urgencies.
Oral agents given with goal of normalizing bp in 24 to 48 hours.
Beta blockers, ace inhibitors
Hypertensive urgency
hypertensive urgency
BP very elevated but no evidence of progressive target organ damage.
Elevated blood pressure associated with severe headache, nosebleeds, or anxiety are urgencies.
Oral agents given with goal of normalizing bp in 24 to 48 hours.
Beta blockers, ace inhibitors
Daily weight
I/Os
Urine output
Response of blood pressure
Electrolytes
Take pulse
Ischemic episodes or TIAs
Hypertension Care: DIURETIC
Hypertension Care: DIURETIC
Daily weight
I/Os
Urine output
Response of blood pressure
Electrolytes
Take pulse
Ischemic episodes or TIAs
hypertensive emergency
bp is extremely elevated (more than 180/120) and must be lowered immediately (generally not less than 140/90) must be done to prevent damage to target organs.
Reduce mean bp by up to 25% in first hour and to about 160/100 in up to 6 hours and then gradually decline.
