Exam 6 Flashcards
HTN is determined by average of two or more BP readings
above prehypertension levels on different dates
The highest reading obtained determines category of
HTN
Having HTN puts the patient at a risk for developing:
– Cardiovascular disease
– Stroke
Prevalence of HTN is very high
– Easy for a healthcare provider to get complacent with
higher BP values because they are seen often
Individuals with “normal” BP
18 – 39 years of age
Follow up every 3 to 5 years
Individuals greater than 39
years of age or at an
increased risk for developing
HTN
Follow up annually
Individuals at an increased
risk for developing HTN
include
• Those with an elevated BP • Systolic: 120 – 129 mmHg • Diastolic: < 80mmHg • Overweight • African American • Increased renin activity, greater sodium and fluid retention • Family history
Primary Hypertension (aka Essential Hypertension)
• Chronic BP elevation (systolic and/or diastolic)
• Unknown Cause
• Contributing factors may include: Sodium & Water retention, altered RAAS
mechanism, stress, insulin resistance (diabetes)
Secondary Hypertension
Chronic BP elevation (systolic and/or diastolic)
• Known cause
• Sign of another problem within the body
• Ex: Kidney disease, tumor on the adrenal gland, atherosclerosis, etc.
Often no signs and/or symptoms
– Referred to as the “Silent Killer” – The only symptom may be an elevated BP reading – HTN is usually diagnosed when seeking healthcare for other reasons
Rare signs and symptoms include
– Headache
– Bloody nose
– Severe anxiety
– Dyspnea
Analyze risk factors for hypertension
• Modifiable: Decreased activity level, smoking, poor diet, insufficient sleep, elevated
blood glucose level, elevated weight, poor stress management, diabetes mellitus
type 2
Is type 2 diabetes a modifiable risk for hypertension?
Yes. Type 2 diabetes can be reversed.
Normal”
<120 mmHg systolic
<80 mmHg diastolic
Elevated
120–129 mmHg systolic
< 80 mmHg diastolic
Stage 1 Hypertension
130–139 mmHg systolic
80–89 mmHg diastolic
Stage 2 Hypertension
> 140 mmHg systolic
>90 mmHg diastolic
If a patient has a SBP and a DBP in two different categories (i.e. 130/95 mmHg)….
they should be
placed in the higher BP category
Therapeutic Measurements for Hypertension: Lifestyle modifications
- Weight reduction
- Incorporate diet changes
- DASH diet
- Dietary Sodium reduction
- Eat more whole foods
- Reduce added sugars
- Increase physical activity
- Tobacco cessation
- Psychosocial risk factors
- Reduce stress
Therapeutic Measurements for Hypertension: Antihypertensive Medication Therapy
• Medications will be started if lifestyle modifications are unsuccessful or patient doesn’t follow
through with them
• Usually providers will start patient’s on a diuretic or beta blocker with initial therapy
Therapeutic Measurements for Hypertension: Patients must be motivated to change their habits
• Hypertension will remain present and will return if lifestyle habits regress or medication therapy is
stopped
Nursing Response if BP is Above Acceptable
Range (for patient’s baseline)
Ensure BP reading is accurate, reassess in 2 minutes on other extremity Observe for related symptoms, although symptoms are sometimes not apparent until BP is extremely elevated. Review orders for antihypertensive treatment • Administer antihypertensive medications as ordered, make this a priority so patient’s blood pressure doesn’t continue to elevate Report and document
Complications of Unmanaged
Hypertension
■ Atherosclerosis ■ Cardiovascular disease – Coronary Artery Disease ■ Myocardial Infarction ■ Heart Failure ■ Left Ventricular Hypertrophy ■ Stroke ■ Kidney Disease ■ Retina Damage ■ The severity & duration of the increase in the BP determines the extent of vascular changes causing organ damage over time ■ Over time, elevated BP will damage the small vessels of the heart, brain, kidneys, and retina ■ This is known as target organ disease
If a patient is having a cardiac infarction, what labs would you run?
Troponin and CK_MB
BNP
If a patient has had a stroke, what lab would you run?
D-Dimer
What labs would you run to see if a patient has kidney failure?
Renin
Creatinine
eGFR
■ Medications will gradually decrease the blood pressure to an
ideal range
– There are countless medications that can reduce blood
pressure
– When an individual is newly diagnosed with HTN, a
mild/less aggressive anti-hypertensive will be
prescribed
■ Medications will be adjusted/added as necessary
until blood pressure is controlled
If the individual is unable to achieve their specific BP goal,
ask questions and follow up!
– Are they taking the medication as prescribed?
– Medication dosage may be increased and/or additional
of another medication from separate drug class added
in
■ It is not uncommon to see a patient on multiple anti
-hypertensives
Patient Education for Hypertension
Control
Lifelong BP Control
• Self-care Measures
• Decreasing stress
• Lifestyle changes
• Control modifiable risk factors
• Prescribed Medication Regimen
• Stay on medications even if s/s are not present
• Rise slowly & change positions slowly
• If patient becomes dizzy with standing, they may fall & injury themselves
• If medications are abruptly discontinued, dangerous situations may occur
• Rebound HTN: acute elevation of blood pressure
• Angina: chest pain
• Dysrhythmias: Irregularities in cardiac rhythm
Hypertension is still present as a patho even if it is well controlled
• If patient does not appropriately manage BP, it will elevate again
Know BP and HR before giving
medications
This is imperative to your nursing care!
Some medications will not affect HR, but BP is
imperative to assess
• Always assess a blood pressure before giving an
antihypertensive
Should take appropriate vitals within 30 minutes to
one hour of administering anti-hypertensives
Know if the medication has vital
sign limits
Ex: Do not administer medication if HR is less than
60 bpm
Ex: Do not administer medication if systolic BP is
less than 100 mmHg
Statins
Treat HLD, do not directly treat HTN
Diuretics
- Loop Diuretics
- Thiazide Diuretics & Thiazide-Like Diuretics
- Potassium-Sparing Diuretics
Medication
Classes for
Hypertension
Angiotensin-converting Enzyme Inhibitor (ACE Inhibitor) Angiotensin II Receptor Blocker (ARB) Calcium Channel Blocker (CCB) Beta Blockers Combined Alpha & Beta Blockers
Statins are given to a patient with atherosclerosis and/or coronary artery disease to
reduce LDL levels by reducing cholesterol synthesis
– This will decrease the plaque build up on coronary walls which will improve blood
flow
Hypertension may be caused secondary to hyperlipidemia
– You may see the patient may on a statin
■ This is not to treat to the HTN, it is to treat the hyperlipidemia
– The goal here is to reduce the cholesterol levels, reduce plaque build up in the
arteries, which should in turn improve blood pressure
– Statins do not directly treat hypertension
Do statins directly affect blood pressure?
No.
Does the nurse need to assess the blood pressure before/after administration of a
statin?
No.
General Information on Diuretics
■ Diuretics are a common drug class for the
provide to choose as initial treatment to
control hypertension
– This usually occurs after lifestyle
changes and diet changes were
attempted (and not successful)
– If HTN does not improve from diuretics
alone, another drug class will be added
on to medication regimen
■ Diuretics should be given during the morning
so the patient doesn’t experience nocturia
■ Diuretics are given to individuals with
Hypertension, Chronic Heart Failure (CHF),
Edema, and Pulmonary Edema
Monitor Lipid Panel Labs while on this medication to see how well it’s working
HDL, LDL, Triglycerides, Total Cholesterol
Statins are hepatotoxic, monitor liver function tests:
AST, ALT, ALP
Assessments with Diuretics
Prior to giving a diuretic, the blood pressure must be assessed
• Possible side effect of hypotension from decreased fluid volume within the body
Assess blood pressure after diuretic administration
• Urine output will begin to change very soon after diuretic administration
Monitor intake and output
Monitor for signs and symptoms of dehydration
• Weights will slowly decrease each day if patient was fluid overloaded, they will not abruptly change with the first urination
Assess daily weights
• Be sure electrolytes are within normal range prior to administration of a diuretic
• If they are not, do not administer. Notify the provider.
• Monitor for signs and symptoms of electrolyte imbalances
• Hyponatremia and hypochloremia: CNS changes
• Hypokalemia: Muscle cramps, muscle weakness, cardiac dysrhythmias
• Priority concern!
