htn Flashcards
reasons why 75% of those with HTN are not controlled
excess body weight insufficient physical activity lifestyle modification complacency among providers poor compliance absence of symptoms
if HTN goes untreated for long what can happen…
HD Angina/MI (CAD) Heart Failure Other vascular diseases Kidneys not getting adequate blood flow, this is one of the most prevalent with long standing HTN
what is metabolic syndrome
known as insulin-resistance syndrome or syndrome X or cardiovascular dysmetabolic syndrome
a group of physical characteristics/conditions that appear to predispose people to heart disease
may require interventions to delay or prevent heart disease
diagnostic factors of metabolic syndrome
abdominal obesity >35 in women, >40 in men hypertension dyslipidemia (low HDL, high trig) hyperinsulinemia (& insulin resistance)\ glucose intolerance
causes of metabolic syndrome
abdominal obesity (apples vs pears) physical inactivity genetic factors diet (high in saturated fats) aging hormones
what affects the management of htn
BP
risk facts (modifiable vs nonmodifiable)
presence of organ damage (BP goals are lower than those with no complications)
*Stage 1 –> just watching it
Creeping to stage 2, getting higher -> may need to be treated with medication
Non-modifiable risk factors (genes) we can’t do anything about but they can do other things such as diet, exercise programs *
GOALS for managing HTN
PREVENT disability and death
MAITAIN BP lower than 130/80
what types of interventions would we use for stage 1
LIFESTYLE!!
weight loss!!
Weight loss decreases BP, serum lipids, improves type II DM, risk for CAD.
If diabetic or has metabolic syndrome –> this will help to improve that as well
10 lbs of weight loss decrease SBP by 4 points
what are types of lifestyle modifications
QUIT ALL FORMS OF NICOTINE (increases catecholamine release which increases HR and BP) LIMIT/AVOID substances that incr BP stress management take meds as prescribed seek regular medical care body movement at least 3-4x a week dietary mgmnt
What types of substances increase BP (PPL SHOULD AVOID THESE)
caffeine illegal drugs (lead to narrowing of vessels) steroids cold medication oral contraceptives tricyclic antidepressants alcohol
dietary management
DASH DIET
increase intake of fruits, veggies and low-fat dairy
decrease in fats, sweets, red meat, sodium
nursing history and assessment for HTN
History + risk factors
assess potential sym of target organ damage (angina, SOB, altered speech, altered vision, nosebleeds, HA, dizziness, balance problems, nocturia)
CV assessment: apical/peripheral pulses
personal, social, financial factors
Need to determine their risk factors
Assess for any organ damage, specifically to cardio, respiratory, renal system
Know the symptoms associated with target organ damage
Neurologic impairment issues related to HTN specifically
Apical and peripheral pulses circulation is compromised to extremities and other areas
Maybe the pt can’t get medication d/t transportation, other factors that can impact pt compliance with medication
goal after nursing history/assessment
pt understands disease process
pt understands treatment regimen
pt is willing to participate in self-care
absence of complications
SET THEM UP FOR SUCCESS… establish relationship where you can understand them and they can understand you… don’t want them to have complications
nursing diagnosis for HTN
Knowledge deficit r/t treatment regimen and control of disease process
noncompliance with therapeutic regimen r/t SE of prescribed therapy
NI for HTN
PT teaching encourage adherence to treatment regimen consultation/collaboration follow-up care emphasize CONTROL rather than cure reinforce and support lifestyle changes lifelong process referrals as necessary
nursing consideration for administration of Anti-HTN meds
ALWAYS CHECK BP AND HR!!!! LOOK AT PARAMETERS OF WHEN TO HOLD MEDICATION, don’t want to lead to HYPOTENSION!!
Look @ side effects, common ones before we give it to the pt
Check BP & HR before administration
Parameters for when to hold
Side effects
Acute/chronic issues affecting BP/HR
gerontaologic considerations
Postural hypotension more common Nonadherence to the plan Include family/ support system Finances Transportation Understanding of therapeutic regimen Reading instructions Monotherapy
Geri –> easy risk for falls
Maybe they have cognitive issues, maybe don’t have enough support systems to help with medication compliance
Do they have the funds? Fixed income?
Are they still driving? Do they have transportation to pick up medication
what is a hypertensive emergency/crisis
Blood pressure > 180/120
Must be lowered immediately to prevent damage to target organs
what is hypertensive urgency
Blood pressure is very high but no evidence of immediate or progressive target organ damage
what to do with a hypertensive emergency
Reduce BP 25% in first hour.
Reduce to 160/100 over 6 hours.
Gradual reduction to normal over few days
Exceptions: ischemic stroke and aortic dissection
Medications
Frequent monitoring of BP and cardiovascular status
in what cases do we need BP to go down IMMEDIATELY
aortic dissection
ischemic stroke
self concept and HTN
personal identity
body image
self esteem
role performance
Look at areas of how this affects their self-esteem and image of self
Whats in their role performance that might be a barrier
Issues with stress management? Issues with self esteem – usually interrelated
