HTN Flashcards
as BP increases, so does the risk for:
MI
HF
Stroke
renal disease
percentage of people greater than 20 with hypertension are aware of having high BP
83%
percentage of people being treated for HTN
76%
percentage of those aware but do not have HTN controlled
48%
equation for blood pressure
blood pressure = cardiac output x systemic vascular resistance
what is systemic vascular resistance
the amount of force exerted on circulating blood by the vasculature of the body
factors influencing blood pressure
CO
systemic vascular resistance
SNS
baroreceptors
vascular endothelium
renal system
endocrine system
neurohormonal factors influencing BP
angiotensin - vasoconstrictor
norepinephrine - increase and maintain BP
normal BP (more of an average than a expectation)
less than 120
less than 80
prehypertension
120-139
80-89
hypertension, stage 1
140-159
90-99
hypertension, stage 2
greater than 160
greater than 100
etiology of primary hypertension
-Also called essential or idiopathic hypertension
-Elevated BP without an identified cause
-90% to 95% of all cases
-Exact cause unknown but several contributing factors
etiology of secondary hypertension
-Elevated BP with a specific cause
-5% to 10% of adult cases
-Clinical findings relate to underlying cause
-Treatment aimed at removing or treating cause
risk factors for primary hypertension
Age
Alcohol
Tobacco use
Diabetes mellitus
Elevated serum lipids
Excess dietary sodium (water retention)
Gender
Family history
Obesity
Ethnicity
Sedentary lifestyle
Socioeconomic status
Stress
possible factors for reason behind primary HTN
Genetic links
Water and sodium retention
Stress and increased SNS activity
Altered renin-angiotensin-aldosterone system (RAAS)
CM of severe HTN
Fatigue
Dizziness
Palpitations
Angina
Dyspnea
Target organ diseases occur most frequently from HTN in:
Heart
Brain
Peripheral vascular disease
Kidney
Eyes
diagnostic studies for HTN
Measurement of BP
Urinalysis
BUN and serum creatinine (in blood)
Creatinine clearance (in urine)
Serum electrolytes, glucose
Serum lipid profile (
Uric acid levels
ECG
Echocardiogram
Ambulatory blood pressure monitoring (ABPM)
What is Ambulatory blood pressure monitoring (ABPM)
Noninvasive, fully automated system that measures BP at preset intervals over 24-hour period
Teach patient to hold arm still and keep diary
Many applications for use
overall goals for HTN
control BP
reduce CVD risk factors and target organ disease
lifestyle modifications for HTN
Weight reduction
-Weight loss of 22 lb (10 kg ) may decrease SBP by approx. 5 to 20 mm Hg - Calorie restriction and physical activity
DASH eating plan (dietary approaches to stop htn)
-Fruits, vegetables, fat-free or low-fat milk, whole grains, fish, poultry, beans, seeds, and nuts
Dietary sodium reduction
-< 2300 mg/day for healthy adults
-< 1500 mg/day for
African Americans
-Middle-aged and older
-Those with hypertension, diabetes, or chronic kidney disease
Moderation of alcohol intake
Physical activity
-Moderate-intensity aerobic activity, at least 30 minutes, most days of the week
-Vigorous-intensity aerobic activity at least 20 minutes, 3 days a week
-Muscle-strengthening activities at least 2 times a week
-Flexibility and balance exercises 2 times a week
Avoidance of tobacco products
-Nicotine causes vasoconstriction and elevated BP
-Smoking cessation reduces risk factors within 1 year
Psychosocial risk factors
-Low socioeconomic status, social isolation and lack of support, stress, negative emotions
-Activate SNS and stress hormones
pt teaching for drug therapy
Follow-up care
Identify, report, and minimize side effects
Orthostatic hypotension
Sexual dysfunction (beta blockers)
Dry mouth (diuresis)
Frequent urination
Time of day to take drug
Failure to reach goal BP in patients taking full doses of an appropriate 3-drug therapy regimen that includes a diuretic
resistant HTN
reasons for resistant HTN
Improper BP measurement
Drug-induced
Associated conditions
Identifiable causes of secondary hypertension
subjective data for nursing assessment of HTN
Past health history
-Hypertension
-Cardiovascular, cerebrovascular, renal, thyroid disease
-Diabetes mellitus, pituitary disorders, obesity, dyslipidemia
-Menopause or hormone replacement
Drugs
Family history
Salt and fat intake
Weight gain or loss
Nocturia
Fatigue, dyspnea on exertion, palpitations, pain
Dizziness, blurred vision
Erectile dysfunction
Stressful events
objective data for nursing assessment of HTN
Blood pressure readings
Heart sounds (S3 - HF, S4 - HTN)
Pulses (bounding)
Edema
Body measurements (BMI)
Mental status changes (dizziness, weak, confusion)
possible nursing diagnoses for HTN
Ineffective health management
Anxiety
Sexual dysfunction
Risk for decreased cardiac perfusion
Risk for ineffective cerebral and renal perfusion
Potential complications: stroke, MI
For nursing planning for HTN pt will:
Achieve and maintain goal BP
Follow the therapeutic plan
-Including HCP appointments
Experience minimal side effects of therapy
Manage and cope with this condition
health promotion for HTN
Primary prevention via lifestyle modification
Individual patient evaluation and education
Screening programs
Cardiovascular risk factor modification
ambulatory care for pt with HTN
Evaluate therapeutic effectiveness
Detect and report adverse effects
Assess and enhance compliance
Patient and caregiver teaching
necessities for home BP monitoring
Patient teaching is critical for accuracy
Proper equipment
Proper procedure
Frequency
Accurate recording and reporting
Target BP
reasons for poor adherence to treatment plan
Inadequate teaching
Low health literacy
Unpleasant side effects of drugs
Return to normal BP while on drugs
High cost of drugs
Lack of insurance
nursing measures to enhance compliance of HTN treatment
Individualize plan
Active patient participation
Select affordable drugs
Involve caregivers
Combination drugs
Patient teaching
parameters for hypertensive crisis
SBP >180 mmHg and/or DBP >110 mmHg
Develops over hours to days
May not require hospitalization
hypertensive urgency
Very severe problems can result if prompt treatment is not obtained
hypertensive emergency
importance for hypertensive crisis
Rate of rise more important than absolute value
clinical manifestations of hypertensive crisis
Hypertensive encephalopathy (Headache, nausea/vomiting, seizures, confusion, coma)
Renal insufficiency
Cardiac decompensation(MI, HF, pulmonary edema)
Aortic dissection
Hypertensive CrisisNursing and Interprofessional Mgmt during hospitalization
IV drug therapy: titrated to MAP
Monitor cardiac and renal function
Neurologic checks
Determine cause
Education to avoid future crisis
medications for antihypertension
ABCDD
ACE inhibitors (-pril)
beta blockers (-olol)
calcium channel blockers (-pine -amil)
diuretics
digoxin
examples of ACE inhibitors
captopril
enalapril
fosinopril
lisinopril
benazopril
examples of beta blockers
acebutolol
metoprolol
propanaolol
nedolol
examples of CCB
verapamil
nifedipine
diltiazem
amlodipine
nicardipine
examples of loop diuretics (-nide -mide)
furosemide
bumatanide
torsemide
examples of thiazide diuretics
hydrochlorothiazide
chlorothiazide
methyclothiazide
osmotic diuretic
mannitol
K+ sparing diuretic
spironolactone
nursing considerations for diuretics
Monitor K+ levels
I/O monitoring
BP monitoring
Give in AM to prevent nocturia
Fall risks
Orthostatic hypotension
MOA of ACE inhibitors
dilates blood vessels
lowers BP
does not directly affect HR
MOA of beta blockers
decrease resistance
decrease workload
decrease CO
MOA of CCB
blocks movement of calcium
relax blood vessels
decrease BP
increase supply O2 to heart
decrease workload
MOA of digoxin
increase force of contraction = increase CO
beats slower
slows impulses sent through AV node-squeeze more blood
MOA of ARBs
lower blood pressure by decreasing vasoconstriction and decreasing sodium and water reabsorption in the kidneys
nursing considerations of ACE inhibitors
monitor BP
potassium retention
dry cough
angioedema - swelling of face and tongue
orthostatic hypotension
dizziness
BUN and creatinine
examples of ARBs
losartan
valsartan
irbesartan
nursing considerations of ARBs
Change position slowly
Monitor K+ levels
Monitor renal labs
Monitor liver labs
BP monitoring
Don’t overlap medications (ACE inhibitors)
nursing considerations of CCB
do not give with BB
monitor BP
stevens-johnsons syndrome
orthostatic hypotension
needs tapering
monitor HR (contractility)
No heart block pts
constipation
nursing considerations for beta blockers
monitor BP
contraindicated with asthma and COPD
rebound tachycardia and HTN
monitor blood sugar
orthostatic hypotension
bradycardia
