Week 11: Nursing Management of the Client w/ HTN Flashcards
What is the most commo risk factor for cardiovascular disease?
Hypertension
What is difficult regarding HTN
it is a silent/quiet disease so typically it is very hard to see symptomology-wise
The American Heart Association defines HTN as what
SBP >130
DBP >80
What does HTN effect in reference to the vessel walls
Increases the pressure on the vessel walls
What does HTN effect in reference to rates of atherosclerosis
increases the rate of atherosclerosis
What does HTN do in regard to the vessel lumen?
Increases narrowing of the vessels (obstruction)
What does HTN do to the organs?
It damages the small vessels to the organs
What does HTN do to the heart
increases the workload
HTN increases incidence of …
thrombus formation
HTN particularly damages the vessles in the ____, ____ and ___
Brain
Kidney
Heart
HTN leads to increased workload of the heart, so what can occur after that
R/L Ventricle Hypertrophy and Ventricle Dilation
This enlargement leads to increased ventricular workload leading to trouble functioning
There is a sharp increase in what with HTN
Thrombus Formation (particularly in the brain)
HTN Related Thrombi can cause what
Infarcts
CVA
Mesenteric, Renal Artery Thrombi
What gender is more likely to have HTN
Male
What groups have higher incidence of HTN
Non Hispanic AA > Non Hispanic Caucasian > Non Hispanic Asian > Hispanic
1 in ___ children meet the HTN guidelines currently
1 in 25
Risk Factors for HTN
Family Hx of Cardiac Diseases and HTN Increased Risk
Smoking
Dyslipidemia (Cholesterol Narrows the vessels more)
Diabetes Mellitus (decreased vascularity and hardening of the vessels)
Obesity
Inactivity
Poor Educatuin
Low SES
Older Age
What are the Hypertension Disparities African Americans Face Compared to other groups
Highest Prevalence of HTN
Develop at a younger age
Higher Mortality Rate
Women > Men
What is the relationship between African Americans and ACE Inhibitors
Do NOT respond well to ACE Inhibitor drugs - disparity in HTN rates then
What are the HTN Disparities Hispanic Americans Face Compared to other groups
Lower Awareness of HTN and tx
Less likely to receive treatment than AA or Cauc.
Lower rates of adequate BP Control
What are the HTN Disparities Asian Americans Face Compared to other groups
Similar disparities to AA
Higher incidences of SE w/ ACE Inhibitors
What are the HTN Disparities Native Americans Face Compared to other groups
lower rates of BP control than AA and Cauc
Male Gender Differences for HTN
HTN More common BEFORE age 55
More likely to suffer an MI than stroke
Female Gender Differences for HTN
HTN more common after 55
More likely to suffer a stroke than an MI
Links to menopause related factors and oral contraceptive use
Normal BP
<120/<80
Elevated BP
120-129/<80
Stage 1 HTN BP
130-139/80-89
Stage 2 HTN BP
> or equal 140 / > or equal to 90
Types of HTN
Primary (Essential, Idiopathic) HTN
Secondary HTN
Primary HTN
95% of all cases
“Essential” or “Idiopathic” HTN
Numerous contributing factors
Secondary HTN
Less common
Stems from another disorders (renal disease, alcohol abuse, pregnancy, etc)
Why is 75% of those with HTN not controlled?
Excess Body Weight (High Obesity in USA)
Insufficient Physical Activity
Lifestyle Modifications - may not feel they can do it
Complacency among providers
Poor compliance
absence of symptoms (AKA “The silent killer”)
What sort of complications occur from longstanding, untreated HTN
end-organ damage
heart disease
angina/MI (CAD)
Heart Failure
Other vascular disorders
Common: Renal Issues - bad bloodflow
Metabolic Syndrome
A group of physical characteristics/conditions that appear to predispose people to heart disease
May require interventions to delay or prevent heart disease
One of the characteristics is related to HTN
Also called “Insulin Resistance Syndrome,” “Syndrome X,” or “Cardiovascular Dysmetabolic Syndrome”
What are the 5 things that define metabolic syndrome
- Abdominal Obesity
- HTN
- Dyslipidemia (low HDL, high trig)
- Hyperinsulinemia (and insulin resistance)
- Glucose Intolerance
What abdominal size is considered obesity for metabolic syndrome in men and women
> 35 “ in women
> 40 “ in men
Causes of Metabolic Syndrome
Abdominal Obesity (Apples v pears - fat in central area)
Physical Inactivity
Genetic Factors
Diet (High saturated fat intake)
Aging
Hormones
Management of HTN Depends on What?
- BP Reading
- Presence of Risk Factors (Modifiable v Non-Modifiable)
- Presence of Organ Damage (Blood pressure goals lower than for those w/ no complications)
What are the 2 big goals for management of HTN
- Prevention of disability and death
2. Maintenance of BP lower than 130/80
When managing disability r/t HTN what is looked at?
Not the HTN itself but rather the conditions superceding it like cardiovascular disease, kidney disease, and stroke related conditions and neurological impairments
What is the big intervention for Stage 1 HTN
Lifestyle Modifications!
What sort of things fall under the interventions of lifestyle modifications
Weight loss
No nicotine / quit
limit substances increasing BP
stress management
taking meds as prescribed
regular med care
body movement
dietary changes
10 pound weight gain can increase Systolic BP by ___ points
4
Weight Loss Decreases what things
BP
Serum lipids
Improves Type II DM
Risk for CAD
Why does Nicotine cause HTN
Because nicotine causes the release of catecholamines
Catecholamines then increase HR and BP
What are some substances that increase BP
Caffeine
Oral Contraceptives
Tricyclic Antidepressants
Cold Medicine
Steroids
Illegal Drugs (narrow arteries)
Alcohol
How often should one be moving their body to treat HTN
body movement at least 3-4 times a week
DASH Diet
Dietary
Approaches to
Stop
Hypertension
What sort of things are increased and decreased in the DASH diet
Intake - Fruit, Vegis, Low Fat Dairy
Decrease - fats, sweets, red meat, sodium
What factors should be looked at during nursing hx and assessment
Hx and Risk Factors
Assess Potential Symptoms of Target Organ Damage
Personal, Social, Financial Factors
What are some potential symptoms of target organ damage
angina
SOB
altered speech
altered vision
nosebleeds
HA
dizziness
balance problems
nocturia
Why is it important to look at peripheral pulses alongside apical pulse with HTN assessment
Because the small vessels to the extremities are compromised with HTN leading to poor circulation
What are some patient goals regarding HTN
patient understanding of disease process
patient understanding of tx regimen
patient participation and willingness in self care
absence of complications
What are some nursing dx for HTN
knowledge deficit r/t treatment regimen and control of disease process
Noncompliance w/ therapeutic regimen r/t SE of prescribed therapy
Important HTN Interventions
patient 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
Important Nursing COnsiderations For Administration of Anti HTN Meds
check BP and HR BEFORE administration
parameters for when to hold
SE
acute/chronic issues affecting BP/HR
- we want to know parameters and baseline so we dont bottom out the patient’s BP *
Gerontologic Considerations of HTN
Postural Hypotension More Common - fall risk
Nonadherence to the Plan more common
Need to include the family/support system
Financial and Transportation Considerations
Understanding of therapeutic regimen - reading instructions and understand, and monotherapy
Hypertensive Crisis
Includes Hypertensive Emergency and Hypertensive Urgency
Hypertensive Emergency
BP > 180/120
Must be lowered immediately to prevent damage to the target organs
Hypertensive Urgency
BP is v. high but no evidence of immediate or progressive target organ damage
What is the goal for the BP after 1 hour, 6 hours, and after a few days for a patient in hypertensive emergency
Reduce BP 25% in 1 hour
Reduce to 160/100 over 6 hours
Gradual reduction from there to normal over the next few days
What situation are we not doing gradual BP reduction of Hypertensive Emergency, but rather rapid dropping intervention
Ischemic Stroke and Aortic Dissection
Important Aspects of Self Concept and HTN
Personal Identity - why do they have it
Body Image
Self Esteem
Role Performance
Stress Management / Stress
The nurse teaches the client , who has recently been diagnosed with hypertension, about his diet restrictions: a low-calorie, low-fat, low sodium diet. Which of the following menu selections would best meet the client’s needs?
- Mixed green salad with blue cheese dressing, crackers and cold cuts
- Ham sandwich on rye bread and an orange
- Baked chicken, an apple, and a slice of wheat bread
- Hot dogs, baked beans, and celery and carrot sticks
- Backed chicken, an apple, and a slice of wheat bread
An industrial nurse at a large printing plant finds a male employee’s blood pressure to be elevated on two occasions 1 month apart and refers him to his private physician. The employee is about 25 lbs. overweight and has smoked a pack of cigarettes daily for more than 20 years, The client’s physician prescribes (atenolol) Tenormin for the hypertension. The nurse should instruct the client to:
- Avoid sudden discontinuation of the drug
- Monitor BP annually
- Follow a 2 g sodium diet
- Discontinue the medication if severe HA develops
- Avoid sudden discontinuation of the drug
