Week 7: Chp 31: Hypertension Flashcards
Normal BP
Systolic BP: less than 120
and Diastolic BP: less than 80
Normal: 120/80
Prehypertensive BP reading
Systolic: 120-129 mm Hg
and Diastolic: less than 80
Stage 1 Hypertension BP reading
Systolic: 130-139 mm Hg
or Diastolic: 80-89 mm Hg
Stage 2 Hypertension BP reading
Systolic: 140 mmHg or higher
or Diastolic: 90 mm Hg or higher
Hypertensive Crisis
Systolic: higher than 180 mm Hg and/or
Diastolic: higher than 120 mm Hg
-consult doctor immediately
Hypertensive Crisis: Hypertensive Urgency
Diastolic BP greater than or equal to 120 mm Hg with no obvious target organ damage (TOD)
Hypertensive Crisis: Hypertensive Emergency
Diastolic BP greater than or equal to 120 mm Hg with evidence of tissue organ damage (TOD)
TOD
tissue organ damage
-damage to the heart, eyes, or kidneys caused by hypertension
Hypertension
common and manageable chronic condition that is a risk factor for atherosclerotic cardiovascular disease, heart failure (HF), stroke, kidney failure, vision loss, dementia, and peripheral artery disease
-carries the risk for premature morbidity or mortality, which increases as systolic and diastolic pressure rise
Risk Factors
- age (tends to rise with age)
- gender
- race (African Americans)
- socioeconomic status (low socioeconomic status)
Essential Hypertension
has no identifiable medical cause
- appears to be a multifactorial, polygenic condition
- heredity is a predisposing factor
- familial
- the risk for this can increased when heredity is combined with unhealthy lifestyle choices such as smoking or a poor diet
- 4 times more common in African Americans
- accelerates more rapidly and more severe with higher mortality in African Americans
Notable Risk factors for Primary Hypertension
- obesity
- salt sensitivity
- renin elevation
- insulin resistance
- vitamin D deficiency
- cigarette smoking
Secondary Hypertension
characterized by elevations in blood pressure due to a specific cause
- most common cause is renal parenchymal disease affecting the renal medulla and renal cortex, where the “work” of the kidney is done
- excessive alcohol intake and use of oral contraceptives can be a cause, also NSAIDs, corticosteroids, cocaine or licorice
Mechanisms that result in hypertension
- increased sodium intake
- renin-angiotensin aldosterone system (RAAS)
- aldosterone
- sympathetic nervous system
Mechanisms that result in hypertension: Increased sodium intake
increased sodium causes fluid retention, increasing stroke volume and blood pressure
Mechanisms that result in hypertension: Renin-angiotensin aldosterone system (RAAS)
- excessive angiotensin II results in vasoconstriction and increased BP
- excess angiotensin also results in increased aldosterone release
Mechanisms that result in hypertension: Aldosterone
- excess aldosterone release results in sodium and water retention, which results in increased stroke volume and blood pressure
- enhanced potassium (K) excretion also occurs, resulting in low plasma K
- low plasms K increases vasoconstriction through closure of K channels
Mechanisms that result in hypertension: Sympathetic Nervous System
- increased sympathetic activity is a primary precursor to hypertension; it can cause vasoconstriction, resulting in increased peripheral vascular resistance and increased BP. may also increased HR
- overactivity of the SNS may result from either inappropriately elevated sympathetic drive from brain centers, an increase in synaptically released neurotransmitters in the periphery, or amplification of the neurotransmitter signal at the target tissue
Clinical Manifestations of Primary Hypertension
evident only after long-term increased BP has resulted in target organ damage (TOD)
-headaches, chest pain, vision changes, SOB, renal dysfunction, dizziness, fatigue, or nosebleeds
Diagnosis
is made on the basis of two or more properly measured BP readings on two or more office visits
-treatment is indicated at that time but may begin immediately if two consecutive readings during a single visit indicate an extreme elevation
What is done to detect tissue organ damage? (TOD)
a thorough history and physical examination
-allows better stratification of cardiovascular risk, encourages the achievement of lower BP target than usual, and helps with selection of most appropriate medication regimen
Treatment
to bring high BP down to a healthy level, treatment guidelines recommend healthy lifestyle changes, medication, or both
-lifestyle changes alone may be the first step in patients with mildly elevated (systolic between 120-129 and diastolic < 80) BP readings
Guidelines for Medications
only prescribing medication beginning at stage 1 if a patient has already had a cardiovascular event such as a heart attack or stroke or is at high risk of heart attack or stroke based on age, diabetes mellitus, chronic kidney disease, or calculation of atherosclerotic risk
-medication depends on ease of use, side effects, and coexisting medical conditions that may necessitate use of one agent versus another
Medications
- ACE
- ARB
- aldosterone antagonists
- direct renin inhibitors
- calcium channel blockers
- centrally acting alpha2 agonists
- sympatholytic: alpha adrenergic blockers and beta adrenergic blockers
Lifestyle Management
- weight
- diet
- alcohol consumption
- exercise
- stress management
Lifestyle Management: Diet
high amounts of sodium (like in processed foods) raise blood BP by facilitating water retention (which boosts blood volume) and even tightening small vessels
- calcium, magnesium, and potassium (found in low-fat and fat-free dairy products, such as milk and yogurt, produce and dried beans) can help body regulate BP; too little can raise BP
- Saturated fat (found in meat, cheese, butter, full-fat dairy products and processed foods) may raise BP
DASH diet foods
Dietary approaches to stop hypertension diet
- diet high in fruits, vegetables, and low-fat dairy products lower elevated pressures
- grains and grain products (include at least 3 whole-grain foods each day)
- fruits
- vegetables
- low-fat or nonfat dairy foods
- lean meats, fish, poultry
- nuts, seeds, legumes
- fats and oils
- sweets (5 or fewer/week)
Complications
- known as the “silent killer” because it can cause considerable damage to the heart, brain, and kidneys (target organs) before symptoms are apparent
- heart failure
- compromises kidney function
- stroke
- aneurysm
- hypertensive crisis; hypertensive urgency + hypertensive emergency
Nursing Diagnosis
- risk for ineffective therapeutic regimen management r/t nonadherence to treatment
- risk for decreased CO r/t left ventricular hypertrophy and eventual left ventricle dilation secondary to increased afterload
Nursing Interventions: Assessments
- Neurological Assessment (important to assess signs + symptoms that could indicate TOD and cerebrovascular disease leading to stroke or aneurysm)
- Assess BP
- Assess HR
- Examine optic fundi (hypertension may lead to retinal damage and eventually retinal hemorrhage because of vascular changes)
- Auscultation for carotid, abdominal, and femoral bruits (bruits are sounds created by blood flow through a stenosed or narrowed vessel)
- Palpation of lower extremities for edema and pulses (weak pulses and peripheral edema can indicate kidney disease and/or HF)
- Serum creatinine, blood urea nitrogen (BUN), estimated glomerular filtration rate, and 24 hour urine for creatine clearance (abnormal levels indicate renal disease, which may develop in patients with hypertension)
- Albumin excretion rate (microalbuminuria is a significant marker of early cardiac, renal, and retinal structural and functional changes in essential hypertension)
- calculation of BMI and waist circumference
Why do we check serum creatinine, blood urea nitrogen (BUN), estimated glomerular filtration rate, and do a 24 hour urine sample
- creatinine clearance
- abnormal levels indicate renal disease, which may develop in patients with hypertension
Nursing Interventions: Actions
- administer antihypertensive medications as ordered
- provide patient with DASH diet for meals ( a 1600-mg sodium DASH eating plan has effects similar to those of antihypertensive single-medication therapy
Nursing Interventions: Teaching
- adherence to medication regimen and lifestyle changes such as:
- DASH diet and sodium restricted diet (diet rich in fruits, vegetables, and low-fat dairy products, and reduced in saturated fat and cholesterol) greater than or equal to 1600 mg sodium per day
- moderate exercise
- limit alcohol
- stress reduction
- smoke cessation
- monitor BP at home
- signs + symptoms of stroke, aneurysm, and TOD
