Nursing Care of Patients with Hypertension Chapter 22 Nursing Care of Patients with Hypertension

Hypertension Incidence 2005–2006: 29% U.S. Adults > 18 Years of Age Increases with Age Non-Hispanic Blacks: 41% Non-Hispanic Whites: 28% Mexican Americans: 22%

Safety: Clean Stethoscope Contaminated with Bacteria, Even MRSA Clean at Start of Shift Clean Between Every Patient Use Clean with Each Hand Hygiene Use Ethanol-based Cleanser or Isopropyl Alcohol Pads

Taking Blood Pressure (BP) Use Calibrated Instrument Have Patient Sit Quietly for 5 Minutes in Chair (Not Exam Table) with Feet on Floor, Arm Supported at Heart Level Use Cuff Bladder Encircling at Least 80% of Arm Take Two BP Measurements (Wait In-between) Tell Patient BP Reading

Hypertension Normal BP is Below 120/80 mm Hg Average of Two or More Readings on Different Dates Highest Reading Determines Category

Classification of Hypertension Systolic Diastolic Pre-hypertension 120–139 or 80–89 mm Hg Stage 1 Hypertension 140–159 or 90–99 mm Hg Stage 2 Hypertension >160 or >100 mm Hg

Follow-Up Care Normal BP: 2 Years Pre-hypertension: 1 Year Stage 1 Hypertension: 2 Months Stage 2 Hypertension: 1 Month >180/110 mm Hg: Immediate Treatment

Blood Pressure Pressure Exerted by Blood on Walls of Blood Vessels Determined by Cardiac Output, Peripheral Vascular Resistance, Vessel Stretch, Blood Viscosity, Blood Volume

Pathophysiology Primary Hypertension Secondary Hypertension Unknown Cause Secondary Hypertension Known Cause Isolated Systolic Hypertension SBP >140 mm Hg

Hypertension Signs/Symptoms None “Silent Killer” Rare Headache, Bloody Nose, Anxiety, Dyspnea Target Organ Disease Damage to Blood Vessels of Heart, Kidney, Brain, Eyes

Diagnosis of Hypertension History Signs and Symptoms Kidney or Heart Disease Medications Blood Pressure Readings Home Blood Pressure Measurements

Diagnostic Tests ECG Blood Glucose Hematocrit Potassium Calcium Lipoprotein, Cholesterol, Triglyceride

Hypertension Risk Factors Nonmodifiable: Unable to be Changed Modifiable: Changeable

Nonmodifiable Risk Factors Family History of Hypertension Age Ethnicity Diabetes Mellitus

Modifiable Risk Factors Weight Diet DASH Limit Sodium Limit Caffeine Alcohol Use Exercise Smoking Stress Management Adequate Sleep

Hypertension Treatment No/Low Risk Hypertensive Lifestyle Changes BP >140/90 mm Hg Over 6 Months Goal of Treatment <140/90 mm Hg <130/80 mm Hg Diabetes/Kidney Disease/ Proteinuria

Hypertension Treatment (cont’d) Lifestyle Changes and Antihypertensive Medications Initial Therapy: Thiazide-type Diuretics Combination Medications

Medications for Hypertension Diuretics Alpha Blockers Beta Blockers Calcium Channel Blockers

Medications for Hypertension (cont’d) Angiotensin-converting Enzyme Inhibitors Central Agents Peripheral Agents Vasodilators Aspirin 100 mg at Bedtime

Complications of Hypertension Atherosclerosis Coronary Artery Disease Myocardial Infarction Left Ventricular Hypertrophy Stroke Kidney/Eye Damage

Hypertensive Emergency SBP >180 mm Hg Systolic DBP >120 mm Hg Systolic Risk for/Progression for Target Organ Dysfunction Immediate Gradual Reduction of BP to Protect Target Organs Treatment: Nitroprusside (Nipride) IV

Hypertensive Urgency Severe BP Elevation Without Target Organ Dysfunction Progression Severe Headaches, Nosebleeds, Shortness of Breath, and Severe Anxiety Oral Medication

Nursing Process Deficient Knowledge Ineffective Therapeutic Regimen Management

Patient Education Lifelong BP Control Self-care Measures Prescribed Medical Regimen