Nursing Management of Clients with Stressors of Circulatory Function HYPERTENSION NUR133 LECTURE # 10 K. Burger MSEd,MSN, RN, CNE

Incidence and Prevalence Hypertension affects about __________ people in the United States Hypertension affects about __________ people worldwide ___________ of the population are unaware they have hypertension Awareness, treatment, and control=goals

Target Organ Damage (TOD) Associated with Hypertension Heart Disease - Left ventricular hypertrophy (LVH) - Congestive heart failure (CHF) - Myocardial infarction (MI) Cerebrovascular accident (CVA) Nephropathy Retinopathy

Definition and Classification SBP => 120 mm Hg DBP => 80 mm Hg Prehypertension /80-89 Stage I Hypertension /90-99 Stage II Hypertension>160/100 * Primary Hypertension (essential, idiopathic) 90% of cases Specific cause unknown

Components of Blood Pressure Blood pressure = CO X SVR CO = cardiac output SVR = systemic vascular resistance

Risk Factors Age greater than 60 yrs old Family history Obesity Sedentary lifestyle Hyperlipidemia Diabetes mellitus Increased intake of Na, ETOH, caffeine Smoking Stress African American ethnicity Metabolic Syndrome

A group of metabolic risk factors that greatly increase risk for: CAD DM type 2 CVA

Complications Associated with Hypertension Coronary Artery Disease (CAD )

Complications Associated with Hypertension Thrombolytic CVA Hemorrhagic CVA

Complications Associated with Hypertension Nephropathy Chronic hypertension causes thickening of nephron blood vessels (nephrosclerosis) which decreases renal blood flow. Result = chronically hypoxic renal tissue and permanent tissue damage

Complications Associated with Hypertension Retinopathy

Complications Associated with Hypertension Malignant Hypertension Condition of severely elevated B/P SBP > 200mm Hg and/or DBP > 120mm Hg Acute, life-threatening emergency Creates hi-risk for target organ damage: Cardiac, Renal, CNS Requires swift intervention to lower B/P Also may be termed: Accelerated –malignant hypertension Incidence generally low: (1-2% of hypertensive client population) Most commonly an unexplained occurrence in clients w/chronic HTN Higher incidences found in:-middle-aged-male-African- American

HTN ASSESSMENT History - dietary, alcohol, smoking habits - stress and physical activity - other health stressors: DM - family hx of heart disease, HTN - ethnic origin or race - symptoms: ha, dizziness, OR NONE Physical - BP both arms: lying, sitting, standing - Fundoscopic exam

HTN Assessment Diagnostics - Anthropometric measures - EKG, Echocardiogram - Lipid Profile - HgAIC - C-reactive protein - homocysteine - Renal studies: BUN, Creat, Renin - Blood chemistries: Na, K, Glucose

Lipid Profiles Desirable Levels LDL < 100 HDL > 40 Total Cholesterol<200 Triglycerides <150

HTN Nursing Diagnosis Deficient knowledge Risk for ineffective therapeutic mgmt Altered nutrition; more than body req Ineffective tissue perfusion Potential for injury: CVA, MI, Retinal Hemorrhage more

HTN Planning Client will: Have BP readings 120/80 or < Be knowledgeable about disease process and potential complications Undertake lifestyle modifications: weight control, dietary/alcohol/smoking habits, stress reduction, exercise etc. Comply with medication regimen

Interventions for Hypertension Patient Education Pharmacological Therapy Lifestyle Modifications

DASH DIET DIETARY APPROACH TO STOP HYPERTENSION Reduce intake of: saturated fat cholesterol red meats refined carbohydrates (sugars) sodium Increase intake of: complex carbohydrates (fiber) fruits & vegetables ( increases K ) low-fat dairy products (increases Ca ) nuts and legumes DASH diet plan

Pharmacological Interventions Diuretics ACE Inhibitors Calcium Channel Blockers Angiotensin II Receptor Blockers Adrenergics: Alpha & Beta Blockers Vasodilators Antihyperlipemics ( CAD therapy )