1. HYPERTENSION

2. Definition
HTN is a persistent elevation of the SBP above 140mmHg and DBP above 90mmHg.
Over sustained period of time
Based on 2 or more reading at different intervals

3. Patho *multifactoral condition Sign – used to monitor clinical status
Risk factor- involves atherosclerotic plaques within arterial walls
Disease- major contributor to death from cadiac, renal, and peripheral vascular disease

4. Types
Primary (essential) – elevated BP of unknown cause; can not identify
Secondary – elevated BP of known cause. Ex: renal Dz, DM, dyslipidemia

5. Factors that affect BP
*Age
*Exercise
*Stress
*Race

6. Factors that affect BP *Age *Gender *Exercise *Medication
*Stress *Obesity
*Race *Diurnal variation
*Disease process
About 30% of the adult population within the U. S. has HTN.
Highest prevalence in African Americans and Hispanics

7. Risk Factors Risk positive risk factors Obesity Stress
Cigarette smoking
Hypercholesteremia
Increased Na intake

8. Risk Factors Risk positive risk factors Obesity Stress
Cigarette smoking
Hypercholesteremia
Increased Na intake
At risk for
Heart attack
Heart failure
Stroke
Cardiac Dz
Renal failure
Impaired vision

9. Signs & Symptoms Subjective H/A (occipital) Lightheadedness Tinnitis
Easy fatigue
Visual disturbances
Palpitations
Brief lapses in memory

10. Signs & Symptoms Subjective Objective Elevated BP readings
H/A (occipital)
Lightheadedness
Tinnitis
Easy fatigue
Visual disturbances
Palpitations
Brief lapses in memory
Objective
Elevated BP readings
Retinal chenges
Possible hematuria
Epistaxis
Cardiac hypertrophy

11. Classification Type SBP DBP Follow-up Normal <120 <80 1-2 yr
Pre-HTN
805-89
1 yr
Stage 1 (mild)
90-99
1 months
Stage 2 (Moderate)
>160
>100
1 week

12. Assessment *Obtain complete history (check for organ damage)
Pain- angina, intermittent claudation, occipital H/A,

13. Assessment
Polyuria, nocturia, fatigue, dizziness, epistaxis, dyspnea on exertion
*Alteration in speech, vision or balance
Labs- U/A, Blood chemistry, EKG
cholesterol level

14. Nsg Dx Knowledge Deficit Disease process * Diet Exercise *Medication
Noncompliance
Treatment regimen *Diet
Exercise

15. Plan/Goal Client will: understand the disease process & its treatment.
Participate in self- care programs
Absence of complications

16. Medical Management
* Diet & Wt. reduction – (restrict Na, Kcal, cholesterol)
*Lifestyle changes – alcohol moderation, exercise regimen, cessation of smoking
*Antihypertensive drug therapy
Use home work med classification sheet as a guide when studying
Med therapy includes—diuretics, beta-blockers, alpha 1 blockers, vasodilators, ACE inhibitors, ARB’s, CCB, renin inhibitors

17. Nurse’s Role Patient/Family teaching
*med, usage, S/E, no abrupt stopping, when to take (no hot baths, alcohol, or strenuous exercise within 3 hrs of taking meds)

18. Nurse’s Role Cont’ Early detection & screening
home or drug store
Risk modification programs
*develop gradual exercise program

19. Nurse’s Role Cont’ Refer for medical treatment
Encourage/Facilitate client in complying with treatment regimen
Administer meds as ordered
Monitor I/O
Daily Wt.
Inform of importance of follow-up care

20. Evaluation *Maintain adequate tissue perfusion
*Complies with self-care program
*Has no complications

21. HTN Crises
HTN emergency (crisis)- acute, life-threatening BP elevations
>180/120mm Hg
*BP must be lowered immediately
*halt/prevent damage to target organs
*requires ICU monitoring with IV meds
HTN urgency- BP must be lowered within a few hours
* managed with oral meds
Both requires close monitoring of BP & cardiovascular status.

22. Orthostatic Hypotension
BP that is below normal
BP falls when pt. sits or stands
*Caused by peripheral vasodilation – (blood leaves the central organs and moves to the periphery).
Pt. c/o feeling faint

23. Nurse’s Role Place in supine position for 2-3 minutes
Check & record BP & pulse
Encourage to sit or stand slowly
Recheck BP & P after 1 minute
Compare results : rise>40 or drop<30, indicate abnormalities