1. Nursing Care for patients with hypertension and heart failure
Hypertension is define as a systolic blood pressure
greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg .
based on the average of two or more the blood pressure
measurements.

2. Classification of hypertension: 1- Primary Hypertension Primary or essential hypertension is the chronic elevation of blood pressure from an unknown cause. 2- Secondary Hypertension Secondary hypertension has a known cause. It is a sign of another problem, such as a kidney abnormality, a tumor of the adrenal gland, or a congenital defect of the aorta. Blood pressure usually returns to normal. (stone)

3. 3- Gestational hypertension Sometimes it is called Pregnancy-Induced Hypertension (PIH). Women who develop high blood pressure after mid-pregnancy. the risk is higher if: -The first pregnancy. -Obesity. -Over 30 years of age. -If there is a personal or family history of gestational hypertension -Chronic renal failure or diabetes mellitus. -Carrying twins or higher multiple pregnancies.

4. Causes of hypertension
Aging (older than 55 years for men, 65 years for women).
Eating of excess salt.
Obesity or .
Sleep apnea.
Sedentary lifestyle .
Drug overdose
stress.
Hormonal conditions.

5. Guidelines of hypertension
Blood pressure(Bp)
Systolic BP(mmHg)
Diastolic BP(mmHg)
Normal
<120
<80
Pre-hypertension
80-89
Hypertension stage 1
90-99
Hypertension stage 2
≥160
≥100

6. Major Risk Factors
Smoking.
Dyslipidemia (elevated LDL or total cholesterol and low HDL cholesterol).
Drinking more than 2 alcoholic drinks a day for men or more than 1 alcoholic drink a day for women.
Diabetes mellitus, impaired renal function
Physical inactivity.
Family history of cardiovascular disease.

7. Clinical manifestation (Signs and symptom)
1- Headache, Dizziness
2- Blurry of vision
3- Shortness of breathing
4- Palpitation
5- Chest pain
6- Nausea and vomiting
7-Epistaxia

8. Prevention
Maintain normal body weight for adults
Reduce dietary sodium intake
physical activity
Limit alcohol consumption.
Consume a diet rich in fruit and vegetables.
6- Decreased smoking

9. Complication of hypertension
1- Cerebrovascular accident (CVA)
2- Angina, Myocardial infarction (MI ), congestive heart failure(CHF).
3-Retinal damage.
4- Renal failure

10. Nursing Interventions
The patient and family should be allowed to maintain a sense of control, make informed decisions regarding care.
Develop the skills necessary to make lifestyle modifications.
Behavioral changes are the most difficult for the patient to initiate and maintain.
Teach patient to take medications as prescribed and not to skip dosages.
Teach patient to change positions slowly to prevent falls.
Check the vital signs regularly ( BP& HR).

11. Heart Failure (HF)
Is the inability of the heart to pump sufficient blood to meet tissues needs for oxygen and nutrients.

12. Causes of HF
Any heart problem may potentially lead to HF
Coronary artery disease (most often).
Myocardial infarction.
Cardiomyopathy.
Heart valve problems.
Hypertension.
Anemia.
In the elderly, the most common cause of HF is cardiac ischemia.

13. ACUTE HEART FAILURE
Pulmonary edema, also known as acute heart failure, is severe fluid congestion in the alveoli of the lungs. Pulmonary edema occurs in an acute event such as a myocardial infarction (MI) or when the heart is severely stressed, causing the left ventricle to fail.

14. Signs and Symptoms of AHF
Rapid respirations with accessory Muscle use
Crackles and wheezes
Coughing
Anxiety, restlessness
Pale skin and mucous membranes
Clammy, cold skin

15. Diagnostic Tests of AHF
Chest x-ray examination
Arterial blood gases
Electrocardiogram
Hemodynamic monitoring

16. Therapeutic Interventions of AHF
Oxygen via cannula, mask, or mechanical ventilation.
Positioning in high or semi-Fowler’s position.
Bed rest.
IV Drugs: morphine, diuretics.
Vasodilators
Frequent vital signs, urine output.
Daily weight.
Treatment of underlying cause

17. CHRONIC HEART FAILURE
Signs and Symptoms
Right-Sided Heart Failure Left-Sided Heart Failure
Jugular vein distention Dyspnea on exertion
peripheral edema Dry cough
Ascites Crackles, wheezing
Weight gain Orthopnea
Spleenomegaly Paroxysmal nocturnal dyspnea
Hepatomegally
GI pain, anorexia, nausea Cyanosis
Fatigue, weakness Tachypnea, tachycardia
Tachycardia Nocturia
Nocturia

18. Diagnostic Tests of CHF
History and physical examination
Electrocardiogram
Chest x-ray examination
Exercise stress test,
Echocardiography
Coronary angiography
Cardiac catheterization
Serum laboratory tests: ABGs, CBC, electrolytes, liver enzymes, BUN, creatinine,

19. Complications of CHF
Hepatomegally
Spleenomegaly
Pleural effusion
Left ventricular thrombus and emboli
Cardiogenic shock

20. Therapeutic Interventions
Noninvasive
Treat underlying cause
Oxygen by cannula or mask
Drug therapy
Individualized activity plan
Dietary sodium restriction
Fluid restriction
Daily weights

21. Invasive
Mechanical assistive devices
Intra-aortic balloon pump
Left ventricular assist device
Heart valve replacement
Cardiac transplant

22. Nursing Intervention
Provide rest, space activities, and conserve energy.
Teach use of assistive devices and lifestyle changes
Monitor for edema, weight gain, jugular vein distention (JVD), lung crackles.
Decrease sodium intake as ordered.
Administer diuretics as ordered.
Monitor intake and output.
Identify barriers to sleep.
Assist patient in identifying positions of comfort for sleeping.

24. 4- Isolated Systolic Hypertension
Isolated systolic hypertension (ISH) is a systolic pressure of 160 mm Hg or greater and a normal diastolic pressure of 90 mm Hg or less. This type of hypertension occurs mainly in elderly people, although it can occur at any age.