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Nursing Management of Clients with Stressors of Circulatory Function HYPERTENSION NUR133 LECTURE # 10 K. Burger MSEd,MSN, RN, CNE
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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
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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
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Definition and Classification SBP => 120 mm Hg DBP => 80 mm Hg Prehypertension120-139/80-89 Stage I Hypertension140-159/90-99 Stage II Hypertension>160/100 * Primary Hypertension (essential, idiopathic) 90% of cases Specific cause unknown
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Components of Blood Pressure Blood pressure = CO X SVR CO = cardiac output SVR = systemic vascular resistance
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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
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A group of metabolic risk factors that greatly increase risk for: CAD DM type 2 CVA
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Complications Associated with Hypertension Coronary Artery Disease (CAD )
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Complications Associated with Hypertension Thrombolytic CVA Hemorrhagic CVA
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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
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Complications Associated with Hypertension Retinopathy
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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
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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
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HTN Assessment Diagnostics - Anthropometric measures - EKG, Echocardiogram - Lipid Profile - HgAIC - C-reactive protein - homocysteine - Renal studies: BUN, Creat, Renin - Blood chemistries: Na, K, Glucose
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Lipid Profiles Desirable Levels LDL < 100 HDL > 40 Total Cholesterol<200 Triglycerides <150
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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
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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
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Interventions for Hypertension Patient Education Pharmacological Therapy Lifestyle Modifications
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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 www.nhlbi.nih.gov
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Pharmacological Interventions Diuretics ACE Inhibitors Calcium Channel Blockers Angiotensin II Receptor Blockers Adrenergics: Alpha & Beta Blockers Vasodilators Antihyperlipemics ( CAD therapy )
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