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DSCC Hypertension
| Question | Answer |
|---|---|
| Hypertension: | -A systolic BP at/or above 140 mmHg and/or diastolic BP at/or above 90 mmHg -If diabetic or heart dz, BP < 130/90 |
| Normal BP: | SBP <120 and DBP <80 |
| Pre-Hypertensive: | SBP 120-139 or DBP 80-89 |
| Stage I Hypertension: | SBP 140-159 or DBP 90-99 |
| Stage II Hypertension: | SBP >160 or DBP > 100 |
| Arterial Baroreceptors: | Monitor level of arterial pressure and counteract a rise in arterial pressure through vagally mediated cardiac slowing and vasodilation |
| Fluid Volume: | Excess of Na and H2O causes ↑ BP, cardiac OP and diuresis |
| Renin, Angiotensin, Aldosterone: | Kidneys produce renin – turns into angiotensin I and then angiotensin II (potent vasoconstrictor). Aldosterone works in kidneys to reabsorb Na (inhibiting fluid loss and ↑ fluid volume) |
| Vascular Autoregulation: | Keeps perfusion of body constant (this is poorly understood) |
| HTN Risk Factors: | -Essential HTN -Secondary HTN |
| Essential HTN: | -No known cause -Risk Factors: Age > 60, family hx of HTN, excessive calorie consumption, physical inactivity, high sodium intake, low potassium intake, excessive alcohol intake |
| Secondary HTN: | Renal disease, primary aldosteronism, Cushing’s dz, Brain tumors, encephalitis, pregnancy, meds: estrogen (oral contraceptives), glucocorticoids, cyclosporine, erythropoietin |
| S/S of HTN: | -Usually NO symptoms (Silent Killer) -Headaches, dizziness, fainting, facial flushing |
| Assessment for HTN: | -Take BP in both arms -Assess for orthostatic hypotension -Evaluate stressors: job-related, economic -Assess coping strategies |
| HTN Diagnostic Testing: | -No labs to detect HTN -Assess for causes of secondary HTN -Renal: U/A – presence of protein, RBCs, casts elevated BUN and creatinine levels Creatinine clearance test -Cushing’s dz: Elevated serum corticoids and 17- ketosteroids in urine |
| HTN Nursing Diagnosis: | -Knowledge Deficit -Risk for Ineffective Therapeutic Regimen Management -Ineffective Tissue Perfusion (Renal, Cerebral, Cardiopulmonary, Peripheral) -Risk for Imbalanced Nutrition: more than body requirements -Sexual Dysfunction -Fluid Volume Excess |
| HTN Lifestyle Modifications: | -Sodium restriction -Weight reduction -Moderation of alcohol intake -Exercise -Relaxation techniques -Tobacco and caffeine avoidance |
| HTN Medications: | Diuretics Calcium channel blockers ACE Inhibitors Angiotensin II receptor blockers (ARBs) Beta-adrenergic blockers Renin inhibitors |
| Diuretics: Thiazide (Hydrodiuril, Urozide) Loop (Lasix, Bumex) Potassium-sparing (spironolactone (Aldactone) | -DOC for asthma, chronic airway limitations, chronic renal disease, and heart failure -Monitor for hyperkalemia (if taking ACE inhibitors or ARBs) and hypokalemia |
| Calcium channel blockers: Verapamil (Calan) and amlodipine (Norvasc) | Interfere with calcium ions, causing vasodilation |
| ACE Inhibitors: Captopril (Capoten) and enalapril (Vasotec) | Block action of angiotensin-converting enzyme (from angiotensin I to II) **Monitor for orthostatic hypotension** |
| Angiotensin II receptor blockers (ARBs): Candersartan (Atacand) and Losartan (Cozaar) | -Block the binding of angiotensin II to its receptors in the vascular and adrenal tissues -Excellent option for those with nagging cough from ACE inhibitors and hyperkalemia |
| Beta-adrenergic blockers: | DOC with ischemic heart dz |
| Renin inhibitors: Aliskiren (Tekturna) | Mild to moderate HTN |
| Indicators of HYPERTENSIVE CRISIS: | Severe headache, extremely high BP, dizziness, blurred vision, disorientation |
| Nursing Interventions for HYPERTENSIVE CRISIS: | -Place in semi-Fowler’s -Admin O2 -Administer IV nitroprusside or nicardipine -Monitor BP q5-15 min until DBP < 90, then q30 min -Observe for neuro or CV complications (seizures, numbness, weakness or tingling of extremities); dysrhythmias; or chest p |
| HTN Patient Education: | Instruct about sodium restriction, weight maintenance or reduction, alcohol restriction, stress management, and exercise |
| -Stop using tobacco – smoking -Stress all medications must be taken as prescribed -Provide oral and written information re: indications, dosage, time of administration, side effects, and interactions with antihypertensives | HTN Patient Education |
Created by:
shall5
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