Nurses Notes on Hypertension

HYPERTENSION

 Definition:   a systolic blood pressure above 140 mmhg or a diastolic pressure above 90 mmhg based on two or more measurements.

Classification:

1.     Optimal- systolic 120 mmhg diastolic 80 mmhg (120/80)

2.     Normal- systolic 130 mmhg diastolic 85 mmhg (130/85)

3.     High normal- systolic 130 to 139 mmhg diastolic 85 to 89 mmhg (130

4.     Stage 1- systolic 140 to 159 mmhg diastolic 90 to 99 mmhg

5.     Stage 2- systolic 160 to 179 mmhg diastolic 100 to 109 mmhg

6.     Stage 3- systolic 180 mmhg or higher diastolic 110 mmhg or higher

Hypertension is a major RISK FACTOR for atherosclerotic cardiovascular disease, heart failure, stroke and kidney failure

I.              ESSENTIAL (PRIMARY) HYPERTENSION

·          It accounts to 90-95% in the adult population have essential HPN

·          Affects more women than men, African- American men

         Pathophysiology:

There is increased in peripheral resistance and or cardiac output secondary to increased sympathetic stimulation, increased renal sodium reabsorption, increased rennin angiotensin aldosterone system activity, decreased vasodilation of the arterioles or resistance to insulin action.

         RISK FACTORS:

Obesity, excessive alcohol intake, overstimulation with coffee, smoking and drug intake.

II.             SECONDARY HYPERTENSION

·          Characterized by elevation in BP with a specific cause such as arterial disease, renal disease, certain medications, tumors and pregnancy hypertension.

DIAGNOSTIC PROCEDURE:

- History and physical examination

- Retinal examination

- Laboratory studies:urinalysis, blood chemistry (sodium, potassium, creatinine, FBS, total and high density lipoprotein), ECG and echocardiography to assess left ventricular hypertrophy

- Special studies: intravenous pyelography, renal arteriography, split renal function studies, rennin levels, 24 hour urine protein, creatinine clearance.

COMPLICATIONS:

·          Renal Hemorrhage

·          Heart failure

·          Renal insufficiency and Failure

·          Cardiovascular Accident (CVA)

·          Transient Ischemic Attack (TIA)

·          Myocardial Infarction (MI)

·          Left Ventricular Hypertrophy

Medical management:

Goal- to prevent death and complications by achieving and maintaining an arterial BP below 140/90 mmhg (130/85 mmhg for people with DM or proteinuria> 1 g/24 hrs. whenever possible.

NURSING MANAGEMENT:

I.              ASSESSMENT

·          Assess BP at frequent intervals , know baseline and note changes in pressure

·          Note the apical and peripheral pulse rate , rhythm and character

·          Assess symptoms such as nose bleeds, angina pain, shortness of breath, alterations in vision, speech or balance (vertigo), headache or nocturia

·          Assess extent to which HPN has affected patient personally, socially and financially

II.             NURSING DIAGNOSIS

1.     Deficient knowledge regarding the relationship between the treatment regimen and control of the disease process

2.     Noncompliance related to side effects of prescribed therapy

III.            PLANNING AND GOALS

·          The major goal of the patient include understanding the disease process and its treatment, compliance with the self care program and absence of complications.

IV.            INTERVENTIONS

1.     Increasing Knowledge

·          Emphasize the concept of controlling HPN ( with lifestyle changes and medications) rather than curing it

·          Arrange a consultation with a dietitian to help patient plan a weight loss

·          Obtain patient education materials

·          Advise patient to limit alcohol intake and avoid use of tobacco (smoking)

2.     Monitoring and Managing Complications

·          Assess all body systems when patient returns for follow up care

·          Question patient about blurred vision, spots or diminished visual acuity

·          Report any significant findings promptly to determine whether additional studies or changes in medications are required.

V. EVALUATION

Expected Patient outcomes:

·          Maintains adequate tissue perfusion

·          Complies with self-care program

·          Experiences no complications