Hypertension

1. Hypertension Karen Ruffin RN, MSN Ed.

2. Blood Pressure Arterial BP = Cardiac Output (CO) x Systemic vascular resistance (SVR) Cardiac Output = stroke volume x beats per min Systemic vascular resistance = force opposing the movement of blood within the blood vessels What is the effect on BP if SVR increased and CO remains constant?

3. Blood Pressure • Definition: the force exerted by the blood against the walls of the blood vessels • Adequate to maintain tissue perfusion during activity and rest • Arterial blood pressure: primary function of cardiac output and systemic vascular resistance

4. Mechanisms that Regulate Blood Pressure • Sympathetic Nervous System • Vascular Endothelium • Renal System • Endocrine System

5. HypertensionAldosterone Mechanism • Increased Aldosterone = • Increases sodium reabsorption = • Increases water reabsorption = • Increases blood volume = • Increases cardiac output

6. Hypertension • Regulatory mechanisms in the health person function in response to the demands on the body • When Hypertension develops, one or more of these mechanisms are defective • Sympathetic Nervous System • Vascular Endothelium • Renal System • Endocrine System

7. HypertensionPathophysiology • Primary (Essential) Hypertension: • Elevated BP without an identified cause • Accounts for 95% of all cases of hypertension • Cause – unknown • Contributing Factors: Increased SNS activity, overproduction of Na+ retaining hormones & vasoconstrictors, increased Na+ intake • Risk Factors: Modifiable & Non-modifiable

8. Primary HypertensionPathophysiology • Heredity – interaction of genetic, environmental, and demographic factors • Water & Sodium Retention – 20% of pts with high Na+ diet develop HTN • Altered Renin-Angiotensin Mechanism – found in 20% of patients • Stress & Increased SNS Activity • Insulin Resistance & Hyperinsulinemia • Endothelial Cell Dysfunction

9. Diagnosis of Hypertension Dx is made after multiple readings over several weeks NIH/Joint Committee Definition: Category Systolic Diastolic Optimal <110 and < 80 Normal <120 and <85 High Normal 130-139 or 85-89 Stage 1140-159 or 90-99 Stage 2 160-179 or 100-109 Stage 3 =>180 or => 110

10. Secondary HypertensionPathophysiology • Specific cause of hypertension can be identified • Affects >5% of adults with hypertension • What conditions can lead to or cause hypertension?

11. Primary HypertensionRisk Factors • Age • Alcohol • Cigarette Smoking • Diabetes Mellitus • Elevated serum lipids • Excess Na+ in diet • Gender • Family History • Obesity • Ethnicity • Sedentary Lifestyle • Socioeconomic • Stress Which risk factors are modifiable or non modifiable?

12. Primary HypertensionClinical Manifestations • Organs that are affected by Hypertension: • Myocardium – angina / left ventricular hypertrophy • Brain – TIA / CVA • Peripheral vascular – Peripheral pulse change • Kidney – renal failure Creatinine / Proteinuria • Eyes – Hemorrhages with or without papilledema

13. Primary HypertensionClinical Manifestations • “Silent Killer” – asymptomatic and insidious • Severe HTN – fatigue, reduced activity tolerance, dyspnea, dizziness, palpitations, angina

14. HypertensionMedical Diagnosis • History and Physical Examination • Renal Function • Serum Creatinine & Urine Creatinine Clearance • Electrolytes – especially K+ • Blood Glucose • Serum Lipids/EKG • Ambulatory BP Monitoring

15. Primary HypertensionMedical Management • Risk Stratification • Level of BP • Presence of Target Organ Disease • Other Risk Factors

16. Primary HypertensionMedical Management • Lifestyle modification • Nutritional therapy • Alcohol consumption • Physical activity • Tobacco avoidance • Stress management • Drug Therapy

17. Stepped Approach to Manage Hypertension Lifestyle modification Not at Goal BP Drug Therapy Not at Goal BP Substitute med / add a 2nd med/ increase dose Not at Goal BP Continue adding / changing meds until control

18. Medical Management – Drug Therapy • Diuretics • Thiazide • Loop • K+ Sparing • Adrenergic Blockers/ Inhibitors • B-Adrenergic Blockers • Central Acting Adrenergic Antagonists • Peripheral Acting Adrenergic Antagonists • A-Adrenergic Blockers • Vasodilators • Angiotensin Inhibitors • Calcium Channel Blockers

19. Antihypertensive Drug Therapy

20. Lack of Responsiveness to Therapy • Nonadherence to Therapy • Drug-Related Causes • Associated conditions • Secondary Hypertension • Volume overload

21. Nursing Care for the Patient with Hypertension • What will you assess???? • What are some potential nursing diagnosis????? • What are your goals for those diagnosis???? • What are your interventions????? • How will you evaluate your goals?????

22. Basic Human Needs • What Basic Human Need is being affected? • What other Basic Human Needs are effected by hypertension?

23. Nursing Care for the Patient with Hypertension

24. Concept Map

25. The patient with essential hypertension is prescribes the beta blocker metoprolol (Lopressor). Which assessment data would make the nurse question administering the medication? • A. The patients blood pressure is 112/90. • B. The patients apical pulse is 56. • C. The patients ha an occipital headache. • D. The patient is complaining of a yellow haze.

26. The nurse is preparing to administer the following medications. Which medications would the nurse question administering? • A. Vasodilator hydralazine(Apresoline) to the patient with blood pressure of 168/94. • B. Beta Blocker Lopressor(metoprolol) to a patient with a serum sodium level of 137. • C. Calcium Channel blocker diltiazem(Cardizem) to a patient with a glucose level of 280. • D. Loop Diuretic(Lasix) to a patient with a K+ of 3.1.

27. Primary HypertensionCase Study