cardiovascular Nursing Hypertension.pptx

Hypertension

1. Nursing Intervention for Clients with Vascular Disorders July, 2015 1

2. Hypertension 2

3. Objectives Define hypertension Identify the risk factors Discuss the pathophysiology of hypertension Discuss the classification of Hypertension Describe the life style and pharmacologic management of hypertension Discuss the complications of Hypertension Discuss the nursing management of patients with hypertension 3

4. Introduction Hypertension is one of the leading causes of the global burden of disease Hypertension is an independent predisposing factor for heart failure, coronary artery disease, stroke, renal disease, and peripheral arterial disease (PAD). 4

5. Definition Clinically, hypertension may be defined as that level of blood pressure at which the institution of therapy reduces blood pressure–related morbidity and mortality. Current clinical criteria for defining hypertension generally are based on the average of two or more seated blood pressure readings during each of two or more outpatient visits A blood pressure of > 140/90 mmHg 5

6. Epidemiology 1.56 billion patients world wide by 2025 Factors for the increasing prevalence Physical inactivity Alcohol and tobacco use Salt rich diet and fats from processed foods 6

7. Mechanisms of Hypertension 7

8. For high blood pressure to occur An increase in peripheral resistance and/or cardiac output must occur secondary to Increased sympathetic stimulation, Increased renal sodium reabsorption , Increased renin–angiotensin–aldosterone system activity, Decreased vasodilation of the arterioles, or Resistance to insulin action. 8

9. Classification (Harrison 18 th edition, AHA) B/P Classification Systolic, mmHg Diastolic, mmHg Normal < 120 And < 80 Pre-hypertension 120-139 Or 80-89 Stage 1 Hypertension 140-159 Or 90-99 Stage 2 Hypertension ≥ 160 Or ≥ 100 Isolated Systolic Hypertension > 140 And < 90 9

10. Types Essential (Primary, idiopathic) Hypertension Accounts approximately 80–95% of hypertension Has no identifiable medical cause Multi-factorial & polygenic 2. Secondary Hypertension 5–20% Elevations in BP with a specific cause, such as Narrowing of the renal arteries, Renal parenchymal disease, Hyperaldosteronism Certain medications, Pregnancy, and Coarctation of the aorta. 10

11. Approach to the Patient: Hypertension History /symptoms Most patients have no specific symptoms referable to their blood pressure elevation Characteristically, a "hypertensive headache" occurs in the morning and is localized to the occipital region Other non-specific symptoms dizziness, palpitations, easy fatigability, impotence… 11

12. Patient's Relevant History Duration of hypertension Previous therapies: responses and side effects Family history of hypertension and cardiovascular disease Dietary and psychosocial history Other risk factors: weight change, dyslipidemia , smoking, diabetes, physical inactivity Evidence of secondary hypertension: history of renal disease…. Evidence of target organ damage: history of TIA, stroke, transient blindness; angina, myocardial infarction, congestive heart failure; 12

13. Physical Examination May reveal no abnormality other than high BP. Changes in the retinas with hemorrhages, exudates, narrowed arterioles, Coronary artery disease with angina or MI is the most common consequence. Left ventricular hypertrophy may occur; HF ensues. Pathologic changes may occur in the kidney ( nocturia and increased BUN and creatinine levels). Cerebrovascular involvement may occur (stroke or TIA) 13

14. Laboratory testing Renal: (U/A, albumin excretion, serum BUN and/or creatinine ) Endocrine: ( Serum sodium, potassium, calcium, TSH ) Metabolic : (FBS, total cholesterol, HDL and LDL) Other ( Hematocrit , electrocardiogram) 14

15. Management 1. Lifestyle Modifications Weight reduction Attain and maintain BMI <25 kg/m 2 Dietary salt reduction < 6 g NaCl /d Adapt DASH (Dietary Approaches to Stop Hypertension) type dietary plan Diet rich in fruits, vegetables, and low-fat dairy products with reduced content of saturated and total fat Moderation of alcohol consumption For those who drink alcohol, consume ≤ 2 drinks/day in men and ≤ 1 drink/day in women Physical activity Regular aerobic activity e.g. brisk walking for 30 min/d 15

16. Pharmacologic Therapy Goal :- To prevent death and complications BP at or below 140/90 mm Hg (130/80 mm Hg for DM or CKD), whenever possible. Drug therapy is recommended for individuals with BP ≥ 140/90 mmHg. Lowering SBP by 10–12 mmHg and DBP by 5–6 mmHg confers relative risk reductions of 35–40% for stroke and 12–16% for CHD within 5 years of the initiation of treatment. Risk of heart failure is reduced by > 50%. Hypertension control is the single most effective intervention for slowing the rate of progression of hypertension-related CKD. 16

17. Pharmacologic… Diuretics Thiazides ( hydrochlorothiazides ) Loop diuretics (Furosemide) Potassium sparing diuretics ( Spironolactone ) Beta blockers Atenolol , Metoprolol , Propranolol , Labetalol ACE inhibitors Captopril , Enalapril Central sympatholytics Clonidine , methyldopa Direct vasodilators Hydralazine 17

18. Hypertensive emergency exists when an elevated BP level must be lowered immediately (not necessarily to less than 140/90 mm Hg) to halt or prevent target organ damage. Hypertensive urgency exists when BP is very elevated but there is no evidence of impending or progressive target organ damage. SBP > 180 or DBP > 110 mmHg 18 Hypertensive Crisis

19. Hypertensive Emergencies… Oral agents (beta-blockers, [ e.g , labetalol ], ACEIs [ e.g , captopril ], or alpha2-agonists [ e.g , clonidine ] can be administered with the goal of normalizing blood pressure within 24 to 48 hours. Close hemodynamic monitoring of the patient’s BP and cardiovascular status is required. Hydralazine 20mg Iv q 20min Vital signs should be checked as often as every 5 minutes. 19

20. Complications of Hypertension Heart Heart disease is the most common cause of death in hypertensive patients. Cardiovascular disease risk doubles for every 20-mmHg increase in systolic and 10-mmHg increase in diastolic pressure. Brain Stroke is the second most frequent cause of death in the world; it accounts for 5 million deaths each year, with an additional 15 million persons having nonfatal strokes 20

21. Complications of Hypertension… Kidney The kidney is both a target and a cause of hypertension. Primary renal disease is the most common etiology of secondary hypertension Peripheral Arteries In addition to contributing to the pathogenesis of hypertension, blood vessels may be a target organ for atherosclerotic disease secondary to long-standing elevated blood pressure 21

22. NURSING PROCESS Assessment Assess blood pressure at frequent intervals; know baseline level Assess for s/s of target organ damage Assess the extent to which hypertension has affected patient personally, socially, or financially. 22

23. Nursing diagnoses Deficient knowledge regarding the relationship between the treatment regimen and control of the disease process Noncompliance with therapeutic regimen related to side effects of prescribed therapy Collaborative Problems/Potential Complications Left ventricular hypertrophy Myocardial infarction HF TIA CVA Renal insufficiency and failure Retinal hemorrhage 23

24. Planning and Goals The major goals for the patient include Understanding of the disease process and its treatment, Participation in a self-care program, and Absence of complications. 24

25. Nursing Interventions Increasing Knowledge Emphasize the concept of controlling hypertension (with lifestyle changes and medications) Advise patient to limit alcohol intake and avoid use of tobacco. Recommend support groups for weight control, smoking cessation, and stress reduction, if necessary. 25

26. Nursing Interventions… Teaching Patients Self-care Provide written information about the expected effects and side effects of medications; Inform patient that rebound hypertension can occur if antihypertensive medications are suddenly stopped Inform patients that some medications, such as beta blockers, may cause sexual dysfunction 26

27. Nursing Interventions… Continuing Care Reinforce importance of regular follow-up. Obtain patient history and perform physical examination at each clinic visit. Assess for medication-related problems (orthostatic hypotension). Assess all body systems when patient returns for follow-up care to detect any evidence of vascular damage. Question patient about blurred vision, spots, or diminished visual acuity 27

28. Evaluation Expected Patient Outcomes Maintains adequate tissue perfusion Complies with self-care program Experiences no complications 28

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