HIGH BLOOD PRESSURE NOTESNATUNGA RONALD.pptx

NURSING

1. HIGH BLOOD PRESSURE HYPERTENTION BUYO REMALIAH ISRON

2. Introduction High blood pressure is generally a symptomless condition in which abnormally high pressure in the arteries increases the risk of problems such as stroke, aneurysm, heart failure. To many people hypertension suggests excessive tension, nervousness, stress. In medical terms how ever hypertension refers to a condition of elevated blood pressure regardless of the cause

3. CLASSIFICATION OF BLOOD PRESSURE FOR ADULTS OF 18 YEARS AND ABOVE Category Systolic ( mmhg ) Diastolic ( mmhg ) normal <120 <80 Pre-hypertensive 120-139 80-89 Hypertensive Stage 1. (mild) Stage 2. (moderate) Stage 3. (severe) Stage 4. (very severe) 140-159 160-179 180-209 210 or more 90-99 100-109 110-119 120 or more

4. Types of hypertension Primary or essential hypertension accounts for 90%-95% of all cases of hypertension. it has no known cause. Secondary hypertension is caused by the underlying factors such as kidney diseases, certain arterial conditions and some drugs like the adrenaline and pregnancy.

5. Causes of hypertensio n Kidney diseases Pheochromocytoma(a tumor of adrenal gland) leads to increased adrenaline secretion Cushing disease/syndrome (hyper secretion of glucocorticoids) too much hydrocortisone deposits too much fats Drugs like oral contraceptives, corticosteroids and cocaine, testosterone preparations. Pregnancy (gestational hypertension)

6. Causes cont’ Coarctation of aorta, which are contraction, compression and narrowing of the aorta Acute intermittent porphyria. Porphryne is organic compound which is pigment in heamoglobin and cytochrome. In cases of too much breakage of red blood cells it is released into the blood serum and causes vaso constriction. Acute lead poisoning (heavy metals) Arteriosclerosis.

7. Predisposing factors to primary hypertension High lipid concentration in the blood Atherosclerosis Diabetes mellitus Over smoking of cigarette Age over 55 years for men and 65 yrs females Family history of hypertension Obesity and sedentary life Stress Stimulants like caffaine , nicotine

8. Age related changes affecting blood pressure Atherosclerotic changes reduce the elasticity of blood vessels causing decrease in cardiac out put and increase in peripheral vascular resistance hence increase in blood pressure Above 60 years the peripheral vascular resistance increases every year hence pulse pressure increases continuously or widens

9. Anatomy and physiology of blood pressure regulation Blood pressure=cardiac output*peripheral vascular resistance Pressure is inversely proportional to surface area. Cardiac out put is the amount of blood pumped out of the heart in one minute It is determined by: Strength of the heart muscles Heart rate Rhythm of the left ventricle Blood volume return to the heart

10. Peripheral vascular resistance is the is the negative force in the blood vessel walls that the heart ventricles must overcome in order to eject blood from the heart. It is determined by: Diameter of blood vessel walls The viscosity of blood( thickness of blood) Elasticity of the blood vessel walls

11. The peripheral resistance of the large blood vessels is low due to high elasticity of blood vessel walls. This helps to take large volume of blood to the periphery. While in the peripheral blood vessels the resistance is high, it helps to complete blood circulation by increasing the pressure The diameter of blood vessel is regulated by vasomotor center in the medulla of brain. This system works through autonomic nervous system

12. Stimulation of sympathetic nervous system causes the release of catecholamine which are vasoconstrictors and they increase peripheral resistance and this raises blood pressure Vasoconstriction reduces blood flow to the kidneys which leads to a complex rennin- angiotensin 1-angiotensin 2(vasoconstrictor) activities Reduced blood flow to kidneys also leads to release of aldosterone from the adrenal cortex it promotes sodium and water absorption leading to increased blood volume

13. Signs and symptoms Occipital headache. Light headedness. Epistaxis (nose bleeding ). Impaired organ function. If the pressure has damaged blood vessels. Flushed face. Tiredness /fatigue.

14. Diagnosis High blood pressure on routine examination and must remain high for 2 o r 3 times of examination Complications Heart attack and heart failure Stroke Kidney failure Blindness

15. Management Essential hypertension can not be cured but can be treated to prevent complications Drugs : Beta adrenergic receptor blockers Propranolol (inderal) 40-120mg o.d Artenolol (temolol)50-100mg od 2. Centrally acting drugs (alpha agonists) Methyldopa (aldomete) 250mg 2-3 times daily Hydralazine 25mg-50mg daily orally or 5-10mg iv diluted with 10mls of water

16. 3. Calcium channel blockers Nifedipine 10-30mg 2-3 times daily. Max 60mg daily Verapamil 240-480mg 3 times a day 4. Angiotensin converting enzyme inhibitors Captopril 12.5mg 2 times daily. Max 50mg 2 times daily 5. Diuretics Furusemide 40-80mg od Bendrofluazide 5mg od

17. NURSING CARE Counsel and educate this patient that the disease is chronic and for control to be effective she/he needs to cooperate with the health workers Drugs will be taken strictly according to doctors orders. Because of risk of malignant hypertension, hypotension or death. Address patients immediate problems other wise stress can worsen the pressure Regular check up of blood pressure and vitals are mandatory.

18. Diet Restrict too much salt with sodium Avoid saturated fats, cholesterol, red meat, sugared beverages, High potassium intake is important hence take fresh fruits and vegetables Adequate calcium is good hence take milk Patient should take poultry and fish products Grains like rice, g nuts, millet and proteinous foods/ fibrous foods.

19. Exercises Daily exercises to reduce weight to recommended Keep certain distance walk daily or slight running to break off fats Other aerobic exercises are recommended The nurse should be able to identify and treat drugs effects like sexual dysfunctions and sedation which are common Depression can worsen hypertension

20. Hypertensive emergency Hypertensive crisis is medical emergency and life threatening. It is some times termed as malignant hypertension. It usually starts abruptly and within a short time the diastolic pressure can reach 140mmhg Causes Abrupt stopping of antihypertensive. Eclampsia. Advancing pheochromocytoma . Cerebral accident.

21. Signs and symptoms Severe head ache Blurred vision Nausea and vomiting Restlessness and confusion. Very elevated diastolic pressure of 130mmhg or more Very high heart and respiratory rate

22. Diagnosis Elevated blood pressure of 200/130mmhg Retinal hemorrhage and papillary edema Medical treatment The goal is to reduce the pressure to non life threatening and gradually to normal over time. This can be done with high doses of: Hydralazine iv Furusemide iv

23. Nursing care Administer the prescribed drugs immediately and put the patient in bed for rest Frequent vital observation Blood pressure 2hourly, then 4hourly Start and maintain oxygen therapy Take appropriate measures if the patient presents with seizures or decreased consciousness Elevate the head of the bed to facilitate breathing Once the patient improves it is important the patient understand management of hypertension