Hypertension.pptx

For 2nd year B.Sc Nursing students

1. HYPERTENSION Presented By: Mr. Nandish.S Asso. Professor Mandya Institute of Nursing Sciences

2. DEFINITION : It is a sustained elevation of blood pressure, when systolic blood pressure is equal to or greater than 140 mm of hg and diastolic pressure is equal to or greater than 90 mm of hg for extended period of time. it is also known as high blood pressure, is a long term medical condition in which blood pressure in the arteries is elevated. It is also called as “ Silent Killer” as patient will not display any symptom.

3. STAGES : Category Systolic BP Diastolic BP Pre Hypertension 120 – 139 80 - 89 Hypertension Stage - I 140 - 159 90 - 99 Hypertension Stage - II 160 - 179 100 - 109 Hypertension Stage - III > 180 > 110 * The term stage is used to define levels of Hypertension.

4. Incidence & Prevalence: According to WHO, around 1.28 billion adults aged between 30 – 79 years have hypertension. 46% of adults with hypertension are unaware that they have this condition. In India, 29.8% of overall population are suffering from this illness (who are diagnosed). Incidence rate is increased along with the age. 33.2% of cases are reported between 40 – 59 years and 63% of cases seen over the age of 60 years.

5. CLASSIFICATION : The Etiology of hypertension can be classified as either primary or secondary. Primary or Essential H ypertension. In this type, BP is elevated without an identified cause and accounts for 90 to 95% cases. Although exact cause is unknown, there are several contributing factors like increased SNS activity, over production of sodium retaining hormones & vasoconstrictors, increased sodium intake, greater than ideal body weight, Diabetes Mellitus & excessive alcohol intake.

6. 2. Secondary Hypertension : In this type, BP is elevated with specific cause that can be identified & corrected. This type accounts for 5 – 10% of cases in adults. Causes of secondary hypertension include : Coarctation or Congenital N arrowing of Aorta Renal diseases such as Renal artery stenosis Endocrine disorders such as Cushing syndrome, Hyperaldosteronism Neurologic disorders like Brain tumors , Head Injury, Quadriplegia Sleep Apnea Medications NSAID’s, Oral Contraceptive pills, estrogen replacement therapy, sympathetic stimulants (Cocaine), Monoamine Oxidase Inhibitors ,… Pregnancy Induced Hypertension

7. Other Types of Hypertension : Malignant Hypertension : it occurs suddenly & drastically. Patient will experience numbness in body, vision problems, extreme fatigue, confusion, anxiety. Isolated Systolic Hypertension : it occurs as a result of old age and poor diet. White C oat Hypertension : it occurs only when a person’s blood pressure is taken in clinical setting, outside of Doctor’s office blood pressure is normal.

8. RISK FACTORS : Age : Blood pressure progressively increases with age. Alcohol : excessive alcohol intake is strongly associated with hypertension. Cigarette smoking : it greatly increases the risk of cardio vascular disease. Diabetes Mellitus : hypertension is more common in diabetes. Elevated Serum Lipids : increased cholesterol & triglycerides are major risk factors for atherosclerosis. Excessive dietary sodium Gender : it is more prevalent in men. Continued…

9. 8) Family History 9) Obesity / weight gain 10) Sedentary lifestyle 11) Socioeconomic status : it is more prevalent in lower socioeconomic groups. 12) Ethnicity : it is high in African & Americans. 13) Stress : people exposed to repeated stress will develop hypertension more frequently.

10. CLINICAL MANIFESTATIONS : It remains asymptomatic until it becomes severe and target organs are affected. Patients may experience variety of symptoms secondary to effects on blood vessels. It include : Fatigue Reduced activity tolerance Dizziness Severe Headache Palpitation Angina / Chest pain Dyspnoea Continued …

11. Nose bleeding Blurred vision Nausea & Vomiting Irregular Heart beat Papilledema

12. COMPLICATIONS : 1) Hypertensive Heart Disease Coronary Artery Disease (CAD) Left Ventricular Hypertrophy Heart Failure 2) Cerebrovascular Disease Cerebrovascular Accident Hypertensive Encephalopathy 3) Peripheral Vascular Disease 4) Nephrosclerosis 5) Retinal damage

13. DIAGNOSTIC STUDIES : History collection & Physical Examination Blood Pressure Monitoring Routine urine analysis Serum Electrolytes (sodium, potassium) BUN, Serum creatinine, serum uric acid Blood Glucose level CBC Fasting Lipid Profile 12 lead ECG Echocardiogram

14. MANAGEMENT : Treatment / management of hypertension is possible in two ways, which include Life style modification Pharmacological therapy

15. LIFE STYLE MODIFICATION : The life style modification measures mainly include, Weight reduction DASH diet (Dietary Approaches to stop Hypertension) Sodium restriction Reduce alcohol Regular Exercise Stress management Caffeine restriction

16. PHARMACOLOGICAL THERAPY : Various group of drugs are used for the treatment of hypertension and they are collectively called as Antihypertensive drugs. They include : Diuretics – it helps the kidneys to inhibit the sodium reabsorption in the distal convoluted tubules and loop of Henle . Ex : Furosemide, Chlorthiazide . 2) Beta Blockers – these medications reduces the workload of heart & blood vessels, which causes heart to beat slowly and with less force. Ex: Atenolol, Propanolol

17. 3) Alpha Blockers – these drugs causes peripheral vasodilation of blood vessels. Ex: Prazosin 4) Vasodilators – these medications act directly on the muscles in the wall of arteries and preventing the muscles from tightening and arteries from narrowing. Ex : Nitroglycerin , Sodium Nitroprusside 5) ACE Inhibitors – these medications will reduce the conversion of Angiotensin – I to Angiotensin – II and prevents vasoconstriction. Ex : Captopril, Ramipril Continued…

18. 6) Calcium channel blockers – these drugs will block the movement of extra cellular calcium into the cells and causing vasodilation & they decrease heart rate. Ex: Amlodipine, Verapamil. Alternative therapies which are helpful to regulate blood pressure include Acupuncture, Relaxation techniques & Diversional therapies

19. NURSING INTERVENTIONS : Monitoring dietary habits. Identify the medical history such as diabetes, CAD, Renal diseases,… Instruct the patients to avoid smoking & alcoholism Check vital signs frequently Periodic check up for blood cholesterol level Encourage the patients to consume more green leafy vegetables & fruits.

20. NURSING DIAGNOSIS .. ?

21. THANK YOU