HYPERTENSION reporting for our ward class

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Remoticado, Shakira œ °
Sabanal, Heizl Jane

Suasin, Louieza Marie

Tan, Leah Margarita

2. OVERVIEW

+ Systemic arterial BP is the pressure exerted on the
walls of the arteries during ventricular systole and
diastole.

+ A normal Blood pressure is measured in millimeters
of mercury (mmHg) and is given as 2 figures.

o Systolic pressure - the pressure when your
heart pushes blood out

o Diastolic pressure - the pressure when your
heart rests between beats

3. y LE WHAT IS HYPERTENSION

» Elevated SBPs of 140 mm Hg or higher or DBPs of 90 mm Hg or higher.
+ These parameters, which also specified that the diagnosis of hypertension =& a

must be based on an average of two or more accurate ringen taken
one to 4 weeks apart.
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Updated Definitions of BP Categories and Stages = ==
For children aged 113 y For children aged > 13 ee ira
Normal BP: < 90th percentile Normal BP: < 120/< 80 mm Hg ~ mm :
Elevated BP: > 90th percentile to < 95th percentile Elevated BP: 120/< 80 to 129/ =

or 120/80 mm Hg to < 95th percentile (whichever < 80 mm Hg

is tower) =

Stage 1 HTN: 2 95th percentile to < 95th percentile Stage 1 HTN: 130/80 to 139/89 coe:

+12 mm Hg, or 130/80 to 139/89 mm Hg (which- mmHg

ever is lower) peal Lc

Stage 2 HTN: 2 95th percentile + 12 mm Hg, or Stage 2 HTN: 2 140/90 mm Hg u ne

> 140/90 mm Hg (whichever is lower) = ve

BP = blood pressure; HTN = hypertension,
Reprinted with permission from Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice
{guideline for screening and management of high blood pressure in children and adolescents
[published correction appears in Pediatrics. 2017:140(6/220173035] Pediatrics. 2017:140(3)
620171904

5. RISK FACTORS

Common inherited and Modifiable risk factors

physical risk factors + Lack of physical activity

+ Unhealthy diet

« Family histo
MESA) + Being overweight or

+ Age

« Gender obese

ce + Drinking too much alcohol
« High cholesterol
+ Diabetes

+ Smoking and tobacco use
+ Stress

6. CLINICAL
MANIFESTATION

Hypertension is often referred to
as the 'silent killer" because many
individuals with high blood
pressure remain asymptomatic
for years.

Common Target Organ Damage in
Hypertension

1. Eye (Retinal) Damage
© Hemorrhages (bleeding in the retina)
+ Exudates (fluid accumulation)
+ Arteriolar narrowing
© Cotton-wool spots (small infarctions)
° Papilledema - In severe cases
2.Cardiovascular System
© Coronary artery disease
° Left ventricular hypertrophy (LVH)
° Heart Failure

7. Common Target Organ Damage in

CLINICAL Hypertension
MANIFESTATION

3. Kidney Damage
© Elevated BUN and Serum creatinine
o Nocturia
4. Cerebrovascular System
o Transient ischemic attack (TIA) or a
stroke
> Cerebral Infarction

8. ASSESSMENT AND DIAGNOSTIC FINDINGS

Diagnosis of Hypertension

1. Obtaining an accurate blood pressure (BP) measurement.
2. Take at least two BP readings on two different occasions, find the
average.
FOR: BP of 2160/100 mm Hg - two accurate readings on one occasion

9. ASSESSMENT AND DIAGNOSTIC FINDINGS
Comprehensive Diagnosis and
Physical Examination
+ Palpation of + Examination of the + Auscultation of + Cardiac
peripheral pulses: neck the abdomen examination

4
J 4 about 3 7
4 andiat the” 2
Fundoscopy
Examination

umbilicus.

10. ASSESSMENT AND DIAGNOSTIC FINDINGS

Laboratory and Diagnostic Tests

+ Urinalysis

+ Blood Chemistry

+ 12-lead electrocardiogram

+ Echocardiography

+ BUN and creatinine levels

« Microalbuminuria or macroalbuminuria

11. MEDICAL MANAGEMENT

” 1.Lifestyle Modifications
° Weight Loss.
o Dietary Changes.
> Increased Physical Activity.
+ Reduced Alcohol Consumption.
+ Smoking Cessation
2.Effective Dietary Approaches
+ DASH (Dietary Approach to Stop Hypertension)
° A diet low in sodium (less than 2 g/day) and high in
potassium (3,500-5,000 mg/day)
A high-potassium diet should be avoided in patients with
Chronic Kidney Disease (CKD).

12. MEDICAL MANAGEMENT

“23, Pharmacologic Therapy
+ First-Line Antihypertensive Medications:
o Thiazide or Thiazide-like Diuretics

- Hydrochlorothiazide
° Angiotensin-Converting Enzyme (ACE) Inhibitors
= Captopril
+ Angiotensin Receptor Blockers (ARBs).
- Losartan
+ Calcium Channel Blockers (CCBs).
- Amlodipine

13. HYPERTENSIVE CRISIS

aso is an umbrella term used to describe the

two conditions that occur due to extremely
high blood pressure levels.

Two types:

« Hypertensive emergency B loo d
+ Hypertensive urgency Pr ess Ur
e
° Ve n
! Occur when systolic blood pressure (SBP) rises "y High
above 180 mm Hg or diastolic blood pressure (DBP) î
exceeds 120 mm Hg High =

14. WHAT ARE THE DIFFERENCES?

Hypertensive

Hypertensive
Urgency

Emergency

+ Stable and show no
evidence of target
organ damage.

« With new or worsening
target organ damage.

15. HYPERTENSIVE EMERGENCY

Assessment

Rapid and Focus to determine possible causes
and target organ involvement.

Management Goals

Reduce SBP by no more than 25% within the
first hour of treatment.

=

16. HYPERTENSIVE EMERGENCY

Management Goals

If the patient is stable, aim for 160/100 mm Hg
within the next 2 to 6 hours.

& Establish a normal, controlled blood pressure

within 24 to 48 hours of starting treatment

Y

17. HYPERTENSIVE EMERGENCY Se
€

Pharmacologic Therapy

Antihypertensive medications with immediate onset of
action.
Intravenous drugs:
o Nicardipine
° Clevidipine
o Labetalol
© Esmolol
° Nitroglycerin
> Nitroprusside

18. HYPERTENSIVE URGENCY 7 «
Management

Close Monitoring of Blood pressure
+ For rapidly changing blood pressure, vital signs may be taken every 5
minutes.
« In stable conditions, taking vital signs every 15 to 30 minutes may be
sufficient.

! Be aware that a sudden drop in blood pressure can occur, necessitating
immediate action to restore it to an acceptable level.

19. HYPERTENSIVE URGENCY

Pharmacologic Therapy

« Sodium nitroprusside
+ Labetalol

+ Fenoldopam

« Clevidipine

20. NURSING MANAGEMENT

For both Hypertensive Emergency and Urgency

« Health history
e Focusing on previous hypertension and medication
adherence.
« Physical examination
+ To determine any signs of target organ damage
« Accurate Blood Pressure measurement
e Measured in both the lying and the standing
position and both arms.

21. NURSING MANAGEMENT

For both Hypertensive Emergency and Urgency

+ Patient education
+ About hypertension, risk, and importance of
adherence to the treatment plan.
o Lifestyle modification like diet, exercise, and stress
management
« Collaboration
° Work with other healthcare team members to
ensure thorough management plan of care. a
e Administering medication as prescribed.