HYPERTENSION - SLIDE SHARE PRESENTATION.

IT WILL BE HELPFULL FOR THE NUSING STUDENTS
IT FOCUSED ON MEDICAL MANAGEMENT AND NURSING MANAGEMENT.
HIGHLIGHTS ON HEALTH EDUCATION.

1. hypertension

2. Blood pressure is the product of cardiac output multiplied by peripheral resistance. C ardiac output is the product of the heart rate multiplied by the stroke volume. In normal circulation, pressure is exerted by the flow of blood through the heart and blood vessels. High blood pressure known as hypertension, can result from a change in cardiac output, a change in peripheral resistance or both. The medications used for treating hypertension decrease peripheral resistance, blood volume or the strength and rate of myocardial contraction. INRODUCTION

3. Hypertension is a systolic blood pressure greater than 140mmHg and diastolic pressure greater than 90mmHg over a sustained period, based on the average of two or more blood pressure measurements taken in two or more contacts with the health care provider after an initial screening. -Joint National Committee 1997 DEFINITION

4. Maximum (systolic) pressure pressure in the artery when the left ventricle is contracting to force the blood into the Aorta and other arteries. Minimum (diastolic) pressure pressure in the artery when the ventricles are relaxing and the heart is filling up, receiving blood from veins. Force exerted by circulating blood on the arterial walls

5. Age Sedentary lifestyle Obesity Salt sensitivity Alcohol, smoking Family history Race (blacks) Too little potassium in diet Too little vitamin D in diet. Stress. RISK FACORS

6. PRIMARY HYPERTENSION For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure called essential hypertension or primary hypertension, tends to develop gradually over many years. CAUSES

7. Adrenal cortical abnormalities: Cushing’s syndrome (Adrenal glands overproduce the hormone cortisol) Primary aldosteronism (over production of aldosterone by adrenal cortex) Aldosteronism causes sodium and water retention, potassium excretion in the kidneys Diseases of the kidney (polycystic kidney disease) SECONDARY HYPERTENSION

8. Disease of the renal arteries supplying the kidney RENOVASCULAR HYPERTENSION Neuroendocrine tumors Medication side effects (NSAID) Kidney problems Adrenal gland tumors Certain defects in blood vessels (congenital) Thyroid problems

9. Certain medications, such as birth control pills, cold remedies, over-the-counter pain relievers and some prescription drugs. Illegal drugs such as cocaine and amphetamines Alcohol abuse or chronic alcohol use Obstructive sleep apnea.

10. CLASSIFICATION

11. AS PER JOINT NATIONAL COMMITTEE

12. < 8 < 85 85-89 90-99 100-109 110 AS PER WHO

13. SHIFT OF RENAL FUNCTION CURVE (IMPAIRED NATRIURESIS) GENETIC PREDISPOSITION HYPERINSULINEMIA EXCESS MINERALOCORTICOID RENAL ARTERY STENOSIS RENIN NON-MODUATION NITRIC OXIDE RENOVASCULAR RESISTANCE GLOMERULAR DISEASE SYMPATHETIC NS ACTIVATION SODIUM & WATER RETENTION ECF/BLOOD VOLUME CARDIAC OUTPUT AUTOREGULATION SYSTEMIC VASCULAR RESISTANCE HYPERTENSION ADPKD RENAL FLUID VOLUME FEEDBACK MECHANISM RESTORATION OF NORMAL SODIUM BALANCE PATHOPHYSIOLOGY

14. MILD SYMPTOMS Headache Morning headache Tinnitus – ringing in ears Dizziness Confusion Fatique Shortness of breath Changes in vision – blindness Nausea CLINICAL MANIFESTATION

15. History collection Family history of hypertension Physical examination Check the vital signs Through the physical examination found that how much blood pressure Obesity Assess the sweating DIAGNOSTIC EVALUATION

16. Laboratory studies Routine lab. Test includes urine analysis, blood chemistry (Na, K, creatinine , FBS, Total and high density lipoprotein, cholesterol level) Renal damage ( BUN and creatinine levels or by micro or macroalbuminuria ) Add. Studies creatinine clearance, renin level, urine test, 24hours urine protein may be perform. 12 lead ECG Echocardiography

17. FIRST LINE DRUGS Diuretics Beta blockers ACE inhibitors Angiotensin II type 1 receptor blockers (Losartan, Telmisartan ) Calcium channel blockers MEDICAL MANAGEMENT

18. II LINE DRUGS Alpha I sympatholytic Alpha II sympathomimetics Direct vasodilators Kallium channel openers Agonist of II receptors in CNS

19. DIURETICS AND RELATED DRUGS Loop diuretics (Lasix) Blocks Reabsorption of Na, Cl & water Thiazide diuretics ( Chlorothiazide ) Decrease of blood volume, renal blood flow and cardiac output depletion of ECF. Negative Na balance, mild hypokalemia directly affect vascular smooth muscle volume. Potassium – Sparing diuretics (Spironolactone or Aldactone ) Competitive inhibitor of aldosterone acts on distal tubule independently of aldosterone.

20. Beta blockers ( Propanolol , Metaprolol Block the sympathetic nervous system, producing a slower HR and lower HR Alpha blockers ( Prazosin Hydrochloride or Minipress ) Peripheral vasodilators acting directly on the blood vessel. Combined Alpha and Beta blockers (Labetalol) Peripheral dilatation and decreases peripheral vascular resistance. vasodilators ( Nitropress ) Decreases peripheral resistance but concurrently elevates cardiac output, acts directly on smooth muscle of blood vessels.

21. ACE inhibitors Inhibit conversion of angiotensin I to angiotensin II lower total peripheal resistance . Example – Captopril, Enalapril , Ramipril . Calcium Antagonists Inhibits calcium in influx reduces cardiac afterload Example – Cardizem SR Inhibits calcium ion influx slows velocity of conduction of cardiac impulse. Example – Verapamil.

22. Lose weight if overweight Limit alcohol Increase aerobic physical activity Reduce sodium intake Maintain adequate intake of dietary potassium, calcium and magnesium for general health Stop smoking and reduce intake of dietary saturated fat and cholesterol. NURSING MANAGEMENT

23. THE DASH (DIETARY APPROACHES TO STOP HYPERTENSION) DIET

24. LIFE STYLE MODIFICATION

25. Fiber, such as blond psyllium and wheat bran Minerals such as calcium and potassium Supplements that increase nitric oxide or widen blood vessels such as cocoa, coenzyme Q10 or garlic Omega-3 fatty acids found in fatty fish, fish oil supplements or flaxseed Probiotics found in fermented dairy products such as cultured yogurt, buttermilk, acidophilus milk, cultured sour cream and cheese. Alternative medicine

26. NURSING DIAGNOSIS 1.Decreased cardiac output related to Increased vascular resistance, vasoconstriction Myocardial ischemia Ventricular hypertrophy/rigidity 2. Activity intolerance related Generalized weakness Sedentary life style Imbalance between oxygen supply and demand NURSING PROCESS

27. 3 . Ineffective coping related to Situational /maturational crisis; multiple life changes Inadequate relaxation; little or no exercise, work overload Inadequate support system Poor nutrition Unmet expectation; unrealistic perceptions Inadequate coping methods Gender differences in coping strategies

28. 4. Acute pain (Headache) related to increased vascular pressure 5. Nutrition imbalanced more than body requirements related to Excessive intake in relation to metabolic need Sedentary activity level Cultural preferences