HYPERTENTION AND HYPOTENTION

HYPERTENTION AND HYPOTENTION

1. TOPIC – HYPERTENTION AND HYPOTENTION PRESENTED BY :- MR . ROMAN BAJRANG BASIC BS.C NURSING 2 ND YEAR RELIANCE INSTITUTE OF NURSING

2. HTN OR HIGH BLOOD PRESSURE IS A DISEASE OF VASKULAR REGULATION IN WITCH THE MECHANISM THAT CONTROL ARTERIAL PRESSURE WITHIN THE NORMAL RANGE ARE ALTERD. According to Brunner & Suddarth's

3. Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long- term medical condition in which the blood pressure in the arteries is persistently elevated. According to lippin cott

4. A) Primary or Essential HTN :- Occurs in approx. 95 %. The diastolic pressure is 90 mmHg & the systolic pressure is 140mmHg or higher & the other causes of HTN are absent. B) Secondary HTN :- 1. Occurs in approx. 5 % of patients with hypertension secondary to other pathology. Renal pathology are :- congenital anomalies, Pyelonephritis,Renal artery obstruction,Acute & Chronic glomerulonephritis. Endocrine disturbances :- Pheochromocytoma Adrenal cortex tumor. Cushing’s syndrome . Medications such as E s tro g e n s ,a n t i - dep re ss a n t s , steroids,NSAIDs .

5. Risk factors High blood pressure has many risk factors, including: Age. The risk of high blood pressure increases as you age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65. Race. High blood pressure is particularly common among people of African heritage, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in people of African heritage.

6. Family history . High blood pressure tends to run in families. Being overweight or obese . The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls. Not being physically active . People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.

7. Using tobacco . Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk. Too much salt (sodium) in your diet . Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure. Too little potassium in your diet . Potassium helps balance the amount of sodium in your cells. If you don't get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.

8. Drinking too much alcohol . Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure. If you drink alcohol , do so in moderation. For healthy adults, that means up to one drink a day for women and two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor. Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure. Certain chronic conditions . Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnea.

9. P a tho p hy s i o l og y

10. Clinical manifestation Headache Dizziness Blurred vision Nausea & vomiting Chest pain Shortness of breath Palpitation

11. blood pressure is extremely high, there may be certain symptoms to look out for,including: Severe headache Fatigue or confusion Vision problems Chest pain Difficulty breathing Irregular heartbeat Blood in the urine

12. Diagnostic evaluation History taking & physical exam. Chest X-ray ECG Proteinuria,↑ed BUN & creatinine Serum potassium 24 hrs. urine output Renal scan Renal duplex imaging

13. Blood Tests Blood tests may be needed to determine if you have secondary hypertension due to a serious or treatable health condition. 5 Blood tests that may be ordered to assist in the diagnosis of hypertension include: Electrolyte levels Blood glucose Thyroid function tests Kidney function tests: blood urea nitrogen (BUN) and creatinine levels Urine Tests Urine tests can help determine if diabetes, kidney failure, or illegal drugs are causing or contributing to high blood pressure

14. Loose weight if body mass index is greater than or equal to 25. Limit alcohol. Get regular aerobic exercise equivalent to 30-45 min of walking most days. Cut sodium intake to 2.4 gm or less per day. Include recommended daily allowances of potassium,calcium & magnesium in diet. 6)Smoking cessation. Reduced dietary saturated fat & cholesterol. Consider reducing coffee intake.

15. Medical management Diuretics (lower BP by promoting urinary excretion) Beta-adrenergic blockers (reducing cardiac output as well as release of renin from the kidneys) (atenolol) Central alpha agonist (diminishing sympathetic outflow from the brain,thereby lowering peripheral resistance) (methyldopa) Peripheral adrenergic agents Combined alpha & beta adrenergic blockers ACE inhibitors (blocking the enzyme that converts Angiotensin-I to Angiotensin-II) (Captopril,remipril) Calcium channel blocker (stop the movement of calcium into the cells causes vasodilation & inhibit reabsorbtion of sodium in the renal tubules) (verapamil) Direct vasodilators (direct smooth muscles relaxants that primarily dilate arteries & arterioles) (hydralazine)

16. Diet People can prevent high blood pressure by following a heart-healthy diet. Reducing salt intake People’s average salt intake is between 9 grams (g) and 12 g per day in most countries around the world. The World Health Organization (WHO) recommend reducing intake to under 5 g a day to help decrease the risk of hypertension and related health problems. Lowering salt intake can benefit people both with and without hypertension.

17. Eating more fruit and vegetables and less fat People who have high blood pressure or people at high risk of developing high blood pressure should eat as little saturated and total fat as possible. Instead, experts recommend: whole grain, high fiber foods a variety of fruit and vegetables beans, pulses, and nuts fish rich in omega-3 twice a week nontropical vegetable oils, for example, olive oil skinless poultry and fish low fat dairy products

18. Nursing m a n a gement

19. Complication

20. Heart attack or stroke . High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications. Aneurysm . Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening. Heart failure . To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart's pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body's needs, which can lead to heart failure. .

21. Metabolic syndrome. This syndrome is a cluster of disorders of your body's metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the "good" cholesterol; high blood pressure and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke. Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure. Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.

22. Hypotension

23. Definition “Hypotension is generally considered as systolic blood pressure less than 90 mm Hg or diastolic less than 60 mm Hg.” - - http://en.wikipedia.org abnormally low blood pressure

24. T y p es Ortho s t a t i c Hypotension Neurally Mediated Hyp o ten si o n Severe Hypotension Linked to Shock

25. • Types :- The three main types of this kind of hypotension are orthostatic hypotension,neurally mediated hypotension & severe hypotension linked to shock. • • Orthostatic Hypotension :- This type of hypotension occurs when standing up from a sitting or lying down position.Orthostatic hypotension occurs if body isn't able to adjust blood pressure & blood flow fast enough for the change in position. The drop in blood pressure usually lasts only for a few seconds or minutes after you stand up.A form of orthostatic hypotension called postprandial hypotension is a sudden drop in blood pressure after a meal.This type of hypotension mostly affects older adults. •

26. • Neurally Mediated Hypotension :- With neurally mediated hypotension (NMH),BP drops after standing for a long time.That may feel dizzy,faint or sick to the stomach as a result.It also can occur as the result of an unpleasant,upsetting or scary situation.NMH affects children and young adults more often than people in other age groups. Children often outgrow NMH.

27. Severe Hypotension Linked to Shock :- Shock is a life- threatening condition in which blood pressure drops so low that the brain, kidneys, and other vital organs can't get enough blood to work well. Blood pressure drops much lower in shock than in other types of hypotension.

28. Etiology

29. Medical conditions that can cause low blood pressure include: Pregnancy. Because the circulatory system expands rapidly during pregnancy, blood pressure is likely to drop. This is normal, and blood pressure usually returns to your pre-pregnancy level after you've given birth. Heart problems. Some heart conditions that can lead to low blood pressure include extremely low heart rate (bradycardia), heart valve problems, heart attack and heart failure. Endocrine problems. Thyroid conditions such as parathyroid disease, adrenal insufficiency (Addison's disease), low blood sugar (hypoglycemia) and, in some cases, diabetes can trigger low blood pressure. Dehydration. When your body loses more water than it takes in, it can cause weakness, dizziness and fatigue. Fever, vomiting, severe diarrhea, overuse of diuretics and strenuous exercise can lead to dehydration.

30. Blood loss. Losing a lot of blood, such as from a major injury or internal bleeding, reduces the amount of blood in your body, leading to a severe drop in blood pressure. Severe infection (septicemia). When an infection in the body enters the bloodstream, it can lead to a life- threatening drop in blood pressure called septic shock. Severe allergic reaction (anaphylaxis). Common triggers of this severe and potentially life-threatening reaction include foods, certain medications, insect venoms and latex. Anaphylaxis can cause breathing problems, hives, itching, a swollen throat and a dangerous drop in blood pressure. Lack of nutrients in your diet. A lack of the vitamins B-12 and folate can keep your body from producing enough red blood cells (anemia), causing low blood pressure.

31. SOME MEDICATIONS CAN CAUSE LOW BLOOD PRESSURE, INCLUDING : Water pills (diuretics), such as furosemide (Lasix) and hydrochlorothiazide (Maxzide, Microzide, others) Alpha blockers, such as prazosin (Minipress) Beta blockers, such as atenolol (Tenormin) and propranolol (Inderal, Innopran , others) Drugs for Parkinson's disease, such as pramipexole (Mirapex) or those containing levodopa Certain types of antidepressants (tricyclic antidepressants), including doxepin (Silenor) and imipramine (Tofranil) Drugs for erectile dysfunction, including sildenafil (Revatio, Viagra) or tadalafil (Adcirca, Cialis), particularly when taken with the heart medication nitroglycerin

32. PATHOPHYSIOLOGY

33. Due to etiological factore such as blood loss,infection Hypotension reduces blood flow and therefore oxygen delivery to organs and tissues, which may cause cellular damage and dysfunction. Hypotension may result from: Reduced cardiac

34. Headache Dizziness Nausea Blurred vision Chest pain Irregular heart beat Shortness of breath

35. Diagnostic evaluation

36. Diagnostic evaluation :- • CBC (complete blood count) :- CBC may reveal anemia from blood loss or elevated white blood cells due to infection. Blood electrolyte measurements :- may show dehydration and mineral depletion, renal failure or acidosis (excess acid in the blood). Cortisol levels can be measured to diagnose adrenal insufficiency and Addison's disease. Blood and urine cultures can be performed to diagnose septicemia and bladder infections,respectively. Radiology studies such as chest x-rays ,abdominal ultrasounds & computerized tomography (CT or CAT) scans may detect pneumonia , heart failure , gallstones , pancreatitis , and diverticulitis . Electrocardiograms (EKG) :- can detect abnormally slow or rapid heart beats, pericarditis & heart muscle damage from either previous heart attacks or a reduced supply of blood to the heart muscle that has not yet caused a heart attack.

37. Holter monitor :- This recordings are used to diagnose intermittent episodes of abnormal heart rhythms.A Holter monitor is a continuous recording of the heart's rhythm for 24 hours that often is used to chart and diagnose intermittent episodes of bradycardia or tachycardia. Patient-activated event recorder :- If the episodes of bradycardia or tachycardia are infrequent,a 24-hour Holter recording may not capture these sporadic episodes.In this situation,a patient can wear a patient- activated event recorder for up to four weeks.The patient presses a button to start the recording when he or she senses the onset of an abnormal heart rhythm or symptoms possibly caused by low blood pressure.The doctor then analyzes the recordings at a later date to identify the abnormal episodes. Echocardiograms :-These are examinations of the structures and motion of the heart using ultrasound .It can detect pericardial fluid due to pericarditis,the extent of heart muscle damage from heart attacks, diseases of the heart valves and rare tumors of the heart. Ultrasound examinations :-USG of the leg veins and CT scans of the chest can detect deep vein thrombosis and pulmonary embolism .

38. Medical management Beta blocker Intravenous heparin or oral warfarin NSAIDs Corticosteroids such as Fludrocortisone

39. Beta blocker such as propranolol should be given. Intravenous heparin or oral warfarin should be given to treat pulmonary embolism. Midodrin should be given.It works by restricting the ability of the blood vessels to expand, which raises blood pressure. NSAIDs should be given. Corticosteroids such as Fludrocortisone may be given.It works by promoting sodium retention by the kidney ,thereby causing fluid retention & some swelling,which is necessary to improve blood pressure.

40. Nursing m a n ag e m e nt

41. Complication Risk of injury from falls. Shock