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Nursing Care for Hypertension: Incidence, Diagnosis, and Treatment

This chapter provides information on the incidence, diagnosis, and treatment of hypertension. It includes guidelines for taking blood pressure measurements, classification of hypertension, and follow-up care. The chapter also discusses the pathophysiology, signs/symptoms, and diagnostic tests for hypertension, as well as the risk factors and complications associated with the condition. Additionally, it covers the management of hypertensive emergencies and urgencies, and provides patient education on lifelong blood pressure control and self-care measures.

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Nursing Care for Hypertension: Incidence, Diagnosis, and Treatment

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  1. Chapter 22 Nursing Care of Patients with Hypertension

  2. Hypertension Incidence • 2005–2006: • 29% U.S. Adults > 18 Years of Age • Increases with Age • Non-Hispanic Blacks: 41% • Non-Hispanic Whites: 28% • Mexican Americans: 22%

  3. Safety: Clean Stethoscope • Contaminated with Bacteria, Even MRSA • Clean at Start of Shift • Clean Between Every Patient Use • Clean with Each Hand Hygiene • Use Ethanol-based Cleanser or Isopropyl Alcohol Pads

  4. Taking Blood Pressure (BP) • Use Calibrated Instrument • Have Patient Sit Quietly for 5 Minutes in Chair (Not Exam Table) with Feet on Floor, Arm Supported at Heart Level • Use Cuff Bladder Encircling at Least 80% of Arm • Take Two BP Measurements (Wait In-between) • Tell Patient BP Reading

  5. Hypertension • Normal BP is Below 120/80 mm Hg • Average of Two or More Readings on Different Dates • Highest Reading Determines Category

  6. Classification of Hypertension SystolicDiastolic • Pre-hypertension 120–139 or 80–89 mm Hg • Stage 1 Hypertension 140–159 or 90–99 mm Hg • Stage 2 Hypertension >160 or >100 mm Hg

  7. Follow-Up Care • Normal BP: 2 Years • Pre-hypertension: 1 Year • Stage 1 Hypertension: 2 Months • Stage 2 Hypertension: 1 Month • >180/110 mm Hg: Immediate Treatment

  8. Blood Pressure • Pressure Exerted by Blood on Walls of Blood Vessels • Determined by Cardiac Output, Peripheral Vascular Resistance, Vessel Stretch, Blood Viscosity, Blood Volume

  9. Pathophysiology • Primary Hypertension • Unknown Cause • Secondary Hypertension • Known Cause • Isolated Systolic Hypertension • SBP >140 mm Hg

  10. Hypertension Signs/Symptoms • None • “SilentKiller” • Rare • Headache, Bloody Nose, Anxiety, Dyspnea • TargetOrgan Disease • Damage to Blood Vessels of Heart, Kidney, Brain, Eyes

  11. Diagnosis of Hypertension • History • Signs and Symptoms • Kidney or Heart Disease • Medications • Blood Pressure Readings • Home Blood Pressure Measurements

  12. Diagnostic Tests • ECG • Blood Glucose • Hematocrit • Potassium • Calcium • Lipoprotein, Cholesterol, Triglyceride

  13. Hypertension Risk Factors • Nonmodifiable: Unable to be Changed • Modifiable: Changeable

  14. Nonmodifiable Risk Factors • Family History of Hypertension • Age • Ethnicity • Diabetes Mellitus

  15. Modifiable Risk Factors • Weight • Diet • DASH • LimitSodium • LimitCaffeine • Alcohol Use • Exercise • Smoking • Stress Management • Adequate Sleep

  16. Hypertension Treatment • No/Low Risk Hypertensive • Lifestyle Changes • BP >140/90 mm Hg Over 6 Months • Goal of Treatment • <140/90 mm Hg • <130/80 mm Hg Diabetes/Kidney Disease/ Proteinuria

  17. Hypertension Treatment (cont’d) • Lifestyle Changes and • Antihypertensive Medications • Initial Therapy: Thiazide-type Diuretics • Combination Medications

  18. Medications for Hypertension • Diuretics • Alpha Blockers • Beta Blockers • Calcium Channel Blockers

  19. Medications for Hypertension (cont’d) • Angiotensin-converting Enzyme Inhibitors • Central Agents • Peripheral Agents • Vasodilators • Aspirin 100 mg at Bedtime

  20. Complications of Hypertension • Atherosclerosis • Coronary Artery Disease • Myocardial Infarction • Left Ventricular Hypertrophy • Stroke • Kidney/Eye Damage

  21. Hypertensive Emergency • SBP >180 mm Hg Systolic • DBP >120 mm Hg Systolic • Risk for/Progression for Target Organ Dysfunction • Immediate Gradual Reduction of BP to Protect Target Organs • Treatment: Nitroprusside (Nipride) IV

  22. Hypertensive Urgency • Severe BP Elevation Without Target Organ Dysfunction Progression • Severe Headaches, Nosebleeds, Shortness of Breath, and Severe Anxiety • Oral Medication

  23. Nursing Process • Deficient Knowledge • Ineffective Therapeutic Regimen Management

  24. Patient Education • Lifelong BP Control • Self-care Measures • Prescribed Medical Regimen

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