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Nursing Management of Clients with Stressors of Circulatory Function HYPERTENSION

Nursing Management of Clients with Stressors of Circulatory Function HYPERTENSION. NUR133 LECTURE # 10 K. Burger MSEd,MSN, RN, CNE. Incidence and Prevalence. Hypertension affects about __________ people in the United States Hypertension affects about __________ people worldwide

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Nursing Management of Clients with Stressors of Circulatory Function HYPERTENSION

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  1. Nursing Management of Clients with Stressors of Circulatory FunctionHYPERTENSION NUR133LECTURE # 10K. Burger MSEd,MSN, RN, CNE

  2. Incidence and Prevalence • Hypertension affects about __________ people in the United States • Hypertension affects about __________ people worldwide • ___________ of the population are unaware they have hypertension • Awareness, treatment, and control=goals

  3. Target Organ Damage (TOD)Associated with Hypertension • Heart Disease- Left ventricular hypertrophy (LVH)- Congestive heart failure (CHF)- Myocardial infarction (MI) • Cerebrovascular accident (CVA) • Nephropathy • Retinopathy

  4. Definition and Classification • SBP => 120 mm Hg DBP => 80 mm Hg • Prehypertension 120-139/80-89 • Stage I Hypertension 140-159/90-99 • Stage II Hypertension >160/100 *Primary Hypertension (essential, idiopathic) 90% of casesSpecific cause unknown

  5. Components of Blood Pressure Blood pressure = CO X SVR • CO = cardiac output • SVR = systemic vascular resistance

  6. Risk Factors • Age greater than 60 yrs old • Family history • Obesity • Sedentary lifestyle • Hyperlipidemia • Diabetes mellitus • Increased intake of Na, ETOH, caffeine • Smoking • Stress • African American ethnicity • Metabolic Syndrome

  7. A group of metabolic risk factors that greatly increase risk for: CAD DM type 2 CVA Metabolic Syndrome

  8. Complications Associated with Hypertension • Coronary Artery Disease (CAD )

  9. Thrombolytic CVA Hemorrhagic CVA Complications Associated with Hypertension

  10. Nephropathy Chronic hypertension causes thickening of nephron blood vessels(nephrosclerosis) which decreases renal blood flow. Result = chronically hypoxic renal tissue and permanent tissue damage Complications Associated with Hypertension

  11. Complications Associated with Hypertension • Retinopathy

  12. Complications Associated with Hypertension • Malignant Hypertension Condition of severely elevated B/P SBP > 200mm Hg and/or DBP > 120mm Hg Acute, life-threatening emergency Creates hi-risk for target organ damage: Cardiac, Renal, CNS Requires swift intervention to lower B/P Also may be termed: Accelerated –malignant hypertension Incidence generally low: (1-2% of hypertensive client population) Most commonly an unexplained occurrence in clients w/chronic HTN Higher incidences found in:-middle-aged-male-African-American

  13. HTN ASSESSMENT • History - dietary, alcohol, smoking habits - stress and physical activity - other health stressors: DM - family hx of heart disease, HTN - ethnic origin or race - symptoms: ha, dizziness, OR NONE • Physical - BP both arms: lying, sitting, standing - Fundoscopic exam

  14. HTN Assessment • Diagnostics - Anthropometric measures - EKG, Echocardiogram - Lipid Profile - HgAIC - C-reactive protein - homocysteine - Renal studies: BUN, Creat, Renin - Blood chemistries: Na, K, Glucose

  15. Desirable Levels LDL < 100 HDL > 40 Total Cholesterol<200 Triglycerides <150 Lipid Profiles

  16. HTN Nursing Diagnosis • Deficient knowledge • Risk for ineffective therapeutic mgmt • Altered nutrition; more than body req • Ineffective tissue perfusion • Potential for injury: CVA, MI, Retinal Hemorrhage +++++++++++++++++++++++++++++more

  17. HTN Planning Client will: • Have BP readings 120/80 or < • Be knowledgeable about disease process and potential complications • Undertake lifestyle modifications: weight control, dietary/alcohol/smoking habits, stress reduction, exercise etc. • Comply with medication regimen

  18. Interventions for Hypertension

  19. DASH DIET DIETARY APPROACH TO STOP HYPERTENSION Reduce intake of: saturated fatcholesterolred meatsrefined carbohydrates (sugars) sodium Increase intake of:complex carbohydrates (fiber)fruits & vegetables ( increases K )low-fat dairy products (increases Ca ) nuts and legumes DASH diet plan www.nhlbi.nih.gov

  20. Pharmacological Interventions • Diuretics • ACE Inhibitors • Calcium Channel Blockers • Angiotensin II Receptor Blockers • Adrenergics: Alpha & Beta Blockers • Vasodilators • Antihyperlipemics ( CAD therapy )

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