NURS 221: hypertension

desired client outcomes: adheres to the self-care program

- adheres to the dietary regiment as prescribed: reduces calories, Na, and fat intake - exercises regularly - takes meds as prescribed and reports side effects - measures BP reoutinely - abstains from tobacco and excessive alcohol intake - keeps follow up appointments

pathophysiological process of hypertension:

- can result from increases in cardiac output, peripheral resistance, or both - must also be a problem with the body's control system - dysfunction of the autonomic nervous system - increased renin-angiotensin-aldosterone system - resistance to insulin action - activation of the immune system

what are the therapeutic effects of pharmacologic therapy for hypertension?

- decreased peripheral resistance, blood volume - decrease strength and rate of myocardial contraction

non-physical diagnosis for hypertension:

- deficient knowledge regarding the relation between the treatment regiment and control of the disease process - noncompliance with therapeutic regiment related to side effects of prescribed therapy

patient assessment - hypertension:

- history and risk factors - assess potential symptoms of target organ damage - personal, social, and financial factors that will influence the condition or its treatment

what are potential complications from hypertension?

- left ventricular hypertrophy - myocardial infarction - heart failure - transient ischemic attacks (TIA) - cerebrovascular disease (CVA, stroke, or brain attack) - renal insufficiency and chronic kidney disease - retinal hemorrhage

medical management goals for hypertension:

- maintain blood pressure of <130/80 - lifestyle modifications: weight reduction, DASH diet, decreased sodium intake, regular physical activity, and reduced alcohol consumption

desired client outcomes: reports knowledge of disease management sufficient to maintain adequate tissue perfusion

- maintains blood pressure at less than 130/80 with lifestyle modifications, meds, or both - demonstrates no symptoms of angina, palpitations, or vision changes - has stable BUN and serum creatinine levels - has palpable peripheral pulses

what are gerontologic considerations with hypertension?

- med regiment can be difficult to remember - expense can be a challenge - monotherapy, if appropriate, may simplify the med regiment and make it less expensive - ensure that older adult patients understand the regiment and can see and read instruction, open med containers, and get prescriptions refilled - include family and caregivers in education

desired outcomes: free of complications

- reports no changes in vision: exhibits no retinal damage on vision testing - maintains pulse rate and rhythm and respiratory rate within normal ranges; reports no dyspnea or edema - maintains urine output consistent with intake; has renal function test results within normal range - demonstrates no motor, speech, or sensory deficits - reports no headaches, dizziness, weakness, changes in gait, or falls

what are interventions for hypertension?

- support educate the patient about treatment regiment - reinforce and support lifestyle changes - taking medications as prescribed - follow-up care

hypertension is defined by the American college of cardiology (ACC)/American heart association (AHA) as:

- systolic blood pressure of 130 mmhg or higher - diastolic blood pressure of 80 mmhg or higher

antihypertensive safety alert:

- the patient and caregivers should be cautioned that antihypertensive medications might cause hypotension - Low blood pressure or postural hypotension should be reported immediately - older adults have impaired cardiovascular reflexes and thus are more sensitive to the extracellular volume depletion caused by diuretics and to the sympathetic inhibition caused by adrenergic antagonists - nurse educates patients to change positions slowly - nurse educated for older adult patients to use supportive devices to prevent falls

what are the goals for clients with hypertension?

- understand the disease process and its treatment - participation in self care program - absence of complications - lower and controlling BP without adverse effects or undue cost

Target Organ Damage: Heart

-left ventricular hypertrophy -dysrhythmias -heart failure

hypertension is based on the average of two or more accurate blood pressure measurements taken __ to __ weeks apart

1 to 4

in a hypertensive emergency what should you reduce the blood pressure to within 2 to 6 hours?

160/100

what do you want a patient's BMI to be?

18-25

in a hypertensive emergency how many hours after treatment should you gradually reduce the blood pressure?

24 to 48

what is stage 1 hypertension treatment for non African American and patients < 60 years old?

ACE - 1 or ARB

the highest prevalence of hypertension is in what ethnicity?

African Americans

patient assessment for hypertension:

History and physical examination -retinal exam Laboratory tests -Urinalysis -Blood chemistry ECG

what are the medications for a hypertensive emergency?

IV vasodilators sodium nitroprusside nicardipine fenoldopam mesylate enalaprilat nitroglycerin

what is considered a normal blood pressure?

Systolic <120 Diastolic <80

what is considered stage 1 hypertension?

Systolic: 130-139 Diastolic: 80-89

the nurse is developing a nursing care plan for a client who is being treated for hypertension. which outcome most appropriate for the nurse to include? a. client will reduce Na+ intake to less than 2g daily b. client will have stable BUN and serum creatinine levels c. client will abstain from fat intake and reduce calories intake d. client will maintain a normal body weight

a

the nurse if providing education to a client recently diagnosed with hypertension who has been started on metoprolol 25 mg daily. as the nurse caring for this client, what important aspects of patient teaching would you focus on with this patient? a. maintaining therapeutic medication regiment and not discontinuing the use of medication abruptly b. informing about the side effects of medciations c. preparing a diet plan d. administering calcium channel blockers e. stressing the importance of adherence to follow up care

a, b ,c

the nursing is teaching a client about some of the health consequences of uncontrolled hypertension. what health problems should the nurse describe? (select all that apply) a. transient ischemic attacks (TIA) b. cerebrovascular disease c. retinal hemorrhage d. venous insufficiency e. right ventricular hypertrophy

a, b, c

a nurse on a medical unit is planning care for an older adult client who takes several medications. which of the following prescribed medications places the client at risk for orthostatic hypotension? (select all that apply) a. furosemide b. aspirin c. metoprolol d. hydrochlorothiazide e. clopidogrel

a, c, d

abnormal physical examination findings?

absent or weak pulses additional cardiac sounds retinal hemorrhages distended jugular veins renal artery bruit

target organ damage: brain

aneurysm development stroke: hemorrhagic or ischemic

what are potential symptoms of target organ damage from hypertension?

angina shortness of breath altered speech altered vision nosebleeds headaches dizziness balance problems nocturia

Blood pressure:

arterial pressure exerted on the walls of the arteries during ventricular systole and diastole

metabolic panel is used to

assess for damage to kidney as a result of untreated

urinalysis hypertension is used to

assess renal function as well as possibility of diabetes

what can cause increased systemic vascular resistance (SVR)?

atherosclerosis high cholesterol nicotine physical inactivity diabetes obesity

target organ damage: peripheral arterial disease

atherosclerosis tissue ischemia: CAD, MI, stroke (ischemic) aneurysms

a 56 year old client at a screen event has a blood pressure reading of 146/96. upon hearing the reading, the client states, "my pressure has never been this high. do you think my doctor will prescribe medication to reduce it?" what is the nurse's best response? a. "yes. it is prevalent among men; it is fortunate we caught this during your routine exam" b. "we will need to reevaluate your blood pressure because your age places you at high risk for hypertesion" c. a single elevated blood pressure does not confirm hypertension. diagnosis requires multiple elevated reading." d.. "you have no need to worry. your pressure is probably elevated because you are being tested"

b

a nurse is establishing health promotion goals for a female client who smokes cigarettes, has hypertension, and a BMI of 26. which of the following goals should the nurse include? a. the client will list foods that are high in calcium, which should be avoided b. the client will walk 30 min 5 days a week c. the client will increase calories intake by 200 cal per day d. the client will replace cigarettes with smokeless tobacco products

b

what are the fast acting oral agent for a hypertensive urgency?

beta-adrenergic blocker - labetalol angiotensin-converting enzyme inhibitor-captopril alpha-agonist-clonidine

a ____________ may not be given to patients having diabetes mellitus since it may elevate blood glucose levels

beta-blocker

frequent monitoring of ________ is an essential part of the medical management of hypertension

blood pressure

hypertensive emergency:

blood pressure >180/120 and must be lowered immediately to prevent further damage to target organs

hypertensive urgency:

blood pressure >180/120 but no evidence of immediate or progressive target organ damage

what is masked hypertension?

blood pressure that is suggestive of hypertension that is paradoxically normal in health care setting

a client who has a history of myocardial infarction is prescribed aspirin 325mg. the nurse recognizes that the aspirin is given due to which of the following actions of the mediation? a. analgesic c. anti-inflammatory c. antiplatelet aggregation d. antipyretic

c

a client with a new diagnosis of hypertension is discussion risk factors with the nurse. the nurse advises the client to avoid tobacco use. what is the primary rationale for this advice? a. quitting smoking will cause the patient's hypertension to resolve b. tobacco use increases the patient's concurrent risk of heart disease c. tobacco use is associated with sedentary lifestyle d. tobacco use causes ventricular hypertrophy

c

an older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker. which topic should the nurse include in health education? a. increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta blocker b. maintaining a diet high in dairy to increase protein necessary to prevent organ damage c. use of strategies to prevent falls stemming form orthostatic hypotension d, limiting exercise to avoid injury that can be caused by intracranial pressure

c

what is stage 1 hypertension treatment for African American and patients > 60 years old?

calcium channel blocker thiazide diuretics'

what factors can blood pressure be affected by?

cardiac output distention of the arteries & volume velocity and viscosity of the blood

a lipid panel is used to

check for cholesterol and triglyceride levels

a community health nurse teaching a group of adults about preventing and treating hypertension. the nurse should encourage these participants to collaborate with their primary care providers and regularly monitor which of the following? a. heart rate b. sodium levels c. potassium levels d. blood lipid levels

d

the staff educator is teaching emergency department nurses about hypertensive crisis. the nurse educator should explain that hypertensive urgency differs from hypertensive emergency in which way? a. the blood pressure is always higher in a hypertensive emergency b. vaigilant hemodynamic monitoring is required during treatment of hypertensive emergencies c, hypertensive urgency is treated with rest and benzodiazepines to lower BP d. hypertensive emergencies are associated with evidence of target organ damage

d

electrocardiogram is used to

determine ischemic changes and cardiac changes

medical management-pharmacological for hypertension:

diuretics beta-blockers alpha1-blockers ACE inhibitors combined alpha and beta blockers vasodilators ARBs calcium channel blockers dihydropyridines direct renin inhibitors

low doses are first initiated and then if the blood pressure doesn't reach the target goal, what will happen?

dose will be increased gradually

what can increase cardiac output?

fluids sodium RAAS increased HR stress infection anxiety caffeine activity

what is white coat hypertension?

hypertensive blood pressure readings in the health care setting that is paradoxically normal ranges in other settings

what are the only exceptions with a hypertensive emergency?

ischemic stroke aortic dissection

consider the patient's _______ if the hypertensive patient is young

lifestyle

target organ damage: chronic kidney disease

nephrosclerosis damaged arterioles shrunken tubules and destroyed glomeruli renal failure

in a hypertensive emergency how much should you reduce the blood pressure within the first hours?

no more than 25%

in a hypertensive urgency with is to be administered within 24 to 48 hours to normalize the blood pressure?

oral agents

target organ damage: retinopathy

reduced blood flow narrowed vessels hemorrhage

what are hypertension symptoms related to organ damage that are seen late and are serious?

retinal and other eye changes renal damage myocardial infarction cardiac hypertrophy stroke

for clients with newly diagnosed primary hypertension, __________ _____ reduction is recommended

saturated fats

what are risk factors for hypertension?

smoking, obesity, physical inactivity, dyslipidemia, diabetes mellitus, microalbuminuria or GFR <60 mL/min, older age, family history, stress, sleep apnea, chronic kidney disease, African American, alcohol consumption (more than 2 drinks/day), poor dietary habits/excess salt sedentary lifestyle

what is considered stage 2 hypertension?

systolic >140 diastolic >90

what is considered an elevated blood pressure?

systolic: 120-129 diastolic: less than 80

what should you also assess during a hypertensive urgency?

target organ damage

a ________ diuretics is an appropriate drug to control hypertension because it doesn't reduce heart rate

thiazide

what are sign and symptoms of hypertension?

usually no symptoms other than elevated blood pressure

what will ETOH originally do to the vessels?

vasodilate and then vasoconstrict