Hypertension

Implementation for ND: Imbalanced Nutrition

-Assess usual food intake -Determine realistic target weight -Dietitian referral -Participate in approved weight loss program

What causes hypertension?

-Can be primary/essential hypertension: no known cause OR -Secondary Hypertension: elevated blood pressure from identified cause- Kidney disease, Coarctation of aorta, Endocrine disorders, Neurologic disorders, Drug use, Pregnancy

Non-modifiable risk factors

-Genetic factors -Age -Race *African Americans- higher BP sooner, -retain salt more -Family history

Implementation for ND: Noncompliance

-Identify Reasons -Evaluate knowledge regarding hypertension -Develop realistic short-term goals for changes -Develop reminders for medication, exercise -Relapses common

Implementation for ND: Ineffective Health Maintenance

-Identify factors that contribute to hypertension -Develop realistic health maintenance plan -Strengths and weakness to maintaining health

Nursing Process: Diagnoses

-Ineffective Health Maintenance -Noncompliance -Imbalanced Nutrition: More than Body Requirements -Excess Fluid Volume

Nursing Process: Planning

-Lifestyle choices to prevent, reduce -BP within acceptable range -Reduce sodium consumption (1500) -Maintain fluid balance

Implementation for ND: Excess fluid volume

-Monitor I&O, daily weights: Weight is best indicator of fluid volume 1 kg= 1 liter -Monitor for peripheral edema -Dietician referral -Adherence to treatment plans

Nursing process: Evaluation

-Strategies to maintain normal BP -Medication use -Measure BP and maintain a log -Diet low in sodium

Modifiable risk factors

-Stress -Smoking -Diet (salt) -Obesity- losing 10lbs can make a difference -Alcohol- recommend limit of 1 drink per day for both men and women

Consequences of untreated hypertension

-Stroke -Blood vessel damage- arterioscleosis -Heart attack -Heart Failure -Kidney failure

Collaborative Care: Drug Regimen

-Usually one antihypertensive at low dose -If Drug is tolerated well but not controlling HTN -> add -After 1 year of successful therapy: Try to reduce drugs and dose -Diuretics is a common drug treatment (review lewis table)

Collaborative Care: Lifestyle modifications

-Weight loss: Loss of 10 pounds reduces BP in many -Dietary changes: DASH diet -Restricted alcohol use & Stop smoking: No more than 1 oz ethanol/day, Women reduce by half, Smoking linked to heart disease -Increase physical activity: Regular exercise- 45 min 6 days/wk, Aerobic exercise -Stress reduction

Nursing Process: Assessment

1. Health promotion: Modifiable risk factors Smoking, Alcohol, exercise, weight, DASH diet, Exercise 5 or more days per week 2. Health history: Headache, neck pain 3. Focused Physical examination: BP on both arms, Pulses- peripheral and apical for pulse deficit

Sodium is 1 teaspoon of salt

2300 milligrams

Hypertension

Abnormally high blood pressure

Goal for HTN treatment

Reduce BP <140/90 mmHg

Prehypertension

Systolic: 120-139 Diastolic: 80-89

Hypertension Stage 1

Systolic: 140-159 Diastolic: 90-99

Normal Blood Pressure

Systolic: <120 Diastolic: <80

Hypertension Stage 2

Systolic: greater than or equal to 160 Diastolic: greater than or equal to 100

Hypertensive Emergency

Systolic: greater than or equal to 180 Diastolic: greater than or equal to 120 *Need treatment within 1 hour

HTN: Clinical Manifestations

Vague symptoms Headache- back of head neck As it gets worse- vision changes nausea, confusion *silent disease