Chapter 31 Hypertension

Lifestyle modifications

- Weight reduction -DASH diet, decreased Na intake -Physical activity -Moderate alcohol consumption

Isolated systolic hypertension

A condition more common in older adults that is associated with cardiovascular and cerebrovascular morbidity and mortalityThe aorta and Large arteries are less able to accommodate the volume of blood pumped out by the heart a.k.a. stroke volume, and the energy that would have stretched the vessels elevates the systolic blood pressure resulting in an elevated systolic pressure without a change in diastolic pressure.

The nurse is evaluating the types of medications prescribed for a client's hypertension. Which of the following medication classifications establishes an action on vasoconstrictive hormones in the blood stream?

ACE inhibitor

Silent killer

Another term for hypertension because people who have it are often symptom free

Cardiac output (x) peripheral resistance

Blood pressure = ________ x ________

A client has severe coronary artery disease (CAD) and hypertension. Which medication order should the nurse consult with the health care provider about that is contraindicated for a client with severe CAD?

Clonidine

Dx

Deficient knowledge regarding the relation between the treatment regimen and control of the disease process •Noncompliance with therapeutic regimen related to side effects of prescribed therapy

Choose the statements that correctly match the hypertensive medication with its side effect. Select all that apply.

Direct vasodilators may cause headache and tachycardia. With thiazide diuretics, monitor serum potassium concentration.

A client with hypertension has been able to maintain a blood pressure of 130/70 mm Hg for 1 year while reducing dietary sodium and taking hydrochlorothiazide (HCTZ) and atenolol. What treatment plan will the nurse educate the client about?

Gradual reducing the HCTZ and the atenolol and continuing to reduce sodium intake

Pt assessment

History and physical examination •Laboratory tests -Urinalysis -Blood chemistry -Cholesterol levels •ECG

Left ventricle

Hypertension for a long period of time may cause enlargement of the ___ _______in the heart because it causes it to work harder to pump blood against the elevated pressure

Loop diuretics

I'm depletion, and blocks the reabsorption of sodium, chloride, and water in the kidneys.*very action Rapid and potent. It is usually used when thiazides fail or the patient needs rapid diuresis

Gerontologic Considerations

Medication regimen can be difficult to remember •Expense can be a challenge •Monotherapy, if appropriate, may simplify the medication regimen and make it less expensive •Ensure that older adult patients understand the regimen and can see and read instructions, open medication containers, and get prescriptions refilled. •Include family and caregivers in educational program

A client is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The client's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV nitroprusside. Upon assessment, which finding requires immediate intervention by the nurse?

Numbness and weakness in the left arm

Left ventricular hypertrophy

Occurs in response to the increased workload placed on the ventricle as it contracts against higher systemic pressure

Nocturia

Pathologic changes in the kidneys may manifest asS/S are increased blood urea nitrogen (BUN) in and serum creatinine level

Hypertensive Emergency

Reduce blood pressure 25% in first hour. •Reduce to 160/100 over 6 hours. •Then gradual reduction to normal over a period of days. •Exceptions are ischemic stroke and aortic dissection. •Medications -IV vasodilators: sodium nitroprusside, nicardipine, fenoldopam mesylate, enalaprilat, nitroglycerin •Need very frequent monitoring of BP and cardiovascular status.

Which of the following is the nurse most correct to recognize as a direct effect of client hypertension?

Renal dysfunction resulting from atherosclerosis

Stage 1 hypertensive

Systolic 140-159 Diastolic 90-99

Stage 2 hypertension

Systolic greater 160 Diastolic greater than 100

Normal blood pressure range

Systolic less 120 Diastolic less than 80

Angina, shortness of breath, alterations in speech, or vision, or balance, nosebleeds, headache, dizziness, or nocturia

These are manifestations of target organ damage

Weight reduction, DASH eating plan, dietary sodium reduction, physical activity, and moderation of alcohol consumption

These are the five lifestyle modofications recommended to prevent and manage hypertension

Myocardial infarction, heart, renal failure, strokes, and impaired vision

These are typical outcomes of prolonged and uncontrolled hypertension

Echocardiography

This is how left ventricular hypertrophy can be assessed

Medication Treatment

Usually initial medication treatment is a thiazide diuretic. •Low doses are initiated, and the medication dosage is increased gradually if blood pressure does not reach target goal. •Additional medications are added if needed. •Multiple medications may be needed to control blood pressure. •Lifestyle changes initiated to control BP must be maintained.

Manifestations of Hypertension

Usually no symptoms other than elevated blood pressure •Symptoms seen related to organ damage are seen late and are serious -Retinal and other eye changes -Renal damage -Myocardial infarction -Cardiac hypertrophy -Stroke

Decrease peripheral resistance, blood volume, or the strength/rate of myocardial contraction

What do you medications used for treating hypertension do?(3 things)

Men its greater than 1.5 and women is greater than 1.3

What is considered an elevated serum creatinine level for men and women

What risk factors would cause the nurse to become concerned that the client may have atherosclerotic heart disease? Select all that apply.

hypertension diabetes obesity family history of eary cardiovascular events

The nurse understands that client education related to antihypertensive medication should include which of the following?

inform client to avoid over-the-counter cold and sinus medications

What is a priority nursing assessment when caring for the patient in a hypertensive crisis receiving intravenous vasodilators?

Assessing the individual's fluid volume status is recommended because if there is volume depletion secondary to natriuresis caused by the elevated blood pressure, then volume replacement with normal saline can prevent large sudden drops in blood pressure when antihypertensive medications are administered.

180/120

At what blood pressure would you be worried about the patient being in hypertensive emergency or hypertensive urgency?

What are the side effects of thiazide diuretics?

Dry mouth, thirst, weakness, drowsiness, Lethargy, muscle aches, tachycardia, G.I. disturbance

A client is being seen at the clinic for a routine physical when the nurse notes the client's blood pressure is 150/97. The client is considered to be a healthy, well-nourished young adult. What type of hypertension does this client have?

Essential (primary)

What is the name for the flow rate of filtered fluid through the kidneys, which indicates renal function?

Glomerular filtration rate (GFR)

Assessment

History and risk factors •Assess potential symptoms of target organ damage -Angina, shortness of breath, altered speech, altered vision, nosebleeds, headaches, dizziness, balance problems, nocturia -Cardiovascular assessment: apical and peripheral pulses •Personal, social, and financial factors that will influence the condition or its treatment

Interventions

Patient education •Support adherence to the treatment regimen •Consultation and collaboration •Follow-up care •Emphasize control rather than cure •Reinforce and support lifestyle changes •A lifelong process

Hypertensive Urgency

Patient requires close monitoring of blood pressure and cardiovascular status. •Assess for potential evidence of target organ damage. •Medications -Fast-acting oral agents: beta-adrenergic blocker— labetalol; angiotensin-converting enzyme inhibitor— captopril; or alpha2-agonist—clonidine

Alpha1 blockers

Peripheral The dilator acting directly on the blood vessel. They asked directly on blood vessels in her effective agents and patience with adverse reactions to hydralazine.

What should be checked and hypertension patient in order to assess their blood flow?

Peripheral pulses

The nurse in an oncology clinic notes that the client being treated has hypertension. What tumor is a predisposing condition for secondary hypertension?

Pheochromocytoma

An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for?

Postural hypotension and resulting injury

Which adrenergic inhibitor acts directly on the blood vessels, producing vasodilation?

Prazosin

Heart, kidneys, brain, and eyes

Prolonged blood pressure elevation gradually damages blood vessels throughout the body, particularly to target organs such as

Evaluating

Reports knowledge of disease management sufficient to maintain adequate tissue perfusion -Maintains blood pressure at less than 140/90 mm Hg with no symptoms of angina, palpitations, or vision changes; stable BUN and serum creatinine levels; and palpable peripheral pulses •Adheres to the self-care program -Reduces calorie, Na, and fat intake; exercises regularly; takes medications as prescribed and reports side effects; measures BP; abstains from tobacco and excessive alcohol intake; keeps appointments

Which term describes high blood pressure from an identified cause, such as renal disease?

Secondary hypertension

The nurse is caring for a client prescribed bumetanide for the treatment of stage 2 hypertension. Which finding indicates the client is experiencing an adverse effect of the medication?

Serum potassium value of 3.0 mEq/L

A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. What are risk factors for cardiovascular problems in clients with hypertension? Select all that apply.

Smoking Diabetes mellitus Physical inactivity

The nurse assesses a healthy middle-aged client with a blood pressure of 158/90 mm Hg. In which classification of hypertension is the client, according to the JNC 8 (Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood pressure) recommendation?

Stage 1

Prehypertensive

Systolic 129-139 Diastolic 80-89

The nurse is obtaining a healthy history from a client with blood pressure of 146/88 mm Hg. The client states that lifestyle changes have not been effective in lowering the blood pressure. Which medication classification does the nurse anticipate first?

Thiazide diuretic

140/90 or lower

This is the goal blood pressure for a patient diagnosed with hypertension

130/80 or lower

This is the goal blood pressure for diabetic or chronic kidney disease patients who have hypertension

Thiazides diuretics

This medication decreases blood volume, renal bloodflow, and cardiac output. It is relatively inexpensive and very effective Orally. It has mild side effects and enhances other antihypertensive medications.- contraindicated in patients with gout or severely impaired kidney function

Aldosterone receptor blockers (ARB)

This medication is a competitive inhibitor of aldosterone binding-it is indicated for patients with a history of myocardial infarction or symptomatic ventricular dysfunction-end in "one"

How do diuretics work

are sometimes called 'water tablets' because they can cause you to pass more urine than usual. They work on your kidneys by increasing the amount of salt and water that comes out through your urine. Too much salt can cause extra fluid to build up in your blood vessels, raising your blood pressure.

Primary or essential hypertension accounts for about 95% of all hypertension diagnoses with an unknown etiology. Secondary hypertension accompanies specific conditions that create hypertension as a result of tissue damage. Which condition contributes to secondary hypertension?

arterial vasoconstriction

Hypertensive urgency

it is a situation in which blood pressure is very elevated but there's no evidence of impeding or progressive target organ damage

High blood pressure

systolic pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg.

Major Risk Factors

•Smoking •Obesity •Physical inactivity •Dyslipidemia •Diabetes mellitus •Microalbuminuria or GFR <60 mL/min •Older age •Family history

DASH diet

A diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat

The nurse is assessing the blood pressure for a patient who has hypertension and the nurse does not hear an auscultatory gap. What outcome may be documented in this circumstance?

A high diastolic or low systolic reading

Hypertensive emergency

A situation in which blood pressure is extremely elevated and must be lowered immediately to prevent damage to target organs

Potassium sparing diuretics

Block sodium reapportion and acts on the distal tubule independently of aldosterone-causes potassium retention-contraindicated in patients with renal disease and hyperkalemia

Ausculatory gap

This occurs when the korotkoff sounds disappear for a brief period as the cuff is being deflated

Renal disease

To be diagnosed as having, _______ you need to have a reduced GFr which this creates an elevated serum creatinine

Greater than 300 mg/ day

What is considered to be an elevated level of albuminuria

Coffee or smoking in the past 30 minutes, patient is at rest for five minutes prior, take at heart level, and no talking during the reading

What is the proper way to get an accurate blood pressure?

In morning unless otherwise directed by a doctor. Usually never at night.

When should diuretics be taken?

Is the normal range for potassium?

3.5-5.1

ARB's

-Avoid use of potassium supplements or salt substitutesDrowsiness, lethargy, headache, diarrhea, GI disturbances and hyperkalemia

Hypertensive emergency

-Blood pressure >180/120 mm Hg and must be lowered immediately to prevent damage to target organs

Medication therapy

-Diuretics, beta-blockers, alpha1-blockers, combined alpha- and beta-blockers, vasodilators, ACE inhibitors, ARBs, Ca channel blockers, dihydropyridines, and direct renin inhibitors

Planning and Goals

-Understanding of the disease process and its treatment •Participation in a self-care program •Absence of complications

A nurse educator is providing information to a small group of clients about hypertension without comorbities. What does the nurse explain about the target goals of the Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC8)?

150/90 or lower

Angiotensin II receptor blockers (ARBs)

Azilsartan (Edarbi) Candesartan (Atacand) Eprosartan. Irbesartan (Avapro) Losartan (Cozaar) Olmesartan (Benicar) Telmisartan (Micardis) Valsartan (Diovan) Angiotensin II receptor blockers, also known as angiotensin II receptor antagonists, or AT₁ receptor antagonists, are a group of pharmaceuticals that modulate the renin-angiotensin system. Their main uses are in the treatment of hypertension, diabetic nephropathy and congestive heart failure

Beta blockers

Block most sympathetic nervous system especially to the heart producing a slower heart rate and lower blood pressure. It reduced pull straight in patients with tachycardia and blood pressure elevation is in advantage is also indicated for patients who have stable angina pectoris and silent ischemia-end in "olol "

Too small

Blood pressure cuff is ______ it will give too low of a blood pressure reading

Hypertensive urgency define

Blood pressure is very high but no evidence of immediate or progressive target organ damage

Diuretic, beta-blockers or both

If the patient has uncomplicated hypertension the recommended initial medications include (2)

Papilledema

In severe hypertension a swelling of the optic disc may be seen, which is called

Which of the following would be inconsistent with a hypertensive urgency?

Intracranial hemorrhage

Collaborative Problems and Potential Complications

Left ventricular hypertrophy •Myocardial infarction •Heart failure •Transient ischemic attack (TIA) •Cerebrovascular accident (CVA, stroke, or brain attack) •Renal insufficiency and failure •Retinal hemorrhage

The nurse is planning the care of a patient admitted to the hospital with hypertension. What objective will help to meet the needs of this patient?

Lowering and controlling the blood pressure without adverse effects and without undue cost

Hypertensive Emergency define

Reduce blood pressure 25% in first hour. •Reduce to 160/100 over 6 hours. •Then gradual reduction to normal over a period of days. •Exceptions are ischemic stroke and aortic dissection. •Medications -IV vasodilators: sodium nitroprusside, nicardipine, fenoldopam mesylate, enalaprilat, nitroglycerin •Need very frequent monitoring of BP and cardiovascular status.