-
-
HTN result of change in
PVR and CO
-
HTN is most important modifiable risk factor for (5)
coronary heart disease, stroke, CHF, PVD, ESRF
-
import not only to identify and treat patients with HTN but also to promote________ and __________ to decrease to prevalence of HTN
healthy life style, prevention strategy
-
pre-hypertension
120-139/80-89
-
stage I HTN
140-159/90-99
-
-
symptoms of HTN
- most
- rarely
- - Most are not aware they have HTN
- - Rarely may have: headache, nose bleeds,fatigue, tinnitus
-
uncontrolled HTN damages
kidney, heart, large and small blood vessels
-
Vital signs with HTN
- BP should be measured how
- assess
- BP should be measured in
- sig diff suggest
- - supine, standing
- - volume depletion
- - both arms
- - aortic dissection
-
ENT observations with HTN
Papilledema suggests
- Presence of new retinal hemorrhages, exudates
- HTN urgency
-
Cardivascular considerations with HTN
- elvaluate for presence of _________
(what suggests this (4))
- Heart Failure
- - JVD, Crackle upon auscultation, peripheral edema, weight gain
-
assess for what abdominal changes with HTN
masses or bruits
-
CNS changes with HTN
LOC, Visual fields, Focal neurologic signs (vision, speech, vertigo, weakness)
-
Risk factors for HTN (12)
over weight, diabetes, age, race, family hx, high normal BP, diet high in sat fats, high salt diet, lack of exercise, ETOH, stress, smoking
-
Assessment/Diagnostic regarding HTN
- - H/P
- - Retinal Exam
- - Lab
- - BUN, Cr, Electrolytes, Micro Albumin, Fasting glucose, cholesterol
- - 12 lead EKG
-
Medical Mgt
- Goal is prevent _____ by _______
- target range for ppl w/ diabetes, chronic renal disease
- - death and complications by achieving and maintaing arterial bp of 140/90 or lower
- - 130/80
-
Lifestyle Modification to manage HTN
- Weight reduction
- Adopt DASH
- Decrease dietarysodium
- Physical activity
- Modification ofalcohol consumption
- - BMI 18.5 to 24.9
- - rich fruit, vegetables, low fat dairy product
- - sodium intake no more than 24g sodium or 6g sodium chloride
- - reg aerobic physical activity at 30 min/day
- - no more than 2 drinks
-
DASH diet
- Grains – grain products
- Vegetables
- Fruits
- Low fat or fat-free diary foods
- Meat, fish, and poultry
- Nuts, seeds and drybeans
-
Limiting Salt
- Upper limit
- preHTN or HTN
- add what instead of salt
- careful about
- - 2400 mg daily
- - 1500mg daily
- - spices
- - "no salt added" "sodium free" "low sodium" "very low sodium"
-
to help get started on the DASH diet consider these strategies:
- change
- forgive itf
- reward
- add
- get
- remeber
- - gradually
- - you backslide
- - success
- - physical activity
- - support if you need it
- - healthy eating isn't an all or nothing proposition
-
Assessment
- HTN detected initially
- HTN diagnosed
- routinely
- HTN treatment regimen
- - careful monitoring BP at frequent intervals
- - routinely scheduled intervals
- - BP assessment to determine effectiveness of medications, changes in BP indicate needed changes
-
H&P
- assess symptoms indicate target
- such as
- check what with apical pulse
- - organ dysfunction
- - angina, SOB, dizziness, or nocturia
- - rate, rhythm, character, check peripheral pulses
-
Collaborative problems/potential complications from HTN include
- - Left ventricular hypertrophy
- - MI, CHF, TIAs, CVA
- - Renal insufficiency and failure
- - Retinal hemorrhage
-
Major Goals for HTN tmt
- understanding
- participation in
- absence of
- - disease process, tmt
- - self-care program
- - complications
-
Nursing Interventions
- Obj of nursing care for HTN pt focus on...
- support and teach
- increasing
- promote
- teach
- contiuing
- monitor and manage
- - lowering and controlling BP without adverse effects and without undue cost
- - adherence
- - knowledge
- - home and community based care
- - self care
- - care
- - potential complications
-
Gerontology Consideration
- compliance more difficult b/c
- mono-therapy
- able to..
- include who
- know when and who to
- caution regarding
- - hard to remember, expense can be a proble
- - treatment with single agent may help with expense and remembering
- - open container and get refills
- - family member or support
- - call if they have side effects of drugs
- - use of herbal meds and OTC meds and their effects on HTN and HTN meds
-
Evaluation - expected pt outcomes
- maintain adequate...
- demonstrate no symptoms of
- stable...(labs)
- palpable...
- - tissue perfusion
- - angina, palpitations or vision changes
- - stable BUN, Cr
- - peripheral pulses
-
Expected pt outcomes - self care plan
- adheres to
- get regular
- meds
- abstain from
- measure what routinely
- keeps
- - diet, reduce calories, sodium, fat intake, increase fruit, vegetable intake
- - exercise
- - take as prescribed/ reports SE
- - tobacco, excessive ETOH intake
- - BP
- - follow up appointments
-
Expected patient outcomes - no complications
- reports no change in
- exhibts no damage in..
- maintains
- reports
- maintains urine output that matches
- has what function in normal range
- demonstrates no....defictis
- reports no...
- - vision
- - retina on vision testing
- - pulse rate, rhythm and respiratory rate withinnormal range
- - on dyspnea or edema
- - with intake
- - renal function test results within normal range
- - no motor, speech, or sensory deficits
- - headache, dizziness, weakness, change ingait or falls
-
Hypertensive emergencies
- severe HTN with acute impairment of
- BP should be lowered how?
- - an organ system
- - aggressively over minutes to hours
-
Hypertensive urgency
- severe elevation of BP, without
- BP can be controlled over
- - evidence of progressive target organ dysfunction
- - several days to weeks
-
Hypertension Emergency
- need to lower BP
- acute life threatening BP elevations require
- have immediate action that is
- - immediately to halt or prevent damage to target organs
- - prompt treatment in an ICU
- - short lived - minutes to 4 hrs
-
Medications of choice for HTN emergency
- those that have what effect
- - immediate, IV vasodilators
- - sodium nitroprusside (Nipride, Nitropress)
- - nicardipiine HCL (Cardene)
- - fenoldopam mesylate (corlopam)
- - enalaprilat (vasotech IV)
- - nitroglycerin (nitro-bid IV, tridil)
-
Sodium Nitropursside (Nipride, Nirtopress)
- usual dose rate
- max dose should never last more than
- diluted to proper strength of
- any other drugs administered with Nitro ?
- protect diluted solution from what and how
- must use what with this drug
- start at what and then...
- - 0.5-10mcg/kg/min
- - 10 min., not controlled DC
- - infusion
- - NO other drug to be admined with Nitro
- - protect from light by using supplied opaque sleeve, foil. do not cover drip chamber or tubing
- - infusion pump
- - 0.3mcg/kg/min and titrate up as needed
-
Nicardipine HCL, dihydrpyridene (cardene)
- type
- does not depress
- does not affect
- major limitation longer half-life so you can
- acute HTN: initial dose; increased to
- effects in...
- titrate to...
- - Ca channel blocker
- - LV function
- - ICP (stroke)
- - rapidly titrate
- - 5mg/hr; 15mg/hr max
- - 15 min
- - lowest dose need to maintain stable BP
-
Fenoldopam mesylate (corlopam)
- rapid acting....; increases
- starting dose....titrate to max of
- - vasodilator, renal blood flow
- - 0.1-0.3mcg/kg/min; 1.6mcg/kg/min
-
Enalaprilat (Vasotech I.V.)
- works by
- IVP over
- Used to treat;
- - blocking an enzyme in the body called angiotensin-converting enzyme (ACE).
- - 5 minutes, dilutedused
- - HTN, CHF
-
Nitroglycerin (Nitro-Bid I.V., Tridil)
- Works by
- Given
- dose based on
- Drug is absorbed by
- SE:
- Drug/Drug
- - dilating blood vessels and reducing workload of the heart
- - IV
- - BP, HF, CP
- - plastics, use special tubing,use glass bottle
- - HA, Dizziness, weakness
- - impotence drugs, ACE Inhibitor, BetaBlockers
-
Causes of HTN Urgency
- Most common cause is
- other causes
- - rapid unexplained rise in BP in patient with chronic essential HTN
- - Diet pills, BCP, Cocaine, Amphetamines, CNS trauma, Post op trauma/comp
-
Hypertensive Urgency
- Situation BP must be lowered within
- Managed using oral dose of fast-acting agents such as
- - a few hours
- - loop diuretics, beta blockers, ace inhibitors, Ca antagonist
-
severe post op HTN is
HTN urgency
-
Nursing considerations with Loop diuretics during HTN urgency
- works
- risk for
- watch for
- monitor other
- cant be on
- lasix IV can cause
- - quickest
- - decrease K, heart palpitations
- - leg cramps, gout
- - other meds
- - digoxin or lithium at same time
- - ottotoxicity (deafness)
-
Beta blockers
- works how
- on first dose be cautious of
- - lowering pulse
- - bronchospasm
-
ACE inhibitors
- can cause (no. one SE)
- alters
- warn pt about taking
- - cough
- - taste
- - K supplement and salt substitues
-
Ca Channel Blocker
- watch for
- teach pt to
- interacts with
- causes
- - peripheral edema
- - weigh daily
- - grapefruit juice
- - constipation
-
when BP decreases quickly on meds monitor
urinary output (renal system)
-
tubing to use with sodium nitropursside (nipride, nirtopress)
protect from light, use supplied opaque sleeve, foil. do not need to cover drip chamber or tubing
-
type of tubing to use with NTG
glass
-
S&S of HTN
HA, nose bleed, ear ringing, vision changes, most are asymptomatic
-
first organ to be affected by HTN
kidneys
-
complications from HTN
- stroke
- CVD
- CHF
- renal
- vision problems
-
- Angina (def)
- occurs when
- - chest pain
- - defect of oxygen for the heart muscle
-
angina can occur when:
- blood or oxygen supply to heart is
- heart is
- or...
- - impaired
- - working harder than usual and needs more oxygen
- - combination of these
-
patterns of chest pain
classic, exertion, variant
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