-
HTN
- most common chronic health problem
- 73 mil americans
- increased risk with age, AA (also inc mortality), males (until age 55 then reversed)
- silent killer
-
HTN 2
- persistent BP elev- 2+ readings, 2 + visits
- primary (essential)- no known cause - 90%
- secondary- due to another disease or drug
- white coat HTN
-
risk factors HTN
- unmod
- - FH
- - AA
- - age
- - gender
- mod
- - obesity
- - uncontrolled DM
- - sedentary
- - stress
- - smoking
- - excess NA intake
- - HLD
-
HTN- bp affected by
- PVR- vessel diameter, elasticity, bld viscosity
- CO- bld volume, contractility, HR
-
patho
- normally- arteries dilate w/systole, constrict w/diastole
- normally, w/stress, adrenal medulla releases catecholamines. in lg amts, cause vasoconstriction via alpha receptors & BP inc. In sm amts, B2 receptors vasodilates & BP dec
-
patho
catecholamines also stimulate beta receptors which activate RAAS. Angiotensin II & II are potent vasocontrictors. aldosterone is released as well, causing inc H2o & Na++ reabsorption. beta receptors also inc contractility & HR leading to incr BP & CO
-
patho
- barorecptors, vascular endothelium, kidneys, and endocrine system also play a role in BP control
- HTN occurs from either a rise in CO or SVR
- in most cases, this is a result of genetic, environmental and demographic factors
- read easy med surg
-
manifestation
- HA
- blurred vision
- angina
- edema
- SOB
- peripheral edema
- chx in MS
- epistaxis
- intermittent claudication
- bruits
-
complications
- eyes- irreversible retinal damage
- kidneys- proteinuria, rbc's, hyaline casts
- brain- chx in MS due to cerebral edema, ischemia, CVA
- peripheral blood vessels- PVD
- heart- MI, LV hypertrophy, HF
-
diag tests
- urinalysis
- bun/crt
- ekg
- cxr
- 24 hr urine
- renal angiography
- us
- eye exam
-
management
- prevention & early diagnosis are goals
- screenings- md office public arenas
- public awareness/education
- stepped care- goal - prevent morbidty & mortality, achieve/maintain BP wnl
-
step
- step 1 lifestyle chx
- step 2 anti htn med
- step 3 inc dose, add or chx med
- step 4 change or add med
-
managements lifestyle
- DASH and low Na
- wt loss
- dec ETOH- < 1-2 drinks/day
- activity- 30" mod exercise most/all days
- smoking cessation
- stress management
-
nursing consideration
- monitor HR, BP, heart & lung sounds q 4h & PRN
- low Na diet, < 2g- teach to read lables
- monitor I&O
- education @ meds, lifestyle chx, S7 to report, f/u care
-
|
|
