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HYPERTENSION

Evidence Based Presentation Medical Surgical Nursing I - 3215 Spring 2013 Monica Carrington & Rebecca Jones

OBJECTIVES
Define Hypertension and explain the pathophysiology Describe current treatments commonly used for Hypertension Evaluate alternative and additional evidence based treatment options for Hypertension

PATHOPHYSIOLOGY

Hypertension: systolic pressure of >140 mm Hg and/or a diastolic pressure of > 90 mm Hg Silent Killer

50 million Americans effected


Worldwide 7.1 million deaths annually **

African Americans and the elderly are the most common hypertensive patients
Disease and Disorders: A Nursing Therapeutics Manual

PATHOPHYSIOLOGY

Primary Hypertension: idiopathic

90% of Hypertensive patients

Secondary Hypertension: separate disease process make the body unable to regulate pressure

6 to 8% of Hypertensive patients

Malignant Hypertension: severely high (240/150 mm Hg), multiple causes leading to coma/ death

2% of Hypertensive patients

Disease and Disorders: A Nursing Therapeutic Manual

PATHOPHYSIOLOGY

JNC7 Express Report

PATHOPHYSIOLOGY

Endothelial damage to vasculature arteriosclerosis increased work load on the heart decreased perfusion of major organs targeted organ damage

Disease and Disorders: A Nursing Therapeutics Manual

DIAGNOSIS

Labs:

BUN Creatinine Total Cholesterol Triglycerides

ECG

Sometimes: UA, CBC, CBG, serum electrolyte, plasma renin, thyroid function
Disease and Disorders: A Nursing Therapeutics Manual

TREATMENT

Joint National Commission 7 Guidelines


Combination therapy Alternative therapy

Adhering to Treatment
Patient involvement Comorbidities

TREATMENT

JNC7 Express Report

NURSING ASSESSMENT

Before treatment:

Lab Interpretation Evaluate what the patient knows

After beginning treatment:

How is patient doing with treatment plan

NURSING INTERVENTION

EDUCATION

Weight Loss Diet low sodium, low cholesterol Alcohol Exercise Medications

Disease and Disorders: A Nursing Therapeutics Manual

RESEARCH

Pharmacological

Ace inhibitors Calcium channel blockers Diuretics Beta blockers

Non-pharmacological treatment options


Body weight Salt restriction More veges and fruit Exercise

Ng, Stanley & Williams 2010

RESEARCH

Ng et al 2010

REALITY

BP measurement Golden standard

Teaching
Medication Combinations (ie Amlodipine + Atenolol) Diet (NSA diet trays)

RESEARCH

Barriers to treatment adherence Patient-centered communication and adherence to treatment

working alliance between the patient and the provider that includes 3 elements: sharing of goals, agreement of tasks, and a sense of attachment (Hartley & Repede, 656).

Importance to Nurse Practitioners, and RNs alike


Hartley & Repede 2011

REALITY

Have you noticed the physicians, NPs and/or nursing staff educating patients? How long does the physician, NP and/or nurse spend explaining answers to patient? Patient understanding/ knowledge of treatment

NURSING DIAGNOSIS

Ineffective self health management r/t modifiable risk factors for hypertension Imbalanced nutrition: more than body requirements r/t lack of knowledge or relationship between diet and disease process Knowledge deficit r/t management of disease

What phrasing should never be used?


Tabers Medical Dictionary

REFERENCES

Kuan Huei, N., Adrian G., S., & Bryan, W. (n.d). Pathogenesis, risk factors and prevention: Hypertension. Medicine, 38 (Cardiovascular Disorders Part 2 of 4), 403-408. doi:10.1016/j.mpmed.2010.05.001 Megan, H., & Elizabeth, R. (September 2011). Nurse Practitioner Communication and Treatment Adherence in Hypertensive Patients. The Journal For Nurse Practitioners, 7654-659. doi:10.1016/j.nurpra.2011.04.017 Hypertension (n.d). Diseases and Disorders: A Nursing Therapeutics Manual. Retrieved from Nursing Central Software. JNC7 Express Report: The Seventh Report by the Joint National Committee on Prevention, Detection and Evaluation and Treatment of igh Blood Pressure. (December 2003). Retrieved from: http://www.nhlbi.nih.gov/guidelines/hypertension/jncintro.htm Nursing Diagnosis (n.d). Tabers Medical Dictionary. Appendix N4: Nursing Diagnoses. Retrieved from Nursing Central Software.

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