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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
African Americans and the elderly are the most common hypertensive patients
Disease and Disorders: A Nursing Therapeutics Manual
PATHOPHYSIOLOGY
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
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
Endothelial damage to vasculature arteriosclerosis increased work load on the heart decreased perfusion of major organs targeted organ damage
DIAGNOSIS
Labs:
ECG
Sometimes: UA, CBC, CBG, serum electrolyte, plasma renin, thyroid function
Disease and Disorders: A Nursing Therapeutics Manual
TREATMENT
Adhering to Treatment
Patient involvement Comorbidities
TREATMENT
NURSING ASSESSMENT
Before treatment:
NURSING INTERVENTION
EDUCATION
Weight Loss Diet low sodium, low cholesterol Alcohol Exercise Medications
RESEARCH
Pharmacological
RESEARCH
Ng et al 2010
REALITY
Teaching
Medication Combinations (ie Amlodipine + Atenolol) Diet (NSA diet trays)
RESEARCH
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).
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
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.