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Nursing Care of
Patients with
Hypertension
Beth Campos MSN RN
Instructor
Learning Objectives
1. Explain the pathophysiology of hypertension
2. Identify causes and risk factors for
hypertension.
3. List signs and symptoms of hypertension.
4. Describe therapeutic measures for
hypertension.
5. Evaluate effectiveness of nursing
interventions.
6. Define classifications and treatment
recommendations for hypertension in adults.
7. Define hypertensive emergency.
8. List common complications of hypertension.
9. Plan nursing care for patients with
hypertension.
Hypertension
Commonly
Hypertension
Normal BP:
2 Years
Pre-hypertension:
1 Year
Stage 1 Hypertension:
2 Months
Stage 2 Hypertension:
1 Month
>180/110 mm Hg: Immediate
Treatment
Types of Hypertension
Primary hypertension (Essential): 90% to 95% of
all cases of hypertension; no specific medical
cause to explain the patients condition, chronic
elevation of unknown cause
Secondary hypertension: cause is known, 5% of
all cases of hypertension; result of another disease or
condition
Caused by underlying factors such as:
kidney disease: pyelonephritis, nephrotic
syndrome, glomerulonephritis
certain arterial conditions: coarctation of aorta
endocrine problems: adrenal tumors
some drugs (estrogens), occasionally pregnancy
Isolated systolic hypertension (ISH): occurs
mainly in older adults. SBP >140mmHg, DBP
90mmHg
Hypertension
Hypertension
Hypertension
Hypertension
Blood
Pressure Regulation
Hypertension
Blood
Pressure Regulation
Vasoconstriction decreases blood flow to the
kidneys, which then release Renin
Renin leads to the formation of
Angiotensin II, another potent
vasoconstrictor
Angiotensin II stimulates the adrenal
cortex to secrete aldosterone, a
hormone that promotes sodium and
water retention
This results in an increased blood volume
Vasoconstriction, cardiac stimulation,
and retention of fluid all contribute to
hypertension
Figure 37-1
Primary (Essential)
Risk Factors:
Hypertension
Primary (Essential)
Hypertension
Modifiable Risk factors
( environmental)
Weight: obesity (central obesity)
Stress, inadequate sleep
Diet: Increase salt intake, decreased
intake of potassium, calcium, magnesium
Excess alcohol consumption
Sedentary lifestyle, Lack of exercise
Smoking: major risk factor
Dyslipidemia
Atherosclerosis
Diabetes mellitus: glucose levels
Hypertension
Manifestations:
Elevated BP measurement: No signs and
symptoms are Silent Killers
Rare: occipital headaches that are more
severe on arising, lightheadedness,
fainting, dizziness, blurry vision, fatigue,
epistaxis, facial flushing, tinnitus
Target Organ Disease signs and
symptoms: has damaged blood vessels in
the heart, kidneys, eyes, or brain. Patient
may have symptoms of impaired function
of those organs
Complications
Heart:
Figure 37-2
Calibrated Instrument
Have Patient Sit Quietly for 5 Minutes in
Chair (Not Exam Table) with Feet on
Floor, Arm Supported at Heart Level
Use Cuff Bladder Encircling at Least 80%
of Arm
Take Two BP Measurements (Wait Inbetween)
Patient Centered Care: Inform Patient of
BP Reading
Management
Management
Lifestyle modifications:
Diet: use DASH diet (Dietary
Approaches to Stop Hypertension)
decreased Na intake or Na restriction: 2
to 3 g/day (decrease BP by 60%), adequate
potassium and calcium. Monitor potassium
with some salt substitutes (may interfere
with medications). Caffeine can increase BP
but does not produce chronic HTN
Weight reduction: lose weight for obese
with low saturated fats and cholesterol.
Control alcohol intake (2 oz. liquor, 8 oz.
wine, 24 oz. beer/day)
Management
Lifestyle modifications:
Regular exercise: begin slowly and
gradually and advance with guidance of
the physician and physical therapist
Smoking cessation: not directly linked
with hypertension but with high
association with cardiovascular diseases
Stress reduction: relaxation techniques
such as yoga, massage, hypnosis,
behavior modification
Management
Anti-Hypertensive medications
Anti-Hypertensive medications
Anti-Hypertensive
medications
Beta adrenergic blockers:
Anti-Hypertensive medications
Anti-Hypertensive medications
Anti-Hypertensive medications
Anti-Hypertensive medications
Assessment
Periodic blood pressure checks detect new or
unknown hypertensive people; provide data to
evaluate effect of therapy in hypertensive people
Complete history and physical examination by
the registered nurse
Blood pressure screenings and monitoring, and
provides important data to evaluate treatment
effectiveness
Home self-measurement and recordings is
a strong predictor of a long termcardiovascular events. Patients are taught to
take BP at home
Health History
Explore past medical for
hypertension or renal, cardiac, or
endocrine disorders
Date and readings of the last blood
pressure measurement
Ask about pregnancy and about
hormone replacement therapy
Current medications, including overthe-counter drugs
Health History
Physical Examination
Nursing Diagnosis
Nursing Diagnosis
Nursing Diagnosis
Ineffective Coping
If depression a side effect of an
antihypertensive, consult physician
to substitute another drug
Sexual Dysfunction
Decreased libido, inability to achieve
an erection, or delayed ejaculation
Advise physician so an alternative
medication or other intervention can
be considered
Hypertension
Older
Patients
Response to drug therapy more difficult to
predict; side effects are more common
Orthostatic hypotension and sedation
problematic for the older person, who is
prone to fall and suffer serious injuries
Depression also must be taken very
seriously because it lowers motivation,
impairs quality of life, and can lead to
suicide
Hypertensive Emergencies
A life-threatening medical emergency
Severe hypertension with acute
Hypertensive
Emergencies
Causes: malignant hypertension,
hypertensive encephalopathy,
eclampsia, pheochromocytoma (adrenal
tumor), cerebrovascular accident
BP should be lowered aggressively
Without treatment, the patient in
hypertensive crisis may incur cardiac
and renal damage
Death may ensue as a result of a
cerebrovascular accident, renal failure,
or cardiac failure
Hypertensive
Emergencies
Diagnosis
Assessment in the ED reveals elevated
blood pressure, pulse, and respiratory rate
Retinal hemorrhage or papilledema, or
both, observed in fundus (back, interior
portion) of eye
Physician may order blood drawn for
arterial blood gases, CBC, electrolytes,
blood urea nitrogen, creatinine, and
cardiac enzymes
Chest radiograph may be requested
Direct blood pressure monitoring through
an arterial catheter preferred
Hypertensive Emergencies
Hypertensive Emergencies
An
Hypertensive
Administer
Emergencies
oxygen as ordered
Hypertensive Emergencies
Collaboration with health team
Patient education: home teachings:
lifestyle changes
Medication compliance
Meal planning: DASH diet (dietary
approach to stop HTN), low sodium
diet (avoid canned fruit and
vegetables), low cholesterol, read food
labels (potassium in salt substitutes)
Home exercise: 30-60min- 4-7x a week
lose weight
Stop smoking, alcohol moderation
Side effects of meds