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Hypertension, References: Ignatavicius, D., Workman, L., Rebar, C., &…
Hypertension
Patient Education
Educate the patient to keep their weight in check and maintaining a BMI of less than 30 would be ideal
Education on how to keep diabetes in check for patients with diabetes
Limit caffeine and alcohol intake
Smoking cessation
Regular exercise regimen
Limit sodium (less than 2g per day) and fat intake
Go to all follow up appointments with provider
If taking potassium depleting medication like diuretics increase oral potassium intake
Avoid grapefruit juice with calcium channel blocker meds
Avoid foods that are high in potassium while taking ARBs meds
Report any manifestations of electrolyte imbalances
Monitor BP at home
Educate patient on the DASH diet
Pathophysiology
When systolic BP is greater than 130 and disatolic BP is greater than 80 for 2 or more assessments of blood pressure
Primary hypertension accounts for most cases of htn. There is no known cause
Secondary htn can be caused by disease states like kidney disease, or as an adverse effect of some medications
Prolonged HTN can cause peripheral vascular disease that can cause damage to heart, brain, eyes, and kidneys. It can also cause hypertrophy of the left ventricle because it has to work so hard.
Risk factors:
primary - fam hx, excessive Na intake, physical inactivity, obesity, alcohol consumption, african american, smoking, HLD, stress, age 60+
secondary - kidney disease, cushings disease, aldosteronism, pheochromocytoma, brain tumors, medications, pregnancy
Assessment
4 mechanisms regulate BP
Arterial baroreceptors
located in carotid sinus, aorta, and L ventricle, control BP by altering the HR. They can also cause vasocontriction or vasodilation
Regulation of body-fluid volume
Functioning kidneys retain fluid when client is hypotensive and excrete when hypertensive
renin angiotensin aldosterone system
renin is converted to ang 2, which causes vasoconstriction and controls aldosterone release, causing kidneys to reabsorb sodium and inhibit fluid loss
vascular autoregulation
maintains consistent levels of tissue perfusion
Manifestations
headaches (esp. in the mornings), facial flushing, dizziness, fainting, retinal changes, nocturia
Labs
BUN, creatinine (elevated)
blood corticoids (elevated)
blood glucose and cholesterol studies
Diagnostics
ECG (to tell cardiac function), chest x-ray (could show cardiomegaly)
Intervetions
Treatment for secondary htn involves removing cause, or fixing the disease that is causing the increase in BP
Meds
Diuretics (thiazide, loop and potassium sparing)
monitor K levels and watch for any muscle weakness, irregular pulse, and dehydration
Calcium channel blockers (amlodipine, diltiazem)
monitor BP and pulse and change clients position slowly
ACE inhibitors (lisinopril)
Monitor for evidence of heart failure (edema), can also cause heart and kidney complications
Angiotensin 2 receptor antagonists (valsartan, losartan)
monitor for manifestations of angioedema or heart failure
Aldosterone receptor antagonists (spironolactone)
monitor kidney function, sodium and potassium levels
Beta blockers (metoprolol)
monitor BP and pulse
Central alpha agonists (clonadine)
monitor BP and pulse, not used for first line management of HTN
Encouraging exercise and diet changes are big part of intervention in addition to finding a anti htn med that works for the patient
References:
Ignatavicius, D., Workman, L., Rebar, C., & Heimgartner, N. (2021). Medical-surgical nursing:
Patient-centered collaborative care.
Evolve
, (10th ed.). ISBN: 978-0-323-61242-5
Holman, H. C., Williams, D., Johnson, J., Ball, B. S., Wheless, L., Leehy, P., & Lemon, T. (2019). RN Adult medical surgical nursing: Review module. Assessment Technologies Institute