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Chapter027

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    Chapter027 Chapter027 Presentation Transcript

    • Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 27: Caring for Clients with Hypertension Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Blood Pressure Physiology • Force produced by the volume of blood in arterial walls – Formula • BP = Cardiac Output × Peripheral Resistance – Factors affecting BP • Age, body size, diet, activity, emotions, pain, position, and disease – Obtain several measurements for comparison Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Question Is the following statement true or false? Blood pressure measurement can be affected by air temperature, time of day, and recent food consumption. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Answer False. Blood pressure measurement can be affected by age, body size, diet, activity, emotions, pain, position, and disease; not by air temperature, time of day, and recent food consumption. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Arterial Blood Pressure • Regulating Arterial Pressure – Autonomic nervous system, kidneys, and endocrine system – Systolic BP; Diastolic BP – Normal range of BP for adults – Increased BP – Screening of BP: People at risk for heart failure, renal failure, and stroke – Highest risk: Older adults, African Americans, and clients with diabetes mellitus Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Arterial Blood Pressure • Systolic Blood Pressure – Force and volume of blood ejected from left ventricle during systole – Ability of arteries to distend – Loss of arterial wall elasticity – Vasoconstriction; Plaque; Vascular disease • Diastolic Blood Pressure – Arterial pressure during ventricular relaxation; Resistance of the arterioles Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Question Is the following statement true or false? Systolic blood pressure may be elevated in older adults due to the loss of elasticity in their arterial walls. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Answer True. Systolic blood pressure may be elevated in older adults due to the loss of elasticity in their arterial walls. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Hypertensive Disease • Prehypertension – Hypertension; Two categories: Stage 1; Stage 2 – Hypertensive heart disease • Elevated BP causes cardiac abnormality – Hypertensive vascular disease • Vascular damage is present – Hypertensive cardiovascular disease • Heart disease and vascular damage accompany hypertension Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Hypertensive Disease • Essential and Secondary Hypertension – Essential hypertension ≈ 95% • Sustained elevated BP with no known cause – Secondary hypertension • Elevated BP resulting from some other disorder – White-coat hypertension • Anxiety – Regular BP check Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Hypertensive Disease • Pathophysiology and Etiology – BP increases with age; Heredity; African Americans – Risk factors: Obesity; Inactivity; Smoking; Excessive alcohol intake; Stress; Hypernatremia – Alterations in other body chemicals – Defects in BP regulation; Renin – Heightened stress: Release of catecholamines elevates BP – Natriuretic factor deficiency Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Question Is the following statement true or false? Race has no effect on hypertension. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Answer False. Hypertension not only may have a genetic component (as it seems to run in families); African Americans are affected by hypertension at a higher rate than other ethnic groups. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Hypertensive Disease • Pathophysiology and Etiology (Cont’d) – Secondary hypertension • Affects fluid volume or renal function or causes arterial vasoconstriction; Predisposing conditions – Organ damage, complications – Accelerated atherosclerosis – Hemorrhage: Visual disturbances or blindness; Cerebrovascular accident – Myocardial infarction; Renal failure Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Hypertensive Disease • Assessment Findings: Signs and Symptoms – Throbbing headache; Dizziness; Fatigue; Insomnia; Nosebleeds; Blurred vision – Angina or dyspnea • Hypertensive heart disease – Bounding pulse – Overweight; Peripheral edema – Ophthalmic examination • Vascular changes, retinal hemorrhages, and papilledema Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Hypertensive Disease • Assessment Findings: Diagnostic Findings – Determine extent of organ damage – Enlarged left ventricle • Electrocardiography; Echocardiography; Chest radiography – MUGA scan; Blood studies; Fluorescein angiography; Urine specimen – Renal vascular problem – Adrenal gland dysfunction Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Hypertensive Disease • Medical Management – Treatment to lower BP and prevent complications – Prehypertension: Nonpharmacologic interventions – Normal BP levels; Cholesterol and triglyceride levels – Diabetes; Chronic kidney disease – Persons older than 50 years of age: Reduced systolic pressure – Antihypertensive drugs Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Hypertensive Disease • Medical Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Nursing Process: Hypertension • Assessment – Client assessment: Medical history, symptoms, and diet history – Physical assessment: BP and cardiac assessment – Client teaching: Nonpharmacologic and pharmacologic treatments – Dietary modifications Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Nursing Process: Hypertension • Diagnosis, Planning, and Interventions – Risk • Decreased cardiac output • Injury: Syncope and dizziness – Expected outcomes • Client maintains an adequate cardiac output • Client will be injury free Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Accelerated; Malignant Hypertension • Serious forms of elevated BP – Accelerated hypertension • Markedly elevated BP • Hemorrhages and exudates in the eyes – Malignant hypertension • Dangerously elevated BP • Papilledema Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Accelerated; Malignant Hypertension • Pathophysiology and Etiology – Abrupt onset; Fatal – Elevated BP in the vascular system – Ruptured arterial blood vessels – Retinal hemorrhages; Stroke – Aneurysm development – Cardiac effects; Renal failure Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Accelerated; Malignant Hypertension • Assessment Findings: Signs and Symptoms – Confusion; Headache; Visual disturbances; Seizures; Possible coma – Sudden rise in BP: Chest pain, dyspnea, moist lung sounds – Renal failure: Severe back pain accompanied by hypotension; Aneurysm – Systolic and diastolic BP; Optic disk – Retinal blood vessels: Hemorrhages; Fluffy white exudates Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Accelerated; Malignant Hypertension • Assessment Findings: Diagnostic Findings – Diagnostic studies: CT scan, PET scan, and MRI • Medical Management – Hypertensive emergencies: Potent IV drugs – Not extremely critical: Antihypertensive drugs – O2 to reduce hypoxia-induced tachycardia Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • Accelerated; Malignant Hypertension • Nursing Management – Medication administration: Monitor response; Restrict activity – IV infusion; Automatic BP recording machine – Assesses client: Neurologic; Cardiac; Renal – Emergency equipment readiness Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
    • End of Presentation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins