here we are to help the students to convey and incresase knowledge regarding hypertension

1. PRACTICE TEACHING
ON
HYPERTESION
PRESENTED BY:
AMIT KUMAR
MSC. NURSING
2011 BATCH

2. Anatomy of the cardiovascular
system

3. Blood vessels
• Blood vessels vary in structure, size and function,
and there are several types: arteries, arterioles,
capillaries, venules and veins
1.Arteries and arterioles
2.Capillaries
3.Venules and Veins

4. The relationship between the heart and the
different types of blood vessel.

5. Arteries and arterioles
These blood vessels transport blood away from the
heart. They vary considerably in size and their walls
consist of three layers of tissue:
• tunica adventitia or outer layer of fibrous tissue
• tunica media or middle layer of smooth muscle and
elastic tissue
• tunica intima or inner lining of squamous epithelium
called endothelium.

6. Capillaries and sinusoids
• The smallest arterioles break up into a number of
minute vessels called capillaries. Capillary walls
consist of a single layer of endothelial cells sitting on
a very thin basement membrane, through which
water and other small molecules can pass. Blood cells
and large molecules such as plasma proteins do not
normally pass through capillary walls.

7. Veins and venules
• Veins return blood at low pressure to the heart. The
walls of the veins are thinner than arteries but have
the same three layers of tissue. They are thinner
because there is less muscle and elastic tissue in the
tunica media, as veins carry blood at a lower pressure
than arteries. When cut, the veins collapse while the
thicker-walled arteries remain open. When an artery
is cut blood spurts at high pressure while a slower,
steady flow of blood escapes from a vein. Some
veins possess valves, which prevent backflow of
blood, ensuring that it flows towards the heart

8. Local regulation of blood flow
• Tissues’ oxygen and nutrient requirements vary
depending on their activities, so it is important that
blood flow is regulated locally to ensure that blood flow
matches tissue needs. The ability of an organ to control
its own blood flow according to need is called auto
regulation. Some organs, including the central nervous
system, liver and kidneys receive proportionately higher
blood flow as a matter of course. Other tissues, such as
resting skeletal muscle, receive much less, but their
blood supply can increase during heavy exercise.

9. Cont-
Blood flow through individual organs is increased by
vasodilatation of the vessels supplying it, and decreased
through vasoconstriction. local control of blood flow
include:
1.Active tissues release of metabolic waste products
increase blood flow into the area
2. metabolic activity increases tissue temperature, which
in turn vasodilatation
3.lack of oxygen, stimulates vasodilatation and a rise in
blood flow

10. HYPERTENSION
Hypertension is defined :
a persistent elevation of the systolic blood pressure
greater than 140 mm Hg and a diastolic blood
pressure greater than or level of 90 mm Hg based
on the average of two more accurate blood pressure
measurements taken during two or more contacts
with a health care provider.

11. • PRIMARY HYPERTENSION :defined as undiagnosed or
unidentified cause of hypertension, also called as idiopathic
hypertension. A combination of systolic and diastolic blood
pressure elevation are diagnosed.
• SECONDARY HYPERTENSION :defined as clients who
develops hypertension from identified causes, such as heart
disease, narrowing renal artery, vascular disorder(aneurysm),
arteriosclerosis, endocrine disorders
• ISOLATED SYSTOLIC HYPERTENSION : systolic blood
pressure is 140 mmhg or high but diastolic blood pressure less
than 90 mm Hg.
Types of hypertension

12. Etiology of Hypertension
• Primary – 90-95% of cases – also termed “essential” of
“idiopathic”
• Secondary – about 5% of cases
▫ Renal or renovascular disease
▫ Endocrine disease
Diabetic melitus
 Phaeochomocytoma
 Cusings syndrome
 Conn’s syndrome
 Acromegaly and hypothyroidism
▫ Coarctation of the aorta
▫ Iatrogenic
 Hormonal / oral contraceptive
 NSAIDs

13. Causes of Secondary HTN
Acute stress Vascular disorder
1. Alcoholism
2. Burns
3. Hyperventilation
4. hypoglycemia
1. Sickle cell crisis
2. Increase intra vascular
volume
3. Dissenting aortic
aneurysm

14. Causes of Secondary HTN
Neurologic disorder Medication
1. Brain tumor
2. Respiratory acidosis
3. Sleep apnea
1. Cocaine use
2. NSAIDS
3. Oral contraceptives
4. Heavy metal poisoning

15. Causes of Secondary HTN
Renal disorder Problem with pregnancy
1. Hydronephrosis
2. Diabetic nephropathy
3. Acute
glomerulonephritis
1. Eclampsia
2. Pregnancy induces
hypertension

16. Epidemiology and risk factors
Non modifiable risk factor modifiable risk factor
• Family history
• Age
• Gender
• Ethnicity
• Diabetes
• Stress
• Obesity
• Nutrients
• Substance abuse

17. PATHOPHYSIOLOGY

18. • Headache
• Dizziness
• Chest pain
• Coronary artery disease with angina and myocardial infarction
• Left ventricle hypertrophy
• Stroke
• Hemiplagia
• Blurring vision
• Proteinurea
• Fatigue
CLINCAL MANIFESTATIONS OF HYPERTENSION

19. Diagnostic evaluation
A. History and physical examination
B. Laboratory test includes :
• Blood chemistry ( Na, K, creatinine, fasting glucose, HDL &
LDL cholesterol, and triglycerides.
• Urinalysis: Blood glucose and hematocrit; serum potassium,
creatinine and calcium albumin excretion.
C. ECG: (Left Ventricular Hypertrophy)

20. Secondary HTN Routine Labs
• Increased creatinine
• abnormal urinalysis
• Unexplained hypokalemia
• Impaired blood glucose
• Impaired TFT (Hypo-/hyper- thyroidism)

21. Hypertensive Crises
• Hypertensive Urgencies:
SYSTOLIC BP > 180 MMHG
DIASTOLIC BP > 120 MMHG
No progressive target-organ dysfunction. (Accelerated Hypertension)
• Hypertensive Emergencies:
SYSTOLIC BP > 200 MMHG
DIASTOLIC BP > 120 MMHG
Progressive end-organ dysfunction. (Malignant Hypertension)

22. Target Organs
• CVS (Heart and Blood Vessels)
• The kidneys
• Nervous system
• The Eyes

23. Effects On CVS
• Ventricular hypertrophy, dysfunction and failure.
• Arrhythmias
• Coronary artery disease, Acute MI
• Arterial aneurysm, dissection, and rupture.

24. Effects on The Kidneys
• Glomerular sclerosis leading to impaired kidney
function and finally end stage kidney disease.
• Ischemic kidney disease especially when renal artery
stenosis is the cause of HTN

25. Nervous System
• Stroke, intracerebral and subaracnoid hemorrhage.
• Cerebral atrophy and dementia

26. The Eyes
• Retinopathy, retinal hemorrhages and impaired
vision.
• Vitreous hemorrhage, retinal detachment
• Neuropathy of the nerves leading to extraoccular
muscle paralysis and dysfunction

27. Retina Normal and Hypertensive
Retinopathy
Normal Retina Hypertensive Retinopathy A: Hemorrhages
B: Exudates (Fatty Deposits)
C: Cotton Wool Spots (Micro
Strokes)
A B
C

28. COMPLICATIONS
• Heart disease
• Renal failure
• Cerebral hemorrhage
• Angina pectoris
• Changes in the vessel wall leading to vessel trauma and
arteriosclerosis throughout the vasculature
• Complications arise due to the “target organ” dysfunction and
ultimately failure.
• Damage to the blood vessels can be seen on fundoscopy.

29. MEDICAL MANAGEMENT
Diuretics and Related Drugs
Thiazide Diuretics Chlorothiazide, hydrochlorothiazide
Loop Diuretics furosemide (Lasix), torsemide (Demadex)
Aldosterone Receptor Blockers spironolactone (Aldactone)
Central Alpha2-Agonists Clonidine
Beta-Blockers Atenolol, propanolol
Alpha1-Blockers Prazosin
Vasodilators sodium nitroprusside, sorbitrate
Angiotensin-Converting Enzyme Inhibitors benazepril (Lotensin), captopril (Capoten)
Angiotensin II Receptor Blockers candesartan (Atacand), telmisartan
Calcium Channel Blockers Amlodipine

30. NURSING MANAGEMENT

31. LIFESTYLE MODIFICATIONS TO PREVENT
AND MANAGE HYPERTENSION
• Weight reduction
• Dietary plan to Stop Hypertension
• Dietary sodium reduction
• Physical activity
• Moderation of alcohol consumption

32. DIETARY APPROACHES TO STOP HYPERTENSION
The diet is based on 2,000 calories per day
Food Group Number of Servings/Day
• Grains and grain products
• Vegetables
• Fruits
• Low-fat or fat-free dairy foods
• Meat, fish, and poultry
• Nuts, seeds, and dry beans
• 7 or 8
• 4 or 5
• 4 or 5
• 2 or 3
• 2 or fewer
• 4 or 5 weekly

33. Increasing Knowledge
• The patient needs to understand how lifestyle changes and medications can
control hypertension.
• encourage the patient to consult a dietitian to help develop a plan for
improving nutrient intake or for weight loss (restricting sodium and fat
intake, increasing intake of fruits and vegetables )
• Do regular physical activity.
• help the patient adjust to reduced salt intake.
• advised to limit alcohol and tobacco should be avoided because anyone
with high blood pressure is already at increased risk for heart disease
• Support groups for weight control

34. Monitoring and Managing Potential
Complications
• When the patient returns for follow-up care, all body
systems must be assessed to detect any evidence of
vascular damage.
• An eye examination with an ophthalmoscope is
particularly important because retinal blood vessel
damage

35. TEACHING PATIENTS SELF-CARE
• collaboration with the health care provider.
• blood pressure control through education about
managing blood pressure
• Involving family members in education programs
enables them to support the patient’s efforts to
control hypertension

36. Summarize the topic
• Anatomy and physiology about blood vessel
• Define hypertension
• Types of hypertension
• Causes of hypertension
• Clinical manifestation of hypertension
• Diagnostic evaluation
• Treatment
• Nursing management