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  2. 2. What is high blood pressure? <ul><li>High blood pressure (HBP) or hypertension means high pressure (tension) in the arteries. Arteries are vessels that carry blood from the pumping heart to all the tissues and organs of the body. </li></ul>
  3. 3. <ul><li>High blood pressure does not mean excessive emotional tension, although emotional tension and stress can temporarily increase blood pressure. Normal blood pressure is below 120/80; blood pressure between 120/80 and 139/89 is called &quot;pre-hypertension&quot;, and a blood pressure of 140/90 or above is considered high. </li></ul>
  4. 4. <ul><li>The top number, the systolic blood pressure, corresponds to the pressure in the arteries as the heart contracts and pumps blood forward into the arteries. The bottom number, the diastolic pressure, represents the pressure in the arteries as the heart relaxes after the contraction. The diastolic pressure reflects the lowest pressure to which the arteries are exposed. </li></ul>
  5. 5. <ul><li>An elevation of the systolic and/or diastolic blood pressure increases the risk of developing heart (cardiac) disease, kidney (renal) disease , hardening of the arteries (atherosclerosis or arteriosclerosis), eye damage, and stroke (brain damage) </li></ul>
  6. 6. <ul><li>These complications of hypertension are often referred to as end-organ damage because damage to these organs is the end result of chronic (long duration) high blood pressure. For that reason, the diagnosis of high blood pressure is important so efforts can be made to normalize blood pressure and prevent complications. </li></ul>
  7. 7. How is the blood pressure measured? <ul><li>The blood pressure usually is measured with a small, portable instrument called a blood pressure cuff ( sphygmomanometer ). (Sphygmo is Greek for pulse, and a manometer measures pressure.) The blood pressure cuff consists of an air pump, a pressure gauge, and a rubber cuff. The instrument measures the blood pressure in units called millimeters of mercury (mm Hg). </li></ul>
  8. 8. <ul><li>The cuff is placed around the upper arm and inflated with an air pump to a pressure that blocks the flow of blood in the main artery ( brachial artery ) that travels through the arm. The arm is then extended at the side of the body at the level of the heart, and the pressure of the cuff on the arm and artery is gradually released. As the pressure in the cuff decreases, a health practitioner listens with a stethoscope over the artery at the front of the elbow. </li></ul>
  9. 9. <ul><li>The pressure at which the practitioner first hears a pulsation from the artery is the systolic pressure (the top number). As the cuff pressure decreases further, the pressure at which the pulsation finally stops is the diastolic pressure (the bottom number). </li></ul>
  10. 10. <ul><li>Blood pressure can be affected by several factors, so it is important to standardize the environment when blood pressure is measured. For at least one hour before blood pressure is taken, avoid eating, strenuous exercise (which can lower blood pressure), smoking , and caffeine intake . Other stresses may alter the blood pressure and need to be considered when blood pressure is measured. </li></ul>
  11. 11. Which lifestyle modifications are beneficial in treating high blood pressure? <ul><li>Lifestyle modifications refer to certain specific recommendations for changes in habits, diet and exercise. These modifications can lower the blood pressure as well as improve a patient's response to blood pressure medications. </li></ul>
  12. 12. <ul><li>Alcohol </li></ul><ul><li>People who drink alcohol excessively (over two drinks per day) have a one and a half to two times increase in the prevalence of hypertension. The association between alcohol and high blood pressure is particularly noticeable when alcohol intake exceeds five drinks per day. The connection is a dose-related phenomenon. In other words, the more alcohol consumed, the stronger is the link with hypertension. </li></ul>
  13. 13. <ul><li>Smoking </li></ul><ul><li>Although smoking increases the risk of vascular complications (for example, heart disease and stroke) in people who already have hypertension, it is not associated with an increase in the development of hypertension. But cigarette smoking can repeatedly produce an immediate, temporary rise in the blood pressure of 5 to10 mm Hg. Steady smokers however, may have a lower blood pressure than nonsmokers. The reason for this is that nicotine in cigarettes causes a decrease in appetite, which leads to weight loss. This, in turn, lowers blood pressure. </li></ul>
  14. 14. <ul><li>Coffee </li></ul><ul><li>In one study, the caffeine consumed in 5 cups of coffee daily caused a mild increase in blood pressure in elderly people who already had hypertension, but not in those who had normal blood pressures. What's more, the combination of smoking and drinking coffee in persons with high blood pressure may increase the blood pressure more than coffee alone. Limiting caffeine intake and cigarette smoking in hypertensive individuals may be of some benefit in controlling high blood pressure. </li></ul>
  15. 15. <ul><li>Salt </li></ul><ul><li>The American Heart Association recommends consumption of dietary salt be less than 6 grams of salt per day in the general population and a lower level (less than 4 grams) for people with hypertension. To achieve a diet containing less than 4 grams of salt, do not add salt to food or cooking. Also, the amount of natural salt in the diet can be reasonably estimated from the labeling information provided with most purchased foods. Note: Take care if using salt substitutes, as some contain sodium! </li></ul>
  16. 16. <ul><li>Other dietary considerations </li></ul><ul><li>Add potassium to your diet. Studies show that people who consume more potassium have lower blood pressures. Good sources of potassium include: </li></ul><ul><li>bananas, </li></ul><ul><li>melons, </li></ul><ul><li>oranges, </li></ul><ul><li>spinach and </li></ul><ul><li>zucchini. </li></ul><ul><li>Check with your doctor first if you are being treated for kidney failure as potassium rich foods may be harmful to you. </li></ul>
  17. 17. Medical Care <ul><li>1. Diagnostic Procedures </li></ul><ul><li>Laboratory </li></ul><ul><li>Radiography </li></ul><ul><li>electrocardiography </li></ul>
  18. 18. Medications <ul><li>Diuretics </li></ul><ul><li>Vasodilators </li></ul><ul><li>Beta-adrenergic blockers </li></ul><ul><li>Alpha-adrenergic blockers </li></ul><ul><li>Calcium channel blockers </li></ul><ul><li>Angiotensin-converting enzymes(ACE)inhibitors </li></ul><ul><li>Angiotensin II receptors blockers </li></ul><ul><li>Centralacting adrenergic </li></ul>
  19. 19. Common Nursing diagnosis <ul><li>Excess fluid volume </li></ul><ul><li>Decreased cardiac output </li></ul><ul><li>Risk for deficient fluid volume </li></ul>