htn

1. Nursing 210
Advanced
Cardiac
UNIT 2
Laurie Brown RN, MSN, MPA-HA, CCRN

2. Hypertension
 “In adults, a condition in which the blood
pressure (BP) is higher than 140 mm Hg
systolic of 90 mm Hg diastolic on three
(two) separate readings… recorded
several weeks apart”.
Blood Pressure = Cardiac Output x Systemic Vascular Resistance

4. Relevance
 Why is
hypertension
clinically
significant?

5. Procedure
Take the Pulse obliteration pressure
OR
Known Blood Pressure
 Add 20-30 mm Hg
 Inflate Bp cuff to this number
 Use the BELL of stethoscope take the
Blood Pressure

6. Types of Hypertension
 “White Coat” Hypertension
 Malignant Hypertension
 Hypertensive Urgency
 Pregnancy Induced
Hypertension

7. Symptoms
 Often, there are no symptoms
until damage has been done…

8. Complications
 Heart
 Brain
 Kidneys
 Aorta
 Arterial vessels
 Eyes

9. Lifestyle modifications
weight loss, diet, exercise, stop smoking, limit alcohol
Medication
Diuretics or Beta-Blocker
Add second drug or substitute
another drug
Add third drug and/or substitute
second drug
Continue adding agents from
other classes Referral to
hypertensive specialist
Step 1
Step 2
Step 3
Step 4
Step 5
Medication Management

10. Causes of Resistant Hypertension
 Improper BP measurement
 Excessive sodium intake
 Inadequate diuretic therapy
 Medication
 Inadequate dose
 Drug actions and interactions
 Smoking

11. Lifestyle modifications
 Weight reduction
 DASH eating plan
 Dietary sodium restriction
 Aerobic physical activity
 Moderation of alcohol consumption
 Cessation of smoking

12. Medications
Classifications and Action
 Diuretics
 Alpha Adrenergic Blockers
 Beta Adrenergic Blockers (olol)
 Calcium Antagonist (ipine)
 ACE Inhibitor (pril)
 Angiotensin II Antagonist (Receptor
blockers or ARB’s) (sartan)
 Vasodilator

13. BP = CO x SVR

14. Treatment Program
Individualized
Step-Care
Therapy for
Hypertension

15. Review
 Analyze this EKG
 What medical orders do you
anticipate?
EKG