simple ppt

1. JOHNY WILBERT, M.Sc[N]
LECTURER,
APOLLO INSTITUTE OF HOSPITAL
MANAGEMENT AND ALLIED SCIENCE

2. Definition
For an adult (ages 18 and older), a normal BP
is a systolic BP below 120 mm Hg and a
diastolic below 80 mm Hg.

3.  An individual classified with prehypertension
has a systolic BP between 120 and 139 mm Hg
or a diastolic pressure between 80 and 89 mm
Hg.
 Stage 1 hypertension can be classified as a
systolic BP between 140 and 159 mm Hg or a
diastolic pressure between 90 and 99 mm Hg.

4.  Stage 2 hypertension can be classified as a
systolic BP equal to or greater than 160 mm Hg
or a diastolic pressure equal to or greater than
100mmHg.
 Hypertension is a major risk factor for
coronary,
cerebral, renal, and peripheral vascular disease.
The disease is initially asymptomatic.
 The goals of treatment include reduction of the
BP and preventing or lessening the extent of
organ damage.

5.  Nonpharmacological approaches, such as
lifestyle changes, may be prescribed initially; if
the BP cannot be decreased after a reasonable
time period (1 to 3 months), the client may
require pharmacological treatment.

6. Etiology
Primary or essential hypertension
1. No known cause
2. Risk factors
a. Aging
b. Family history
c. Black race, with higher prevalence in males
d. Obesity
e. Smoking
f. Stress
g. Excessive alcohol
h. Hyperlipidemia
i. Increased intake of salt or caffeine

7. Secondary hypertension
1. Treatment depends on the cause and the
organs involved.
2. Secondary hypertension occurs as a result of
other disorders or conditions.
3. Precipitating disorders or conditions
a. Cardiovascular disorders
b. Renal disorders
c. Endocrine system disorders
d. Pregnancy
e. Medications (e.g., estrogens, glucocorticoids,

8. clinical manifestation
1. May be asymptomatic
2. Headache
3. Visual disturbances
4. Dizziness
5. Chest pain
6. Tinnitus
7. Flushed face
8. Epistaxis

9. Diagnostic evaluation
History collection, physical examination
Initial lab screen should include 12-lead ECG,
urinalysis, blood glucose, serum sodium,
potassium, calcium creatinine(to measured
glomerular filtration rate), lipid profile (total
cholesterol, HDL, and triglycerides).
 Additional laboratory and diagnostic studies may
be required in individuals with suspected
secondary hypertension and/or evidence of target
organ damage.
Other tests may be ordered at the discretion of the
clinician such as complete blood count, chest x-
ray, uric acid or TSH

10. Treatment
1. Goals
a. One treatment goal is to reduce the BP.
b. Another treatment goal is to prevent or
lessen the extent of organ damage.
2. Question the client regarding the signs and
symptoms indicative of hypertension.
3. Obtain the BP two or more times on both
arms, with the client supine and standing.
4. Compare the BP with prior documentation.
5. Determine family history of hypertension.
6. Identify current medication therapy.

11. 7. Obtain weight.
8. Evaluate dietary patterns and sodium intake.
9. Assess for visual changes or retinal damage.
10. Assess for cardiovascular changes such as
distended neck veins, increased heart rate, and
dysrhythmias.
11. Evaluate chest x-ray for heart enlargement.
12. Assess the neurological system.
13. Evaluate renal function.
14. Evaluate results of diagnostic and laboratory
studies.

12. Nonpharmacological interventions
1. Weight reduction, if necessary, or maintenance
of ideal weight
2. Dietary sodium restriction to 2 g daily as
prescribed
3. Moderate intake of alcohol and caffeine
containing products
4. Initiation of a regular exercise program
5. Avoidance of smoking
6. Relaxation techniques and biofeedback therapy
7. Elimination of unnecessary medications that
may contribute to the hypertension

13. Pharmacological interventions
1. Medication therapy is individualized for each
client and the selection of the medication is
based on such factors as the client’s age, culture,
presence of coexisting conditions, severity of the
hypertension, and client’s preferences.

14.  Antihypertensives
 ACE inhibitors(Angiotensin converting enzyme
inhibitors)(eg.ramipril, enalapril)
 Beta blockers(eg.betaloc, atenolol)
 Calcium channel blockers(eg.amlodipine,
nifedipine)
 Diuretics(eg.lasix)
 Vasodialator( eg.NTG)

15. Client education
Describe the importance of compliance with the
treatment plan.
Describe the disease process, explaining that
symptoms
usually do not develop until organs have suffered
damage.
Initiate and assist the client in planning a regular
exercise
program, avoiding heavy weight-lifting and
isometric exercises.
Emphasize the importance of beginning the
exercise program gradually.
Encourage the client to express feelings about
daily stress.

16. Assist the client to identify ways to reduce stress.
Teach relaxation techniques.
Instruct the client in how to incorporate relaxation
techniques into the daily living pattern.
Instruct the client and family in the technique for
monitoring blood pressure.
Instruct the client to maintain a diary of blood
pressure readings.
Emphasize the importance of lifelong medication
and the need for follow-up treatment.

17. Instruct the client and family about the dietary
restrictions, which may include sodium, fat,
calories, and cholesterol.
Instruct the client in how to shop for and
prepare low sodium meals.
Provide a list of products that contain sodium.
Instruct the client to read labels of products to
determine sodium content, focusing on
substances listed as sodium.
Instruct the client to bake, roast, or boil foods,
avoid salt in preparation of foods, and avoid
using salt at the table.

18. Instruct the client that fresh foods are best to
consume and to avoid canned foods.
Instruct the client about the actions, side
effects, and scheduling of medications.
Advise the client that if uncomfortable side
effects occur to contact the physician and not to
stop the medication.
Instruct the client to avoid over-the-counter
medications.
Stress the importance of follow-up care.