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Assessment and Management of
Patients With Hypertension and crisis
Hypertension
High blood pressure- Defined by the Seventh Report of
the Joint National Commission on the Prevention,
Detection, Evaluation, and Treatment of High Blood
Pressure (JNC 7) as:
 a systolic pressure greater than 140 mm Hg and a
diastolic pressure greater than 90 mm Hg. based on
the average of two or more accurate blood pressure
measurements taken during two or more contacts
with a health care provider
Accurate blood pressure measurement technique
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Classification of Blood Pressure for Adults
Age 18 and Older
 Isolated systolic hypertension, is an
elevated systolic pressure without a
change in diastolic pressure.
 It is more common in older adults and is
associated with significant cardiovascular
and cerebrovascular morbidity and
mortality.
Types of Hypertension—
“The Silent Killer”
 Primary hypertension: High blood pressure that is
not related to another medical condition
 Secondary hypertension: Another medical
condition that causes high blood pressure, usually
occurring in the kidneys, arteries, heart, or
endocrine system
Factors that Influence the
Development of Hypertension
 Increased sympathetic nervous system
activity
 Increased reabsorption of sodium chloride
and water by the kidneys
 Increased activity of the rennin-
angiotensin system
 Decreased vasodilatation
 Insulin resistance
Manifestations of Hypertension
 Usually NO symptoms other than elevated blood pressure
 Symptoms seen related to organ damage are seen late and
are serious
 Retinal and other eye changes
 Renal damage
 Myocardial infarction
 Cardiac hypertrophy
 Stroke
Major Risk Factors
 Smoking
 Obesity (BMI ≥ 30)
 Physical inactivity
 Dyslipedemia
 Diabetes mellitus
 Impaired renal function (Microalbuminuria or GFR < 60)
 Older age(older than 55 years for men, 65 years for
women)
 Family history
Complications
Patient Assessment
 Health History and physical examination
 Laboratory tests
 Urinalysis
 Blood chemistry
 Cholesterol levels
 ECG
Lifestyle Modifications
 Weight loss
 Reduced sodium intake
 Regular physical activity
 Diet: high in fruits, vegetables, and low-fat dairy
 DASH diet:
• Grains: 7-8 daily servings.
• Vegetables: 4-5 daily servings.
• Fruits: 4-5 daily servings.
• Low-fat or fat-free dairy products: 2-3 daily servings.
• Meat, poultry, and fish: 2 or less daily servings.
• Nuts, seeds, and dry beans: 4-5 servings per week.
• Fats and oils: 2-3 daily servings.
Medication Treatment
 Usually initial medication treatment is a thiazide diuretic.
 Low doses are initiated and the medication dosage is increased
gradually if blood pressure does not reach target goal.
 Additional medications are added if needed.
 Multiple medications may be needed to control blood pressure.
 Lifestyle changes initiated to control BP must be maintained.
Medication Therapy for Hypertension
 Diuretic and related drugs
 Thiazide diuretics
 Loop diuretics
 Potassium sparing diuretics
 Aldosterone receptors blockers
 Central alpha2-agonists and other centrally acting drugs
 Beta-blockers
 Beta-blockers with intrinsic sympathomimetic activity
 Alpha and beta blockers
Medication Therapy for Hypertension
(continued)
 Vasodilators
 Angiotensin-converting enzyme (ACE)
inhibitors
 Angiotenisin II antagonists
 Calcium channel blockers
 Nondihydropyridines
 Dihydropyridines
Nursing History and Assessment
 History and risk factors
 Assess potential symptoms of target organ
damage
 Angina, shortness of breath, altered
speech, altered vision, nosebleeds,
headaches, dizziness, balance
problems, nocturia
 Cardiovascular assessment: apical and
peripheral pulses
 Personal, social, and financial factors that
will influence the condition or its
treatment
Nursing Diagnoses
 Knowledge deficit regarding the relation
of the treatment regimen and control of
the disease process
 Noncompliance with therapeutic regimen
related to side effects of prescribed
therapy
 Collaborative Problems/Potential Complications
Based on the assessment data, potential complications that
may develop include the following:
 Left ventricular hypertrophy
 Myocardial infarction
 Heart failure
 TIAs
 Cerebrovascular accident (CVA, stroke, or brain attack)
 Renal insufficiency and failure
 Retinal hemorrhage
Goals:
 Patient understanding of disease process
 Patient understanding of treatment
regimen
 Patient participation in self-care
 Absence of complications
Interventions
 Patient teaching
 Support adherence to the treatment
regimen
 Consultation/collaboration
 Follow-up care
 Emphasize control rather than cure
 Reinforce and support lifestyle changes
 A lifelong process
Gerontologic Considerations
 Noncompliance
 Include family
 Understanding of therapeutic regimen
 Reading instructions
 Monotherapy (one type of medication)
Hypertensive Crises
 Hypertensive emergency
 Blood pressure > 180/120 and must be
lowered immediately to prevent
damage to target organs
 Hypertensive urgency
 Blood pressure is very high but no
evidence of immediate or progressive
target organ damage
Hypertensive Emergency
 Reduce BP 25% in first hour.
 Reduce to 160/100 over 6 hours.
 Then gradual reduction to normal over a period of
days.
 Exceptions are ischemic stroke and aortic
dissection.
 Medications
 IV vasodilators: sodium nitroprusside,
nicardipine, fenodopam mesylate, enalaprilat,
nitrogylcerin
 Need very frequent monitoring of BP and
cardiovascular status.
Hypertensive Urgency
 Patient requires close monitoring of blood
pressure and cardiovascular status.
 Assess for potential evidence of target
organ damage.
 Medications
 Fast-acting oral agents: beta adrenergic
blocker— labetalol; angiotensin-
converting enzyme inhibitor— captopril;
or alpha2-agonist—clonidine
week 9 Assessment and Management of Patients with Hypertension- crisis.ppt

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week 9 Assessment and Management of Patients with Hypertension- crisis.ppt

  • 1. Assessment and Management of Patients With Hypertension and crisis
  • 2. Hypertension High blood pressure- Defined by the Seventh Report of the Joint National Commission on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) as:  a systolic pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg. based on the average of two or more accurate blood pressure measurements taken during two or more contacts with a health care provider
  • 3. Accurate blood pressure measurement technique
  • 4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Classification of Blood Pressure for Adults Age 18 and Older
  • 5.  Isolated systolic hypertension, is an elevated systolic pressure without a change in diastolic pressure.  It is more common in older adults and is associated with significant cardiovascular and cerebrovascular morbidity and mortality.
  • 6. Types of Hypertension— “The Silent Killer”  Primary hypertension: High blood pressure that is not related to another medical condition  Secondary hypertension: Another medical condition that causes high blood pressure, usually occurring in the kidneys, arteries, heart, or endocrine system
  • 7. Factors that Influence the Development of Hypertension  Increased sympathetic nervous system activity  Increased reabsorption of sodium chloride and water by the kidneys  Increased activity of the rennin- angiotensin system  Decreased vasodilatation  Insulin resistance
  • 8. Manifestations of Hypertension  Usually NO symptoms other than elevated blood pressure  Symptoms seen related to organ damage are seen late and are serious  Retinal and other eye changes  Renal damage  Myocardial infarction  Cardiac hypertrophy  Stroke
  • 9. Major Risk Factors  Smoking  Obesity (BMI ≥ 30)  Physical inactivity  Dyslipedemia  Diabetes mellitus  Impaired renal function (Microalbuminuria or GFR < 60)  Older age(older than 55 years for men, 65 years for women)  Family history
  • 11. Patient Assessment  Health History and physical examination  Laboratory tests  Urinalysis  Blood chemistry  Cholesterol levels  ECG
  • 12. Lifestyle Modifications  Weight loss  Reduced sodium intake  Regular physical activity  Diet: high in fruits, vegetables, and low-fat dairy  DASH diet: • Grains: 7-8 daily servings. • Vegetables: 4-5 daily servings. • Fruits: 4-5 daily servings. • Low-fat or fat-free dairy products: 2-3 daily servings. • Meat, poultry, and fish: 2 or less daily servings. • Nuts, seeds, and dry beans: 4-5 servings per week. • Fats and oils: 2-3 daily servings.
  • 13. Medication Treatment  Usually initial medication treatment is a thiazide diuretic.  Low doses are initiated and the medication dosage is increased gradually if blood pressure does not reach target goal.  Additional medications are added if needed.  Multiple medications may be needed to control blood pressure.  Lifestyle changes initiated to control BP must be maintained.
  • 14. Medication Therapy for Hypertension  Diuretic and related drugs  Thiazide diuretics  Loop diuretics  Potassium sparing diuretics  Aldosterone receptors blockers  Central alpha2-agonists and other centrally acting drugs  Beta-blockers  Beta-blockers with intrinsic sympathomimetic activity  Alpha and beta blockers
  • 15. Medication Therapy for Hypertension (continued)  Vasodilators  Angiotensin-converting enzyme (ACE) inhibitors  Angiotenisin II antagonists  Calcium channel blockers  Nondihydropyridines  Dihydropyridines
  • 16. Nursing History and Assessment  History and risk factors  Assess potential symptoms of target organ damage  Angina, shortness of breath, altered speech, altered vision, nosebleeds, headaches, dizziness, balance problems, nocturia  Cardiovascular assessment: apical and peripheral pulses  Personal, social, and financial factors that will influence the condition or its treatment
  • 17. Nursing Diagnoses  Knowledge deficit regarding the relation of the treatment regimen and control of the disease process  Noncompliance with therapeutic regimen related to side effects of prescribed therapy
  • 18.  Collaborative Problems/Potential Complications Based on the assessment data, potential complications that may develop include the following:  Left ventricular hypertrophy  Myocardial infarction  Heart failure  TIAs  Cerebrovascular accident (CVA, stroke, or brain attack)  Renal insufficiency and failure  Retinal hemorrhage
  • 19. Goals:  Patient understanding of disease process  Patient understanding of treatment regimen  Patient participation in self-care  Absence of complications
  • 20. Interventions  Patient teaching  Support adherence to the treatment regimen  Consultation/collaboration  Follow-up care  Emphasize control rather than cure  Reinforce and support lifestyle changes  A lifelong process
  • 21. Gerontologic Considerations  Noncompliance  Include family  Understanding of therapeutic regimen  Reading instructions  Monotherapy (one type of medication)
  • 22. Hypertensive Crises  Hypertensive emergency  Blood pressure > 180/120 and must be lowered immediately to prevent damage to target organs  Hypertensive urgency  Blood pressure is very high but no evidence of immediate or progressive target organ damage
  • 23. Hypertensive Emergency  Reduce BP 25% in first hour.  Reduce to 160/100 over 6 hours.  Then gradual reduction to normal over a period of days.  Exceptions are ischemic stroke and aortic dissection.  Medications  IV vasodilators: sodium nitroprusside, nicardipine, fenodopam mesylate, enalaprilat, nitrogylcerin  Need very frequent monitoring of BP and cardiovascular status.
  • 24. Hypertensive Urgency  Patient requires close monitoring of blood pressure and cardiovascular status.  Assess for potential evidence of target organ damage.  Medications  Fast-acting oral agents: beta adrenergic blocker— labetalol; angiotensin- converting enzyme inhibitor— captopril; or alpha2-agonist—clonidine