Health alterations class 24: Hypertension

Primary hypertension

Majority of cases, interaction between genes and environment

May be silent or have dizziness, fatigue, palpations, dyspnea, angina

Secondary hypertension

Primary cause of HTN in children

Elevated BP with specific cause that can be identified and corrected

Complications of HTN: heart

Coronary artery disease (restriction of vessels and angina or MI)

Left ventricular hypertrophy

Heart failure

Complications of HTN: Brain

Cerebrovascular disease (stroke)

Complications of HTN: Peripheral vasculature

Aneurysms (weakened BV)

Peripheral arterial disease (weakening and narrowing of BV)

Complications of HTN: Kidneys

Nephrosclerosis

Complications of HTN: Eyes

Retinal damage

Diagnostic studies for HTN

History and physical

Lab tests to support dx (urinalysis, LBC, cholesterol, ECG, blood sugar, lytes)

BP monitoring

Management of HTN

Routine BP monitoring (often at home, same times each day)

Life style modifications (DASH diet, weight reduction, exercise, decreased alcohol and smoking, stress management)

Meds

Goal BP for HTN

Less than 140/90

For diabetes or kidney disease: less than 130/80

DASH diet

Balanced diet with low salt, sugar and lower fat

Nursing care for diuretic therapy

Moniter lytes and fluids

For potassium sparing, watch potassium levels

After a year of meds may slowly reduce

Nursing care for beta blockers

Educate not to abruptly stop, ween off with HCP

Transition from sit to stand slowly bc may have orthostatic hypotension

Nursing care of nitroglycerin

Side effect of headache

Used for MI, angina and hypertensive crisis

Nursing care of ACE inhibitors

Moniter for side effect of dry, hacking cough

Nursing care of ARBs

Used when ACE inhibitors cause cough, not as effective

Nursing care for calcium channel blockers

Monitor for dizziness and hypotension

Hypertensive crisis

Sudden elevation in BP, dystolic over 120

may be from stopping meds or not taking enough or from recreational drugs

Signs and symptoms of hypertensive crisis

HTN encephalopathy: sudden rise in BP, headache, N/V, seizures, confusion, stupor, coma

Blurred vision, transient blindness

Renal failure

Rapid cardiac decompensation

Management of hypertensive crisis

IV meds to lower BP (don’t want to suddenly lower, can get decreased perfusion to brain and cause a stroke)

Frequent monitoring of BP and HR

ECG monitoring

Focused assessment (neuro, cardiac, intake and output)