Exemplar_ Hypertension_NUR 310_2_2024

Hypertension Overview

Page 1: Introduction

  • Hypertension: A significant modifiable risk factor for cardiovascular disease (CVD).

Page 2: Definitions

Hypertension is defined as a persistent systolic BP (SBP) of 140 mm Hg or more, diastolic BP (DBP) of 90 mm Hg or more, or current use of antihypertensive medication

  • Hypertension:

    • Persistent systolic BP (SBP) of 140 mm Hg or more.

    • Diastolic BP (DBP) of 90 mm Hg or more.

    • Current use of antihypertensive medication.

  • Prehypertension:

    • SBP of 120 to 139 mm Hg.

    • DBP of 80-89 mm Hg.

Page 3: Types of Hypertension

  • Primary Hypertension:

    • Elevated BP without an identified cause.

  • Secondary Hypertension:

    • Elevated BP with a specific cause that can often be identified and corrected.

    • Can lead to hypertensive crisis (SBP > 180 mm Hg and/or DBP > 120 mm Hg).

Page 4: Risk Factors for Primary Hypertension

  • Age

  • Alcohol consumption

  • Tobacco use

  • Diabetes mellitus

  • Elevated serum lipids

  • Excess dietary sodium

  • Gender

  • Family history

  • Obesity

  • Ethnicity

  • Sedentary lifestyle

  • Socioeconomic status

  • Stress

Page 5-6: Risk Assessment Case Study

  • Case Study: Identifying the greatest risk for developing hypertension among various individuals.

    • Greatest Risk: A 56-year-old man with a family history of stroke.

Page 7: Case Study - C.S.

  • Profile: 40-year-old male truck driver with unhealthy habits.

    • BP: 182/104, weight: 230 lb, height: 5 ft 9 in.

Page 9: Assessment Cues

  • Subjective Data: Family history, dietary habits, weight changes, symptoms (fatigue, dizziness, etc.).

  • Objective Data: BP readings, heart sounds, pulses, edema, body measurements, mental status changes.

Page 10: Clinical Manifestations

  • Often asymptomatic until severe.

  • Symptoms may include fatigue, dizziness, palpitations, angina, dyspnea, headaches, and nosebleeds.

  • Hypertensive Crisis Symptoms: Severe headaches, dyspnea, and nosebleeds.

Page 11: Diagnostic Measures

  • BP measurement

  • Urinalysis

  • BUN and serum creatinine

  • Creatinine clearance

  • Serum electrolytes, glucose

  • Serum lipid profile

  • ECG

  • Echocardiogram

Page 12: Complications

  • Target organ diseases affecting:

    • Heart

    • Brain

    • Peripheral vascular disease

    • Kidney

    • Eyes

Page 14: Nursing Diagnosis

  • Ineffective health management

  • Readiness for enhanced health self-management

  • Anxiety

  • Risk for decreased cardiac perfusion

  • Potential complications: Stroke, MI

Page 15: Care Plan Goals

  • Maintain adequate BP for perfusion.

  • Avoid complications.

  • Adhere to therapeutic regimen.

  • Engage with community resources.

Page 16-18: Health Promotion and Compliance

  • Health Promotion: Lifestyle modifications, screening programs, risk factor modification.

  • Compliance Issues: Inadequate teaching, low health literacy, drug side effects, cost, lack of insurance.

  • Enhancing Compliance: Individualized plans, active participation, affordable drugs, caregiver involvement.

Page 19-20: Dietary Recommendations

  • Weight Loss: 22 lb loss may decrease SBP by 5-20 mmHg.

  • Dietary Approaches: Mediterranean or DASH diets.

  • Sodium Intake:

    • < 2300 mg/day for healthy adults.

    • < 1500 mg/day for specific high-risk groups.

  • Alcohol Moderation: Limit intake based on gender.

Page 21: Sodium Awareness

  • High Sodium Foods: Breads, pizza, cold cuts, soups, burritos.

  • Recommendations: Check labels for lower-sodium options.

Page 23: Physical Activity Guidelines

  • Moderate Activity: 150 minutes/week.

  • Vigorous Activity: 75 minutes/week.

  • Strength Training: At least 2 times a week.

Page 24: Tobacco Avoidance

  • Nicotine causes vasoconstriction and elevated BP.

  • Smoking cessation reduces risk factors within 1 year.

Page 27-28: Drug Therapy Education

  • Follow-Up Care: Monitor side effects, manage orthostatic hypotension, and educate on medication timing.

  • Medications for C.S.: Furosemide & Metoprolol.

Page 29: Evaluation of Outcomes

  • Goals: Achieve and maintain target BP, follow therapeutic plan, manage side effects.

Page 30-32: Hypertensive Crisis

  • Definition: SBP > 180 mmHg and/or DBP > 110 mmHg.

  • Urgency vs. Emergency: Urgency may not require hospitalization; emergency involves target organ damage.

  • Complications: Encephalopathy, renal insufficiency, cardiac issues.

Page 33-34: Non-Responsiveness to Treatment

  • Explore causes: progressive target organ damage, drug interactions, adherence issues.

Page 35-36: Dietary Restrictions

  • Meat to Avoid: Roasted duck due to high fat content.

Page 37-41: Drug Therapy Classes

  • Diuretics: First-line for primary hypertension.

  • Beta Blockers: For patients with a history of MI or HF.

  • ACE Inhibitors: Added for uncontrolled hypertension.

  • Vasodilators: Used in heart failure and hypertensive crisis.

This note summarizes the key points regarding hypertension, its risk factors, assessment,