Nursing Care of Patients With Hypertension

# Nursing Care of Patients With Hypertension

Introduction

  • Author: Cynthia Reihmann MSN, RN

  • Published by: F.A. Davis Company, 2019

Learning Outcomes

  • Explain the pathophysiology of hypertension.

  • Identify causes and risk factors for hypertension.

  • List signs and symptoms of hypertension.

  • Describe therapeutic measures for hypertension.

  • Define classifications and treatment recommendations for hypertension in adults.

Learning Objectives

  • Define hypertensive emergency.

  • List common complications of hypertension.

  • Plan nursing care for patients with hypertension.

  • Evaluate effectiveness of nursing interventions.

Key Considerations in Nursing Care

  • What’s normal: Understand baseline blood pressure values and individual patient normal ranges.

  • What’s wrong: Recognize signs and symptoms indicative of hypertension.

  • What does it look like: Visual cues or measurements that indicate hypertension.

  • How do we treat it: Understand treatment modalities available.

  • How do we prevent it: Strategies for patient education and lifestyle changes.

Definition of Blood Pressure

  • Definition: The force produced by the volume of blood against the arterial walls.

  • Determining Factors:

    • Cardiac Output: The volume of blood the heart pumps in a minute.

    • Peripheral Vascular Resistance: The resistance blood vessels offer to blood flow.

    • Vessel Stretch: The ability of blood vessels to expand and contract.

    • Blood Viscosity: The thickness of blood, which affects flow.

    • Blood Volume: The total amount of blood in circulation.

Blood Pressure Classification

  • Normal Blood Pressure (BP):

    • Systolic: Less than 120 mmHg

    • Diastolic: Less than 80 mmHg

  • Screening Recommendations:

    • For those with normal BP: Every 3 to 5 years.

    • For individuals over age 39 or at increased risk: Annually.

Stages of Hypertension

  • Stage 1 Hypertension:

    • Systolic: 130 to 139 mmHg

    • Diastolic: 80 to 89 mmHg

  • Stage 2 Hypertension:

    • Systolic: >139 mmHg

    • Diastolic: >89 mmHg

  • Measurement should involve two or more separate collections of blood pressure readings.

Types of Hypertension

  • Primary Hypertension (Essential Hypertension):

    • Description: Unknown cause; contributes to most hypertension cases.

  • Secondary Hypertension:

    • Description: Known cause, often due to underlying conditions or medications.

Risk Factors for Hypertension

Nonmodifiable Risk Factors:

  • Family History of Hypertension: Genetic predisposition.

  • Age: Increased risk as age advances.

  • Race and Ethnicity: Certain groups show higher prevalence.

Modifiable Risk Factors:

  • Weight: Obesity increases risk significantly.

  • Diet: High sodium and poor nutritional intake contribute.

  • Physical Activity: Lack of exercise is a risk factor.

  • Glucose Control: Poor control of diabetes increases risk.

Signs and Symptoms of Hypertension

  • Often asymptomatic, hence referred to as the “silent killer.”

  • As blood pressure elevates, symptoms may include:

    • Headache

    • Bloody Nose

    • Anxiety

    • Dyspnea (shortness of breath)

Diagnosis of Hypertension

  • Risk Factors: Family, personal health history.

  • Signs and Symptoms: Clinical observations.

  • Other Considerations:

    • Assess for kidney or heart disease.

    • Review current medications.

    • Obtain multiple BP readings.

    • Use of ambulatory BP monitoring and home BP measurements.

Treatment for Hypertension

Lifestyle Changes:

  • Adoption of healthier living practices.

  • Consideration of Antihypertensive Medications based on severity/response.

Medication Classes for Hypertension:

  1. Diuretics:

    • Examples: Thiazide diuretics such as Hydrochlorothiazide.

    • Mechanism: Increases urine output by inhibiting water and sodium reabsorption in the kidneys.

    • Nursing Actions: Monitor potassium levels to prevent hypokalemia.

  2. Calcium Channel Blockers:

    • Examples: Verapamil, Amlodipine, Diltiazem.

    • Mechanism: Alters the movement of calcium ions through the cell membrane, promotes vasodilation, lowering blood pressure.

    • Nursing Actions: Monitor vital signs, advise on slow positional changes to prevent hypotension, avoid grapefruit to reduce toxicity risk.

  3. ACE Inhibitors:

    • Examples: Lisinopril, Enalapril.

    • Mechanism: Prevents the conversion of angiotensin I to angiotensin II, which prevents vasoconstriction.

    • Nursing Actions: Monitor for persistent cough as a side effect.

  4. Beta Blockers:

    • Examples: Metoprolol, Atenolol.

    • Mechanism: Blocks the sympathetic nervous system (beta adrenergic receptors), resulting in a slower heart rate and lowered blood pressure.

    • Nursing Actions: Monitor heart rate and vital signs regularly.

Complications of Hypertension

  • - Atherosclerosis: Hardening of the arteries due to plaque buildup.

  • Coronary Artery Disease: Decrease in blood flow to the heart.

  • Myocardial Infarction: Heart attack due to blocked blood flow.

  • Heart Failure: The heart's inability to pump blood effectively.

  • Stroke: Brain ischemia due to reduced blood flow.

  • Kidney/Eye Damage: Hypertension affects small vessels leading to organ damage.

Hypertensive Crisis

Hypertensive Emergency:

  • Definition: Evidence of new or worsening target organ damage.

Hypertensive Urgency:

  • Definition: Asymptomatic but marked elevation of blood pressure.

Accelerated Hypertension:

  • Definition: Recent significant increase over baseline BP leads to target organ damage.

  • Symptoms: Severe headaches, nosebleeds, shortness of breath, severe anxiety.

  • Treatment: Immediate medical intervention.

Malignant Hypertension:

  • Description: BP higher than 180 mmHg systolic / 110-120 mmHg diastolic with papilledema present.

  • Progression: Leads to target organ dysfunction.

  • Treatment: Immediate gradual reduction of BP using IV antihypertensive such as Nitroprusside (Nitropress).

Patient Education for Hypertension Management

  • Lifelong BP Control:

    • Importance of self-care lifestyle measures and adherence to a prescribed medical regimen.

  • Health Promotion and Disease Prevention:

    • Maintain a healthy Body Mass Index (BMI).

    • Limit caffeine and alcohol intake.

    • Employ stress management techniques.

    • Smoking cessation practices.

    • Limit sodium and fat intake in diet.

Patient Safety Measures

  • Patients should be educated about the risks of dizziness and how it may increase the chances of falls.

  • Advice: Rise slowly to prevent orthostatic hypotension, especially when transitioning from sitting to standing.