Exam 3 Chapter 33 Hypertensive Disorders

What is the definition of HTN?*

A persistent systolic b/p greater than 140mm
OR a diastolic b/p of 90mm or greater ( these b/p require meds)

What is the incidence of HTN?

1 in 3 adults have HTN

What is primary hypertension?

Elevated b/p without an identifying cause.
Can be ESSENTIAL OR IDIOPATHIC

What is the hallmark sign of primary hypertension?

A PERSISTENT INCREASE IN SVR** SYSTEMIC VASCULAR RESISTENCE

What is secondary hypertension?

B/P that is elevated because of a specific cause.
Treatment is aimed at removing the cause( stress, dietary factors, )

What is "white coat hypertension

Elevated B/P readings in a clinical setting

How is white coat hypertension treated?

By
****Blood pressure monitoring at home( 1st)
or ambulatory blood pressure monitoring

How is white coat HTN diagnosed?

Diagnosis is made when b/p is elevated at 2 or more visits.

Know RAAS and how is raises b/p

...

What are some causes of secondary HTN?

Cirrhosis- Portal circulation is impaired
Cushing's
Medications- NSAIDS, OCP'S ESTROGEN REPLACEMENT
Brain injuries/tumors=pt who are quadrapalegia
Pregnancy induced HTN

Classifications of b/p in JNC 8*** for test purposes

...

What is isolated systolic hypertension?

Systolic b/p is greater than 140mm and a diastolic pressure 90mm

What the risk factors for hypertension

Age greater than 50
Alcoholism due to cirrhosis
cigarette smoking
diabetes
Pt's with elevated cholesterol
Pt's who eat excessive sodium
African Americans*
GENDER
MEN GREATER THAN 55***
WOMEN AGES 64 OR OLDER***
Fhx of htn
obesity
sedentary lifestyle
socio

Why is hypertension referred to as the silent killer?

It is frequently asymptomatic...In the beginning there may not be symptoms. Symptoms may only be seen until severe until severe target organ damage

What are the symptoms of SEVERE HTN?

Fatigue
Dizziness
Palpitations
Angina- Chest pain
Dyspnea

What are some complications of hypertension?

CAD- Coronary artery disease**
LVH- Left ventricle hypertrophy
PVD- seen often- check pedal pulses, skin temp.
RETINAL DAMAGE*
S/S INCLUDE BLURRED VISION OR LOSS OF VISION
**

How do you assess your patient for HTN?

ASSESS:
VITALS B/P, PULSE, include orthastatics- USE CORRECT CUFF SIZE
Fhx
History of heart/kidney disease
history of high b/p and previous tx
Assess MEDS- OTC, HORMONE REPLACEMENT, herbals, and street drugs.
Alcohol use
Cigarette use
Weekly exercise?
Die

What is a hallmark sign of target organ disease that patients may complain of?

Nocturia-- Getting up at night to PEE
Fatigue
Dyspnea
Blurred vision
ED
Decreased libido

What is important when taking a patients B/P

USE THE CORRECT SIZED CUFF
Have the patient sit with feet on the floor- DO NOT CROSS LEGS/Back is supported and arm supported at heart level
Ask pt. if they have had caffeine within 30 minutes of taking their blood pressure

How are orthostatic b/p taken

laying down
sitting
standing up
take these 2-3 minutes apart

How is orthostatic HTN diagnosed?

When there is a drop in systolic blood pressure of 20mm or greater and 10mm or greater in diastolic pressure AND heart rate typically increases by 20 from supine to standing because of low intravascular volume

What are some things that the nurse needs to look at on physical exam in someone who has HTN?

Fundoscopic exam===LOOK for RETINAL DAMAGE/HEMORRHAGE.THIS IS A MAJOR COMPLICATION***KNOW THIS
Auscultate neck veins for carotid bruits, heart sounds
Assess abdomen to hip ratio
Peripheral circulations- Pedal pulses, femoral pulses, edema
**Neuro exam- du

What diagnostic labs can be used to diagnose secondary HTN?

BMP= SODIUM, BUN, CREAT, LIPID
CBC
EKG-12 LEAD
Echo
24 hr. Creatinine clearance to check kidney functions
CXR- to visiualize any heart enlargement
Ambulatory b/p monitoring- Pt needs to monitor b.p at home of wear a monitor for 24hrs.

What is the target goal for B/P in hypertensive patients?

Maintain b/p under 140/90 with minimal side effects over long term.
and LESS THAN 130/80 IN PATIENTS WHO HAVE KIDNEY DISEASE DUE TO INCREASED RISK FR TARGET ORGAN DAMAGE.***

What are the goals of managing HTN in patients?

Achieving and maintaining a good BP
Reduce cardiovascular risk
Reduce target organ damage

What are the interventions are needed in the pt. with HTN?

Lifestyle modifications
adhering to Drug therapy
Exercising
Take medications as prescribe
Reduce alcohol
Stop smoking- it is a vasoconstrictor!
Stress management

What specific diet is important for HTN patients?

The DASH DIET

The DASH DIET IS VERY IMPORTANT! What is the purpose of this diet?

It emphasizes sodium restrictions TO 2300 MG QD
Promote fruits, veggies, and they CAN HAVE FAT FREE AND LOW FAT MILK
Whole grains
Fish
Poultry
Beans
REDUCE SALT, RED MEAT, SWEETS.!!!

How much sodium is the cardiac or diabetic allowed per day?

LESS THAN 1500mg

KNOW MEDICATIONS POSTED IN BB

...

What does the nurse need to teach the patients about their hypertensive medications?

Side effects( Erectile dysfunction)--These may decrease over time DO NOT STOP TAKING MEDS.
Have patients dangle on the side of thed be to prevent orthostatic hypotension
dry mouth-increase fluids
eat foods high in potassium-Bananas, MD may rx K= supplemen

When is B/P HIGHEST?

At night

When is B/P at the lowest?

In the AM

When should HTN meds be taken?

Take as early in the morning as possible. ESPECIALLY IF THEY ARE ON A DIURETIC SO THEY WONT BE UP ALL NIGHT PEEING.

What is resistant HYPERTENSION?

Hypertension due to meds, ( aleve) obesity, increased salt intake and fluid retention, increased alcohol use, in a pt. whose B/P was once controlled

Why is HTN more prevalent in the older population?

Due to decreased peripheral vascular resistance from atherosclerosis.
Decreased renal functioning
Arthritis- Because NSAIDs can cause an increase in BP

Why are patient non compliant with anti-hypertensive medications?

Pt. education/lack of insurance
Expense of medicines

What is a hypertensive crisis?

IT IS AN EMERGENCY! BECAUSE IT CAUSES TARGET ORGAN DAMAGE in a matter of hrs

What are the causes of hypertensive crisis?

A severely elevated b/p ex 220/140 with evidence of acute organ damage such as LOC, seizures

What is hypertensive urgency?

An elevated b/p ex 180/110 over days to weeks with NO EVIDENCE OF TARGET DAMAGE***

What patient are most likely to experience a hypertensive urgency or hypertensive crisis?

A patient who fails to take medications prescribed or patients who are under medicated, drug use

What are the s/s of a hypertensive crisis( THIS IS AN EMERGENCY)

Hypertensive encephalopathy- Confusion, LOC
Renal compromise including complete renal failure
Aortic dissection---EXCRUCIATING PAIN THAT RADIATES TO THE BACK
Absent pulses in the lower pulse

How is HYPERTENSIVE URGENCY treated?

Oral meds:
ACEI- ACE Inhibitors
ARB's Agiotensin Receptor Blockers
CCB- Calcium Channel Blockers
Captopril, Labetalol, Clonidine are the most common meds given

How is a HYPERTENSIVE EMERGENCY treated?

IV Meds- Vasodilators, ARB's, Beta blockers, ACE inhibitors.
Pt. Will be in ICU for close monitoring
Then MAP is used instead of b/p reading as a guide
Assess b/p q2-3 minutes
MEASURE URINE OUTPUT EVERY 1 TO ASSESS KIDNEY FUNCTION***
Perform neuro checks