NURSE_THINK_NOTES- hypertension
NURSE THINK NOTES - HYPERTENSION
Related Concepts: Perfusion and Clotting Related Exemplars: PAD,
... [Show More] Atherosclerosis, CVD Helpful Tables:
Risk Factors Table 36-1 Drug Therapy Chart 36-1
Normal <120 / <80 Prehypertension 120-139/80-89 Stage 1 140-159/90-99
Stage 2 >160 / >100
Different types:
Essential: most common type and not caused by existing health problems. Develops when a patient has any one or more risk factors listed on Table 36-1. Continuous elevation of Bp can cause damage to vital organs.
• Medial hyperplasia: thickening of the arterioles thus decreasing perfusion so damages the organs; = MI, PVD, renal failure, strokes
Secondary: caused by specific diseases or medications taken by the patient. Renal Disease, aldosteronism, Cushing’s syndrome.
• Isolated systolic HTN: SBP >140, DBP < 90
Meds: Caffeine, stimulants, estrogen-containing oral contraceptives
Orthostatic hypotension: decrease in BP when the patient changes positions from lying to sitting.
Hypertensive crisis: BP higher than 180 systolic and 120 diastolic. Causes damages to the heart and kidneys; patient may report shortness of breath, headache, chest pain, dizziness, and difficulty speaking.
Place patient in semi-fowlers Administer oxygen
Start IV of NS solution
Monitor BP every 5 to 15 minutes
Observe for neuro or cardiac complications
* A gradual reduction of BP is preferred because rapid reduction could cause cerebral ischemia, MI, and renal failure.
Malignant hypertension: severe elevated BP that rapidly progresses. S/s: morning headaches, blurred vision, and dyspnea.
If not treated right away pt may develop kidney failure, left ventricular heart failure, or stoke.
Priority Assessments:
• BP throughout the day and compare to baseline.
• Cardiac Assessment to see if the BP has affected the function of the heart, perfusion to extremities (palpate pulses), and has caused any other cardiac issues.
• If the BP has maintained at a high level check kidney function as well.
• Assess for any edema
• s/s: HA, facial flushing, dizziness, fainting, anxiety, tachycardia, sweating, pallor
Priority Labs and Diagnostics:
• Lipid Panel: check for any risk of atherosclerosis and/or clot. HDL (normal value: Men
>55, women >45), LDL (should be <130), and total cholesterol (should be lower than 200)
• Ankle-brachial index: quick way to test for PAD; compares the BP measure in arm to ankle and gives a percentage. Normal value is 1-1.4, slight blockage would read as 0.91-0.99, and PAD is anything less than 0.91
• BUN/Creatinine: to detect any kidney failure or impaired function; with HTN these levels are increased. Creatinine clearance test: normal value (women: 87-107) (men: 107-139)
• ECG: L arterial and ventricular hypertrophy is the 1st ECG sign of heart dz resulting from
HTN
Priority Nursing Interventions:
• Monitor Blood Pressure, especially before giving medications
• Medication Therapy
• Monitor Labs such as total cholesterol, HDL, LDL, triglycerides, blood sugar,
• Monitor electrolytes- Potassium specifically.. Electrolyte imbalance can lead to cardiac dysrhythmias
• Patient Education
Priority Medications:
• Diuretics: take in morning rather than at night to prevent nocturia
• Thiazide
• Hydrochlorothiazide (Hydrodiuril, Microzide, Oretic, Urozide)
• Inhibit Na, Cl & H2O and promoting K, bicarb and magnesium excretion
• Risk for hypokalemia - monitor serum K levels, asses for irregular pulse and muscle weakness, eat foods high in potassium
• Causes diuresis = orthostatic hypotension; teach pts to get up slowly
• Used w/caution in pts with DM - can interfere w/serum glucose levels
• Used w/caution in pts with gout or hyponatremia - can worsen w/thiazides
• Loop diuretics
• Furosemide ( Lasix, Furosemide), Torsemide (Demadex)
• Inhibit Na, Cl. H2O absorption & promote K secretion
• Cause hypovolemia, hypokalemia - monitor for serum K levels, assess for irregular pulse and muscle weakness, eat foods high in K
• Use w/caution in older adults bc loop diuretics can cause dehydration and
orthostatic hypotension = risk for falls
• Monitor & report dizziness, falls or confusion
• Safter for pts with gout and DM
• Potassium-sparing diuretics
• Spironolactone (Aldactone, Novo-spiroton), Triamterene (Dyrenium), Amiloride (Midamor)
• Inhibit reabsorption of Na ions, retaining K in body
• Assess for hyperkalemia : wkness, irregular pulse
• Decrease intake of foods high in potassium
• Beta Blockers
• Atenolol (Tenormin, Apo-Atenol), Metoprolol ( Lopressor, Toprol, Toprol-XL, Betaloc), Bisoprolol (Zebeta)
• Monitor closely for hypoglycemia - BB mask symptoms of hypoglycemia
• Low-dose Aspirin should be considered AFTER BP is controlled dt increased risk for hemorrhagic stroke in pts w/uncontrolled HTN
• Monitor for orthostatic hypotension; teach pts to rise slowly from sitting to
prevent dizziness
• DO NO TAKE if SBP <100 mmHg or of pulse is < 60
• S.E include: fatigue, depression, sexual dysfunction, confusion, risk for falls
• DO NOT DC ABRUPTLY bc it can cause angina, MI, or rebound HTN
• Calcium Channel Blockers
• Verapamil hydrochloride (Calcan, Nu-Verap), Amlodipine (Norvasc)
• Most effective in older adults and African Americans
• Monitor pulse and BP before taking; DO NO TAKE if pulse is <60 or SBP
< 100 mm Hg
• If taking Verapamil, avoid grapefruit; Grapefruit is safe with amlodipine
• ACE inhibitors (-prils)
• Captopril (Capoten), Lisinopril (Prinivil, Zestril), Enalapril (Vasotec)
• S.E: nagging cough - if cough develops, DC meds
• Get up slowly to avoid severe hypotensive effect
• Orthostatic hypotension - if dizziness continues or if there's an decrease in SBP notify provider
• DO NOT GIVE if SBP is <100 mm HG
• Angiotensin II Receptor Blockers (ARBs) (-statins)
• Losartan (Cozaar), Valsartan (Diovan), Candesartan (Atacand)
• Not as effective in African Americans unless taken w/diuretics, BB, CCB.
• Using ACE and ARBs at the same time increases risk for hyperkalemia; monitor K levels, every 2 wks for the first few months then monthly
• Avoid foods high in potassium
• DO NOT TAKE if SBP is < 100 mm Hg
Alternative therapy:
• Garlic: lowers cholesterol and BP
o S.E: affect the liver and causes bleeding - caution with pts going through invasive procedures
o Biofeedback
o Meditation
o Acupuncture
Priority Potential and Actual Complications:
• Stoke
• Heart attack
• Kidney Failure
• Development of other diseases
Patient Teaching (Goals):
• Smoking cessation: nicotine is a vasoconstrictor causing high blood pressure, so nurse needs to educate patient on the importance of smoking cessation.
• Lifestyle Changes (Nutrition Therapy & Exercise): Restrict sodium intake and reduce weight if overweight or obese. Decrease alcohol consumption and avoid caffeine. The patient should try to work out 40 minutes moderate-to-vigorously at least four times a week.
• Encourage patient to keep track of their blood pressure at home
• Encourage Patient to get up slowly when on medications to minimize effects of orthostatic hypotension
Test Question:
A patient with hypertension has a blood pressure reading of 187/121 and shows symptoms of shortness of breath, headache, chest pain, and difficulty speaking. What is this patient experiencing?
A. Orthostatic hypotension
B. Hypertensive crisis *
C. Heart Attack
D. Stroke
The answer is B. Hypertensive crisis. This is an emergent situation and could cause damage to organs such as the kidneys and the heart. (pg. 727 in Med-Surg) [Show Less]