115-NCLEX-RN Review Made Incredibly Easy, Fifth Edition (Incredibly Easy Series)-Lippincott-16083_p72

48 Cardiovascular system

Hypertension

Persistent elevation of systolic or diastolic blood pressure (systolic pressure higher than 140 mm Hg, diastolic pressure higher than 90 mm Hg) indicates hypertension. Hyperten-sion results from a narrowing of the arteri-oles, which increases peripheral resistance, necessitating increased force to circulate blood through the body.

There are two major types of hypertension. Essential hypertension, the most common, has no known cause, though many factors play a role in its development. Secondary hypertension is caused by renal disease or other systemic diseases.

Mild to very severeHypertension is classified according to three stages:

prehypertension: systolic 120 to 139 mm Hg or diastolic 80 to 89 mm Hg

stage 1: systolic 140 to 159 mm Hg or diastolic 90 to 99 mm Hg

stage 2: systolic 160 mm Hg or higher or diastolic 100 mm Hg or higher

CAUSES Cushings disease No known cause (essential hypertension) Hormonal contraceptive use Pheochromocytoma Pregnancy Primary hyperaldosteronism Renovascular disease Thyroid, pituitary, or parathyroid disease Use of drugs, such as cocaine

CONTRIBUTING FACTORS (ESSENTIAL HYPERTENSION) Aging Atherosclerosis Diet (sodium and caffeine) Family history Obesity Race (more common in blacks) Sex (more common in males over age 40) Smoking Stress

Nitrates: isosorbide (Isordil), nitroglycerin Vasodilator: nitroprusside (Nitropress)

INTERVENTIONS AND RATIONALES Assess cardiovascular status, vital signs, and hemodynamic variables to detect signs of reduced cardiac output. Assess respiratory status and oxygena-tion to detect increasing fluid in the lungs and respiratory failure. Keep the client in semi-Fowlers position to increase chest expansion and improve ventilation. Administer medications, as prescribed, to enhance cardiac performance and reduce excess fluids. Administer oxygen to enhance arterial oxy-genation. Measure and record intake and output. Intake greater than output may indicate fluid retention. Monitor laboratory studies to detect elec-trolyte imbalances, renal failure, and impaired cardiac circulation. Provide suctioning, if necessary, and assist with turning, coughing, and deep breathing to prevent pulmonary complications. Restrict oral fluids because excess fluids can worsen heart failure. Weigh the client daily. A weight gain of 1 to 2 lb (0.5 to 1 kg) per day indicates fluid gain. Measure and record the clients abdominal girth. An increase in abdominal girth suggests worsening fluid retention and right-sided heart failure. Maintain the clients prescribed diet (low sodium) to reduce fluid accumulation. Encourage the client to express feelings, such as a fear of dying, to reduce anxiety.

Teaching topics Explanation of the disorder and treatment plan Medications and possible adverse effects Limiting sodium intake and supplementing diet with foods high in potassium Recognizing signs and symptoms of fluid overload Elevating legs when seated Contacting the American Heart Association

Understanding risk factors for hypertension is

important. After all, some of these

risk factors can be modified, eliminating

the need for drug therapy.

313419NCLEX-RN_Chap03.indd 48313419NCLEX-RN_Chap03.indd 48 4/8/2010 7:01:46 PM4/8/2010 7:01:46 PM

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115-NCLEX-RN Review Made Incredibly Easy, Fifth Edition (Incredibly Easy Series)-Lippincott-16083_p72