HYPERTENSION
• THEORETICAL CONCEPTS
• NURSING PRACTISE
Mónica Roque
Adult Nurse
February 2014
DEFINITION OF HYPERTENSION
• High blood pressure
The pressure exercised by blood on the walls of the
blood vessels
• Cardiac outputdetermined by:
• Peripheral vascular resistance
• Viscosity (Thickness)
The product of the heartrate multiplied by the
stroke volume.
The ability of the vessels to stretch.
• The amount of circulating blood
volume 2
MEASURING BLOOD PRESSURE
Universal advices
Measurement should be done in both arms at first visit
The patient should be seated for at least 5 minutes, relaxed and not moving or speaking
Remove tight clothing, support arm at heart level, ensure arm relaxed and avoid talking
during the measurement
Thepatient should not have exercised, eaten or smoked for at least half na hour prior to taking
blood pressure. 3
MEASURING BLOOD PRESSURE
Manual measurement CHOOSE THE CORRECT CUFF
SIZE!
4
Indication Width (cm) Length (cm)
Child/Small adult 10-12 18-24
Standard Adult 12-13 23-35
Large Adult 12-16 35-40
Adult Tight Cuff 20 42
Bladder too large:Underestimation of BPBladder too
small:Overestimation of BP
5
Measuring blood pressure
Manual measurement
Palpate the brachial pulse along the inner upper arm.Explanation: Where the stethoscope will be placed when listening Korotkoff sounds.
Choose the correct cuff and apply it to the upper arm. The centre of the bladder must be in line with the brachial artery.Explanation: the cuff needs to be positioned to allow the stethoscope diaphragm clear access to the brachial artery.
Place the diaphragm of the stethoscope over the brachial artery, near to cubital fossa.
Close the control valve on the sphygmomanometer Inflate the cuff, so that the dial reads 30mmHg above your earlier estimated Systolic pressure (150mmHg, approximately).
Open the air valve fully, to rapidly deflate the cuff. Release the patient from the equipment.
The last sound that listen is the Diastolic pressure (measures the pressure in the arteries between beats).
The Korotkoff sounds are quite faint, but distinctive, when recognized. Listen carefully for the first ‘Bump’, note the associated dial reading. This is the real
Systolic pressure (measures the pressure in the arteries when the heart beats).
Gently open the valve for a slow controlled release of air from the cuff.
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MEASURING BLOOD PRESSURE
Manual measurement
CLASSIFICATION OF BLOOD PRESSURE
CATEGORY SYSTOLIC (MMHG)
DIASTOLIC (MMHG)
Optimal <120 <80
Normal 120-129 80-84
High normal 130-139 85-89
Stage 1 Hypertension 140-159 90-99
Stage 2 Hypertension 160-179 100-109
Stage 3 Hypertension ≥180 ≥110
CAUTION: The systolic and diastolic pressures are measured in millimetre of mercury (mmHg).
7
RISK FACTORSNon-modificable
8
Family history
Age
Gender
Race and Ethnicity
Diabetes Mellitus disease
Other chronic diseases
• Two third of adults who have diabetes also have hypertension.
• The risk of developing hypertension when someone has a familiar background of diabetes and obesity is 2 to 6 times great than a person without this family history.
The probability to have hypertension increases with age.
• More common in men than women.
• Women are more likely to develop hypertension after menopause.
More common in
black.
• High cholesterol;• Kidney diseases;• Sleep apnea.
RISK FACTORSModificable
9
Weight
Stress
Unhealthy Diet
Addictions
Sedentary life
Overweight or obesity (If we have higher body mass index, our body need more blood to supply nutrients and oxygen to the tissues. As the blood volume in circulation increases, it will increase the pressure in artery walls.)
• Tobacco (chemicals in tobacco can damage the lining of the artery walls)
• Alcohol (the regular consumption of 3-4 alcoholic drinks per day, increases the risk of hypertension and reduce the action of antihypertensive therapy.)
• Sodium intake;• Low potassium
intake (Potassium helps to balance the amount of sodium in cells.);
• High-fat diet.
TYPES OF HYPERTENSION
10
Primary Hypertension• Chronic elevation of blood pressure from an
unknown cause.• 90%-95% of all cases
Secondary Hypertension• Signify high blood pressure from an identified cause
(e.g. kidney disease)• 5%-10% of all cases
Systolic Isolated Hypertension• It’s a high value of systolic pressure, and a normal
value of diastolic pressure.• It’s rare.
SIGNS AND SYMPTOMS
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NORMALLY, HYPERTENSION IS A SILENT KILLER – CAUSES NO SIGNS OR SYMPTOMS!
• Headache
• Bloody nose
• Blurred vision
• Dizziness
• Fatigue, activity
intolerance
• Palpitations
• Blood spots in the
eyes
• Facial flushing
Target organ
diseases
Heart
Kidney Brain
Eyes
NURSING PRACTISETHE BEST CARE
12
Individual Assessment:
Medical background:
• Food habits (alcohol use, salt and fat intake, weight gain/loss)
• Elimination (nocturia)
• Activity (fatigue, activity intolerance, dyspnoea on exertion, palpitation, angina, chest
pain, intermittent claudication, muscle cramps, )
• Addictions
• Cognitive/perception (blurred vision, paresthesia)
• Coping/stress (stressful life events, noncompliance)
NURSING INTERVENTIONS
13
Teaching
Therapy Adherence
Health Promotio
n
MAIN GOALS:
• Maintain or enhance
cardiovascular functioning.
• Prevent complications.
• Provide information about disease
process, prognosis, and therapy.
• Support active client control of
condition.
Regular blood pressure measurement is ESSENTIAL!
OBJECTIVE OF NURSING CARE:
Decrease and control the blood pressure
NURSING INTERVENTIONS
14
Teaching
Therapy Adherence
Health Promotio
n
Life style modifications
• DIET:
reduce salt and sodium intake;
diet rich in fruits, vegetables, proteins,
potassium and calcium;
• REGULAR PHYSICAL ACTIVITY – 20 to 30
minutes of moderate activity 4/5 days a week
• WEIGHT REDUTION (in cases of overweight
or obesity)
• SMOKING CESSATION
• STRESS MANAGEMENT – use non-
pharmacologic strategies, like yoga or relaxing
training
• LIMIT ALCOHOL CONSUMPTION – for men,
no more than 2 drinks per day, and for women,
no more than 1 drink per day
NURSING INTERVENTIONS
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Teaching
Therapy Adherence
Health Promotio
n • Hypertension’s pathology
• Correct blood pressure
measurement
• Drug therapy
• Inform about support groups
and Community support
Patient/Family
NURSING INTERVENTIONS
16
Teaching
Therapy Adherence
Health Promotio
n
• Explain the importance
about therapy adherence.
• In case of Non-adherence:
Understand the patient’s
reasons;
Adjust clinical treatment
according to the patients’
cultural beliefs and individual
attitudes
REFERENCES:
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• Blood pressure measurements devices. V. 2.1. MHRA. (2013)
• Brunner, Standard. Textbook of Medical-Surgical Nursing. Lippincott Williams
& Wilkins; Twelfth, North American Edition (November 24, 2009)
• Marilynn E. Doenges, Mary Frances Moorhouse, Alice C. Murr. Nursing care
plans : guidelines for individualizing client care across the life span. Ed. 8.
David Plus (2010)
• NICE clinical guideline 127 Hypertension: clinical management of primary
hypertension in adults. NHS. (2011)
• WHO – A global brief on hypertension. (2013)
• Williams, S., Hopper, P. – Understanding medical-surgical nursing. Ed. 2. F. A.
David Company – Philadelphia (2003)