Seminar by

DHANYA V THILAKAM

FIRST YEAR MSC NURSING

HYPERTENSION

BY

DHANYA V THILAKAM

FIRST YEAR MSC NURSING

Called the silent killer

About 31% of the adult in the united states

have hypertension

the prevalence increases significantly as

people are older or have other

cardiovascular risk factors

The prevalence also varies by ethnicity with

African Americans having the highest

prevalence

The WHO International society of

hypertension classifies non hypertensive

subjects with a systolic pressure of a130-139

mm Hg or a diastolic pressure of 85-89 mm

Hg of having a “ high ‘ normal blood

pressure

It is defined as a persistent elevation of the

systolic blood pressure at alevel of 140 mm

of Hg or higher and diastolic blood pressure

at a level of 90 mm Hg or higher.

STAGE 1 HYPERTENSION

STAGE 2 HYPERTENSION

SEVERE HYPERTENSION

ESSENTIAL HYPERTENSION

1) GENETIC FACTORS

2) FETAL FACTORS

3) ENVIRONMENTAL FACTORS

4) HUMORAL MECHANISMS

5) INSULIN RESISTANCE

Secondary Hypertension Is Where Blood

Pressure Elevation Is The Result Of A

Specific And Potentially Treatable Cause

. These Patients May Be Amenable To

Curative Treatment , Thereby Sparing

Them From Life-long Medical Therapy

That Is Frequently

Unpleasant, Sometimes Ineffective ,And

Always Expensive

RENAL DISEASES

ENDOCRINE CAUSES

Chron’s syndrome

Adrenal hyperplasia

Phaeochromocytoma

Cushing’s syndrome

Acromegaly

CARDIOVASCULAR CAUSES

The major cause is

coarctation of the aorta

DRUGS

PREGNANCY

hypertension in people who are actually

normotensive except when their blood

pressure is measured by ahealth care

professional .An intermittent vasovagal

response accounts for the transient elevation

in blood pressure

Occurs when the systolic blood pressure is

140mm of Hg or higher but the diastolic

pressure remains less than 90 mm of Hg.It is

thought to emerge because of increased

cardiac output or atherosclerosis induced

changes in blood vessel compliances or both

in older adult

Characterised by a diastolic pressure above

110-120 mm of Hg .It results when

hypertension is left untreated or is

unresponsive to treatment and becomes a

truly severe emergency condition as the

pressure continuous to rise unchecked.

Cardiac •Heart rate

•Inotropic state

•Neural (pons and medulla)

•Humoral (hormones)

Cardiac Output

Renal Fluid Volume Control•Renin–angiotensin

•Aldosterone

•Atrial natriuretic factor

Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

• Chemosensitive cells that respond to changes in pCO2

and pO2 and pH levels (Hydrogen ion).

pO2 and

pH pCO2

Stimulation of

vasomotor

center

CO HRvasoconstrictio

n

BP (speeding return of

blood to the heart and

lungs)

Short-term Regulation of Rising Blood Pressure

Rising blood

pressure

Stretching of arterial

walls

Stimulation of baroreceptors in

carotid sinus, aortic arch, and other

large arteries of the neck and

thorax

Increased impulses to the

brain

Physical examination may reveal no abnormalities other than elevated blood pressure.

Occasionally, retinal changes such as hemorrhages , exudates (fluid accumulation), arteriolar narrowing and cotton-wool spots (small infarctions) occur .

In severe hypertension, papilledema(swelling of the optic disc)may be seen . People with hypertension may be asymptomatic and remains so for many years.

. Coronary artery disease with angina and myocardial infarction are common consequences of hypertension

.Left ventricular hypertrophy occurs in response to the increased workload placed on the ventricle as it contracts against higher systemic pressure

Pathologic changes in the kidneys(indicated by increased blood urea nitrogen{BUN}and serum creatininelevels) may manifest as nocturia.

Cerebrovascular involvement may lead to a stoke or transient ischemia attack (TIA) , manifested by alterations in vision or speech , dizziness , weakness ,a sudden fall , or transient or permanent paralysis on one side (hemiplegia).

Cerebral infarctions accounts for most of the strokes and TIAs in patients with hypertension.

Stroke

Heart attack

Heart failure

Kidney failure

Eye damage

Peripheral artery disease

A thorough health history and physical

examination are necessary .

The retinas are examined and laboratory

studies are performed to assess possible

target organ damage

.Routine laboratory tests include urinalysis

, blood chemistry (i.e analysis of sodium

, potassium ,creatinine ,fasting glucose ,and

total and high-density lipoprotein{HDL}

Cholesterol levels) and a 12 lead

electrocardiogram (ECG),

Left ventricular hypertrophy can be assessed

by echocardigraphy .

Renal damage may be suggested by elevation

in BUN and creatinine levels or by

microalbuminuria or macroalbuminuria .

Additional studies, such as creatinine

clearance , reninlevel , urine tests , and 24-

hour urine protein may be performed .

The goal of hypertension treatment is to prevent complications and death by achieving and maintaining the arterial blood pressure at 140/90 mm Hg or lower.

JNC 7 specifies a lower goal pressure of 130 /80 mm Hg for people with diabetes mellitus or chronic kidney disease, which is defined as either a reduced glomerular filtration rate (GFR)resulting in a serum creatinine of greater than 1.3 mg/dL in a women or greater than 1.5 mg/dL in men , or albuminuria of greater than 300mg/dL.

1. diuretics

2. β-adrenoceptor antagonists (β-blockers)

3. Ca-channel blockers

4. inhibitors of angiotensin (ACE-

inhibitors/AT1-blockers)

5. α-adrenergic blockers

FOOD GROUPS No of servings

/day

Grains and grain products 7 or 8

Vegetables 4 or 5

Fruits 4 or 5

Low fat or fat free dairy food 2 or 3

Meat ,fish , and poultry 2 or fewer

Nuts ,seeds and dry beans 4 or 5 weekly

ASSESSMENT

A complete history is obtained to assess for

signs and symptoms that indicate target

organ damage (i.e , whether specific tissues

are damaged by the elevated blood pressure

). Such manifestation may include angina

pain ; shortness of breath; alternation in

speech ,vision or balance ;nose bleeds

;headaches; dizziness ‘ or nocturia

During the physical examination , the nurse must also pay specific attention to the rate , rhythm ,and character of the apical peripheral pulses to detect effects of hypertension on the heart and blood vessels. A thorough assessment can yield valuable information about the extent to which the hypertension has affected the body and about any other personal ,social , or financial factors related to the condition. For example , some patient’s ability to adhere to an antihypertensive medication regimen may be influenced by the financial resources to buy the medication and health insurance

Deficient knowledge regarding the relation between the treatment regimen and control of the disease process

Non-compliance with therapeutic regimen related to side effects of prescribed therapy

altered tissue perfusion ( renal,cerebral, cardio pulmonary,and peripheral ) relatedred to pheripheral blood flow

Altered nutrition : High Risk for more than Body requirements related to learned eating behaviours ,ethic and cultural values, lack of social support for weight loss , and or imbalance between activity level and caloric intake

Fatigue related to altered body chemistry

(medications)

altered sexuality pattern related to effects

of medical treatment ( drugs)

ineffective individual coping related to

effects of chronic illness and major changes

in lifestyle

The major goals of the patient include

understanding of the disease process and its

treatment , participation in a selfcare

program , and absence of complications

INCREASING KNOWLEDGE

PROMOTING HOME AND COMMUNITY - BASED

CARE

TEACHING PATIENTS SELF – CARE

MONITORING AND MANAGERING POTENTIAL

COMPLICATIONS

Research finding demonstrate that weight loss

, reduced alcohol and sodium intake , and regular

physical activity are effective lifestyle adaptations to

reduce blood pressure

Studies also show that diets high in fruits , vegetables

,and low –fat dairy products can prevent the

development of hypertension and can lower elevated

blood pressure

Consumption of garlic reduces hypertension

The prognosis from hypertension depends on a

number of features ;

The level of blood pressure

The presence of target-organ changes

Coexisting risk factors for cardiovascular

disease , such as hyperlipidaemia , diabetes

,smoking ,obesity ,male sex

Age at presentation

Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL,et al, editors. Harrison's principles of internal medicine. 14th ed. New York:McGraw Hill; 1998

Suzanne C. Smelter, Brenda G Bare,Brunner& Suddarth ‘s Textbook of Medical Surgical Nursing,12 th edn,Lippincott;2010

Praveen Kumar ,Michel Clark ,Kumar & clarkclinical Medicine ;5th edn ;Saunders 2002

en.wikipedia.org/wiki/Essential_hypertension

circ.ahajournals.org/content/101/3/329.full

www.ncbi.nlm.nih.gov/pubmed/11785064