Nursing management : Hypertension
Nursing management Nursing Assessment Subjective Data Important Health Information Past health history: Known duration and past workup of high BP; cardiovascular, cerebrovascular, renal, or thyroid disease; diabetes mellitus; pituitary disorders; obesity; dyslipidemia; menopause or hormone replacement status Medications: Use of any prescription or over-the-counter, illicit, or herbal drugs or products; previous use of antihypertensive drug […]
Hypertension in older persons
Hypertension in older persons BP goal for people > 60 is < 150/90 Preferred antihypertensive drugs Thiazide diuretic Calcium channel blockers ACE inhibitors or ARBs Caution use of NSAIDS Hypertensive crisis SBP >180 mmHg and/or DBP >110 mmHg Hypertensive urgency Develops over hours to days May not require hospitalization Hypertensive emergency Very severe problems can […]
Hypertension : Nursing diagnoses
Nursing diagnoses Ineffective health management related to lack of knowledge of pathology, complications, and management of hypertension Anxiety related to complexity of management regimen Sexual dysfunction related to side effects of antihypertensive medication Risk for decreased cardiac tissue perfusion Risk for ineffective cerebral tissue perfusion Risk for ineffective renal perfusion Potential complication: stroke, MI Planning […]
Resistant hypertension
Resistant hypertension Failure to reach goal BP in patients taking full doses of an appropriate 3-drug therapy regimen that includes a diuretic. Reasons include Improper BP measurement Drug-induced Nonadherence (e.g., due to drug side effects, finances) Illegal drugs (e.g., cocaine, amphetamines) Inadequate drug dosages Inappropriate combinations of drug therapy Nonsteroidal anti-inflammatory drugs Sympathomimetics (e.g., decongestants, […]
Hypertension medication : Angiotensin Inhibitors – Calcium Channel Blockers
Angiotensin Inhibitors Angiotensin-Converting Enzyme Inhibitors Benazepril (Lotensin) Captopril Enalapril (Vasotec) Fosinopril Lisinopril (Zestril) Moexipril (Univasc) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) Inhibit ACE, reduce conversion of angiotensin I to angiotensin II (A-II). Inhibit A-II–mediated vasoconstriction. Aspirin and NSAIDs may reduce drug effectiveness. Addition of diuretic enhances drug effect. Should not be used with […]
Hypertension medication : Adrenergic Inhibitors
Adrenergic Inhibitors Central-Acting α-Adrenergic Agonist Clonidine (Catapres) Clonidine patch (Catapres-TTS) Reduce sympathetic outflow from CNS. Reduce peripheral sympathetic tone, produces vasodilation, and decreases SVR and BP. Sudden discontinuation may cause withdrawal syndrome, including rebound hypertension, tachycardia, headache, tremors, apprehension, sweating. Chewing gum or hard candy may relieve dry mouth. Alcohol and sedatives increase sedation. Transdermal […]
Hypertension medication : Diuretics
Drug Examples Mechanism of Actions Nursing considerations Diuretics Thiazide and Related Diuretics Chlorothiazide (Diuril) Chlorthalidone Hydrochlorothiazide Indapamide Metolazone (Zaroxolyn) Inhibit NaCl reabsorption in the distal convoluted tubule. Increase excretion of Na+ and Cl−. Initial decrease in ECF. Sustained decrease in SVR. Lower BP moderately in 2-4 wk. Monitor for orthostatic hypotension, hypokalemia, and alkalosis. Thiazides […]
Lifestyle modifications : Blood Pressure
Lifestyle modifications Weight reduction Weight loss of 22 lb (10 kg ) may decrease SBP by approx. 5 to 20 mm Hg Calorie restriction and physical activity DASH eating plan Fruits, vegetables, fat-free or low-fat milk, whole grains, fish, poultry, beans, seeds, and nuts Dietary sodium reduction < 2300 mg/day for healthy adults < 1500 […]
Diagnostic studies : Blood Pressure
Diagnostic studies Diagnostic assessment History and physical examination, including an ophthalmic examination Routine urinalysis Basic metabolic panel (serum glucose, sodium, potassium, chloride, carbon dioxide, BUN, and creatinine) Complete blood count Serum lipid proile (total lipids, triglycerides, HDL and LDL cholesterol, total-to-HDL cholesterol ratio) Serum uric acid, calcium, and magnesium 12-lead electrocardiogram (ECG) Optional: 24-hr urinary […]
Complications : Blood Pressure
Complications Target organ diseases occur most frequently in Heart Hypertensive heart disease Coronary Artery disease Hypertension disrupts the coronary artery endothelium This results in a stiff arterial wall with a narrowed lumen, and accounts for a high rate of CAD, angina, and MI. Left ventricular hypertrophy Increased contractility increases myocardial work and O2 demand Heart failure […]