Nursing 210 Advanced Cardiac UNIT 2

1
Nursing 210Advanced Cardiac UNIT 2
Laurie Brown RN, MSN, MPA-HA, CCRN
2
Hypertension

• In adults, a condition in which the blood
  pressure (BP) is higher than 140 mm Hg systolic
  of 90 mm Hg diastolic on three (two) separate
  readings recorded several weeks apart.
• Blood Pressure Cardiac Output x Systemic
  Vascular Resistance

3
(No Transcript)
4
Relevance

• Why is hypertension clinically significant?

5
Procedure

• Take the Pulse obliteration pressure OR
• Known Blood Pressure
• Add 20-30 mm Hg
• Inflate Bp cuff to this number
• Use the BELL of stethoscope take the Blood
  Pressure

6
Types of Hypertension

• White Coat Hypertension
• Malignant Hypertension
• Hypertensive Urgency
• Pregnancy Induced Hypertension

7
Symptoms

• Often, there are no symptoms until damage has
  been done

8
Complications

• Heart
• Brain
• Kidneys
• Aorta
• Arterial vessels
• Eyes

9
Medication Management
Continue adding agents from other classes
Referral to hypertensive specialist
Step 5
Add third drug and/or substitute second drug
Step 4
Add second drug or substitute another drug
Step 3
Medication Diuretics or Beta-Blocker
Step 2
Lifestyle modifications weight loss, diet,
exercise, stop smoking, limit alcohol
Step 1
10
Causes of Resistant Hypertension

• Improper BP measurement
• Excessive sodium intake
• Inadequate diuretic therapy
• Medication
• Inadequate dose
• Drug actions and interactions
• Smoking

11
Lifestyle modifications

• Weight reduction
• DASH eating plan
• Dietary sodium restriction
• Aerobic physical activity
• Moderation of alcohol consumption
• Cessation of smoking

12
Medications Classifications and Action

• Diuretics
• Alpha Adrenergic Blockers
• Beta Adrenergic Blockers (olol)
• Calcium Antagonist (ipine)
• ACE Inhibitor (pril)
• Angiotensin II Antagonist (Receptor blockers or
  ARBs) (sartan)
• Vasodilator

13
BP CO x SVR
14
Treatment Program

• Individualized Step-Care Therapy for Hypertension

15
Review
EKG

• Analyze this EKG
• What medical orders do you anticipate?