Chapter 33: Hypertension

1
Chapter 33 Hypertension
2
Overview of BP Pg. 507

• Force produced by the volume of blood within the
  walls of arteries.
• Measured pressure reflects the ability of
  arteries to stretch and fill with blood,
  efficiency of heart as a pump and the volume of
  circulating blood

3
Overview of BP

• Affected by age, body size, diet, activity,
  emotions, pain, position, gender, time of day and
  disease states
• Use of Birth Control Pills

4
Overview of BP

• Studies of healthy persons show that blood
  pressure can fluctuate within a wide range and
  still be normal. It is important to obtain
  several measurements for comparison.
• A diastolic elevation is more serious,
  reflecting pressure on arterial wall during the
  resting phase of the cardiac cycle

5
Arterial Blood Pressure

• Regulated by autonomic nervous system, kidneys
  and endocrine glands
• Normal ranges from 100/60 to 139/89
• Tends to increase age, most likely from
  arteriosclerotic and atherosclerotic changes in
  blood vessels or other effects of chronic
  diseases.

6
Systolic BP

• Systolic is determined by the force and volume of
  blood ejected from left ventricle during systole
  and the ability of arterial system to distend at
  the time of contraction

7
Systolic BP

• The walls of the arteries are normally elastic
  yield to the force volume of ventricular
  contraction
• In older Pts, the SBP may be ? due to the loss
  of arterial elasticity (arteriosclerosis)

8
Systolic BP

• Narrowing of the arterioles, either by
  arteriosclerosis or some other mechanism that
  causes vasoconstriciton, ? peripheral resistance,
  which in turn ? SBP.
• This resistance is compared to the narrowing of a
  tube, such as a drinking straw or a garden hose.
• The narrower the lumen, the ? the pressure needed
  to move air or liquid through it.

9
Diastolic BP

• Diastolic reflects arterial pressure during
  ventricular relaxation and depends upon
  resistance of arterioles and the diastolic
  filling times.

10
Diastolic BP

• If arterioles are resistant (constricted) blood
  is under greater pressure

11
Hypertensive Disease Pg. 508

• HTN sustained ? of SBP gt 140 or DBP gt90 or
  both.

12
Hypertensive Disease

• When a cardiac abnormality results from elevated
  BP the term hypertensive heart disease is used.
• When vascular damage is present without heart
  involvement the term hypertensive vascular
  disease is used.
• When both heart disease and vascular damage term
  hypertensive cardiovascular disease is used

13
Essential Secondary Hypertension

• Essential Hypertension is sustained elevation of
  BP without any known cause--95 of cases
• Secondary hypertension is an elevation that
  results from or is secondary to some other
  disorder
• Essential HTN can be related to unknown cause and
  secondary is due to a known cause

14
Pathophysiology Pg 509

• Blood pressure often increases with age and may
  run in families
• African Americans are affected at a higher rate
  than other ethnic groups
• ? risk with obesity, inactivity, smoking,
  excessive alcohol intake ineffective stress
  management.

15
Pathophysiology

• Hypernatremia increases blood volume and
  increases BP
• Low serum potassium may cause Na retention
  because the kidneys try to maintain a balanced
  number of cations (positive charge

16
Pathophysiology

• Secondary HTN may accompany any primary condition
  that affects fluid volume or renal function or
  causes arterial vasoconstriction.
• Kidney disease, pheochromocytoma (tumor of
  adrenal gland), hyperaldosteronism,
  atherosclerosis and use of cocaine or other
  cardiac stimulants such as weight control drugs
  and caffeine and oral contraceptives

17
Pathophysiology

• Regardless if Essential or secondary-- both have
  same effect on organs
• Size of heart increases and heart failure
  develops
• Can cause angina as the myocardium does not
  receive enough oxygen
• It accelerates arteriosclerosis and
  atherosclerosis

18
Patho---Effects of Hypertension

• Eyes, brain, heart and kidney are all affected by
  hypertension
• Hemorrhage of tiny arteries of retina can cause
  blindness
• CVA can occur
• MI and renal failure can occur

19
Signs and Symptoms Pg 509

• May be asymptomatic. Called the silent killer
• May have throbbing or pounding headache
• Dizziness, fatigue, insomnia, nervousness
• Nosebleeds and blurred vision
• Angina or shortness of breath may be 1st symptom
  of hypertensive heart disease

20
Signs and Symptoms

• Pulse may be bounding
• Flushed face from engorgement of of superficial
  blood vessels
• Peripheral edema
• Vascular changes in eyes, retinal hemorrhages or
  a bulging optic disk

21
Treatment

• See table 33-1 page 508 for recommendations for
  BP checks
• Non-pharmacological interventions used first--wt.
  reduction, moderate exercise, decreased Na, no
  smoking or alcohol, diet low in fat

22
Drugs for HTN Table 33-1

• Pg 511---refer make sure you go over the
  nursing considerations!!!!!

23
Nursing Assessment Pg 510

• Take BP in both arms in standing, sitting and
  lying position. Use appropriate size cuff
• Use same arm and same position when taking
  routine vitals
• Do cardiac assessment

24
Accelerated HTN Pg 513

• Markedly elevated BP, accompanied by hemorrhages
  exudates in the eye.
• If untreated, may progress to malignant HTN.

25
Malignant HTN

• Dangerously elevated BP accompanied by
  papilledema (swelling of the optic nerve at its
  point of entrance into the eye)

26
Malignant Hypertension Patho

• Have an abrupt onset if untreated, are followed
  by severe symptoms and complications.
• Fatal unless quickly reduced. Even with intensive
  tx the kidneys, brain, and heart may be
  permanently damaged
• Dangerously high and papilledema (swelling of
  optic nerve. Retinal hemorrhage leads to
  blindness
• Stroke, renal failure, left ventricular failure
  with pulmonary edema or MI if not lowered

27
Signs and Symptoms Pg. 513

• Confusion, headache, visual disturbances,
  seizures and possible coma
• Sudden marked rise in BP causes chest pain,
  dyspnea and moist lung sounds
• Renal failure is evidenced by less than 30 ml/hr.
• Sudden, severe back pain accompanied by
  hypotension is indication that aortic aneurysm is
  dissecting or has ruptured.
• 160/115 or higher suddenly, brain swells

28
Emergency Treatment of Malignant

• In true emergency goal is to lower BP within 1 to
  2 hours
• Nitropress, nitroglycerine, Normodyne IV given if
  critical
• If not critical, Procardia, verapamil, captopril,
  minipress given orally. Oxygen given to reduce
  hypoxia-induced tachycardia

29
Nursing care Pg. 514

• Give meds using pump, check rate hourly
• Automatic BP cuff if arterial line not used
• Restrict activity/ bedrest
• Report 160/115 stat
• Monitor for neurologic, cardiac and renal
  complications
• Crash cart in room

30
FYI

• Accelerated hypertension is characterized by
  markedly elevated BP
• Malignant hypertension is a dangerously elevated
  BP
• Both have changes in the eye. Ophthamologic
  changes indicate extremely high intravascular and
  rising intracranial pressures

31
HTN Complications4Cs

• CHF (congestive heart failure)
• CVA (cerebrovascular accident)
• CAD (coronary artery disease)
• CRF (chronic renal failure)

32
Interactive Crash Cart Tutorial (FYI) scroll
down link to view
http//richacls.com/Home20Page/Providers20Page/t
he_learing_center.htm