NCM 112 LEC
HYPERTENSION Methylphenidate
Ergotamine
HYPERTENSION Ketamine
systolic blood pressure > 140 mmHg and Desflurane
diastolic pressure > 90 mmHg Carbamazepine
more than 140/90 mmHg Bromocryptine
based on the average of 2 or more accurate BP Metoclopramide
measurements taken during 2 or more contacts Antidepressants
o Venlafaxine
Buspirone
TYPES OF HYPERTENSIONS Clonidine
PRIMARY HYPERTENTION (90 – 95%)
essential hypertension CLINICAL MANIFESTATIONS
cause: unidentified
SECONDARY HYPERTENSION (5 – 10%)
cause: identified
renal disease, endocrine disorder, certain
medications, pregnancy, vascular disorders
etc.)
COMPLICATIONS OF HPN
Heart Disease (CAD with angina or M.I, Left
Ventricular Hypertrophy, Heart Failure)
Chronic Kidney Disease (CKD)
Stroke CVA or TIA
Peripheral Arterial Disease
Retinopathy
RISK FOR HYPERTENSION
DIAGNOSTIC EVALUATION
Excessive Alcohol
Physical Inactivity Urinalysis
Cigarette Smoking Blood Chemistry – Serum Na, K, Creatinine,
Obese or Overweight Fasting Blood Glucose, Lipid Panel,
Chronic Kidney Disease Cholesterol Level
Family History of HPN 12 Lead ECG, Echocardiography
Certain Supplements & Medicines Additional Tests: Creatinine Clearance, Rennin
Stress Level Urine Test, 24 Hour Urine Collection
Too much Salt in Diet Retinal Examination and other laboratory
studies to check for target organ damage
DRUG-INDUCED HYPERTENTION
(PRESCRIPTION MEDICATIONS) ASSESSMENT
Steroids through health and physical examination
Estrogens risk factor assessment to classify and guide the
NSAIDS treatment
Phenylpropanolamines o MAJOR RISK FACTORS
Cyclosporine/Tacrolimus Smoking
Erythropoietin
Sibutramine
NCM 112 LEC
Dyslipidemia (elevated LDL producing slow HR, BP
or total cholesterol and/or
low HDL cholesterol)
MEDICAL MANAGEMENT
Alpha1 Blocker
peripheral vasodilator acting directly
GOAL of HPN treatment
on the blood vessels to hydralazine
prevent Complications and death by
achieving and maintaining the arterial BP at
Combined Alpha and Beta
140/90 mmHg or lower
Blockers
blocks alpha and beta adrenergic
Weight Reduction
receptors causing peripheral dilation
maintain normal body weight (BMI 18.5 – 24.9
and decrease peripheral vascular
kg/m2)
resistance
Adopt DASH (Dietary Approaches to
Vasodilators
Stop HPN) eating plan
consume diet rich in fruits, vegetables, and
Angiotensin – Converting Enzyme
low-fat dairy products with reduced content of
(ACE Inhibitors)
saturated and total fat
Angiotensin II Receptor Blockers
Dietary Sodium Reduction
(ARBs)
reduce to no more than 100 mmol per day (2.4
block the effects of angiotensin II at the
– 6 grams NaCl)
receptor
Physical Activity Calcium Channel Blockers
engage in regular aerobic physical activity at
least 30 minutes per day, most days of the
week THE NURSING PROCESS
Moderation of Alcohol Consumption Assessment
limit consumption to no more than 2 drinks careful monitoring of BP
per day in most men and no more than 1 assess for signs and symptoms that indicate
drink per day in women target organ damage
physical assessment
PHARMACOLOGIC THERAPY Diagnosis
deficient knowledge regarding relation
Diuretics: between the treatment regimen and control of
Thiazide the disease process
decreases blood volume, renal blood noncompliance with therapeutic regimen
flow; depletion of ECF; directly related to side effects of prescribed therapy
affects vascular smooth muscle
Planning and Goals
Loop – Volume Depletion
Major Goal
blocks reabsorption of Na+, Cl
o understanding of the disease process
and water in kidney
and its treatment, participation in self-
care program, and absence of
K+ Sparing Diuretic
complications
blocks Na reabsorption, acts on
distal tubule independently of
Nursing Interventions
aldosterone
increase the client’s knowledge
o disease process and impact of lifestyle
Aldosterone Receptor Blocker
competitive inhibitors of aldosterone changes and medications
binding
teaching patients self care
Central Alpha2 agonist and other centrally o educate client and family members
acting drugs about high blood pressure and how to
manage it through medication,
Beta Blocker lifestyle changes of diet, weight
control, and exercise, setting goal
NCM 112 LEC
blood pressures, and providing
assistance with social support
o provide written information about
the expected effects and side effects of
medications
o teach client about rebound PHARMACOTHERAPY
hypertension and that it occurs if
anti-HPN med are suddenly stopped INTRAVENOUS VASODILATORS
o teach male and female clients that Sodium Nitroprusside (Nitropress)
some medications, such as Beta Nicardine HCL (Cardene), Enalaprilat
Blockers, may cause sexual (Vasotec), and Nitroglycerine (Nitro-Bid)
dysfunction and that other given minutes to 4 hours
medications are available if problems extremely close hemodynamic monitoring of
in sexual function or satisfaction client’s BP and cardiovascular status
should arise
o encourage and teach clients to
measure BP at home HYPERTENSIVE URGENCY
o teach client regarding importance of
regular follow-up care INTRAVENOUS VASODILATORS
BP is very elevated but there is no evidence
monitor and manage complications of impending target organ damage
o stress importance of regular follow often associated with severe headaches,
up care to detect symptoms nosebleeds, or anxiety
suggesting that HPN is progressing
to the extent of target organ damage
TREATMENT
o caution patient and caregivers that
oral doses of fast acting agents
anti-HPN medication may cause
o Beta Blockers
HYPOTENSION and that low blood
pressure and Postural Hypotension o ACE inhibitors
should be reported immediately extremely close hemodynamic monitoring of
client’s BP and cardiovascular status
HYPERTENSICE CRISES
ANEURYSM
HYPERTENSIVE EMERGENCY
ANEURYSM
acute, life-threatening situation in which BP is
extremely elevated and must be lowered a localized sac or dilation formed at a
immediately in an intensive care setting to halt weak point in the wall of the artery
and prevent damage to target organs tends to enlarge gradually
some may remain stable over many
years of observation
CONDITIONS ASSOCIATED WITH
HYPERTENSIVE EMERGENCY CLASSIFICATIONS
HPN of pregnancy shape/form
Acute MI (Myocardial Infarction) TRUE ANEURYSMS
Dissecting Aortic Aneurysm Saccular
Intracranial Hemorrhage o a bulbous protrusion of one side of
the arterial wall
TREATMENT Fusiform
o symmetric, spindle-shaped;
THERAPEUTIC GOALS expansion of entire circumference
of involved vessel
reduction of the mean BP by up to 25% within
the first hour of treatment FALSE ANEURYSMS
further reduction of BP to a goal pressure of (PSEUDOANEURYSM)
Dissecting
about 160/100 mmHg over a period of up to 6
o usually, a hematoma that splits
hours, and then a more gradual reduction in
the layers of the arterial wall
BP over a period of days
NCM 112 LEC
more common in men than women
(50 – 70 years old)
factors: poorly controlled HPN,
blunt chest trauma, cocaine use
SOME OF THE CAUSES OF ANEURYSMS
TWO KINDS OF DISSECTING AORTA
weakness in the blood vessel wall that is present
from birth (congenital aneurysm) Ascending Aortic Dissection
o Marfan’s Syndrome Descending Aortic Dissection
o Ehlers-Danlos Syndrome
high blood pressure (hypertension) over many
years resulting in damage and weakening of blood
vessels
fatty plaques (atherosclerosis) resulting in a
weakness of the blood vessel wall
infections like syphilis
mechanical (post-stenotic and AV fistula)
pregnancy-related degenerative
anastomotic and graft aneurysms
smoking
intense anger
LOCATION
THORACIC AORTIC ANEURYSM
o most frequently in men (40 – 70 years
old)
o most common site for a dissecting
aneurysm
o usually asymptomatic in the early
stage
o cause: atherosclerosis (85%)
o 1/3 of patients die of rupture
ABDOMINAL AORTIC ANEURYSM
o usually below the renal arteries
(infrarenal aneurysms)
o common in Caucasian, the elderly,
and men (60 – 90 years old)
o most abdominal aneurysms are
asymptomatic
o occur more often than thoracic
aneurysm
OTHER ANEURYSMS
popliteal
subclavian
renal
femoral artery
DISSECTING AORTA
splitting of the arterial wall with
tearing of the intima or
degeneration of the media
