Hypertension (2).pdf

HYPERTENSION N221A - Med Surgical Aluem Tark, PhD, FNP-BC, RN, CHPN 1  HYPERTENSION For adults, HTN occurs when systolic BP is at or greater than 140 mm Hg or diastolic BP is at or greater than 90 mm Hg for two or more a...

HYPERTENSION N221A - Med Surgical Aluem Tark, PhD, FNP-BC, RN, CHPN 1  HYPERTENSION For adults, HTN occurs when systolic BP is at or greater than 140 mm Hg or diastolic BP is at or greater than 90 mm Hg for two or more assessment of BP For > 60 yrs, BP should be equal to or less than 150/90mm Hg Essential HTN (primary HTN) : accounts for most cases of HTN No known cause Secondary HTN Caused by disease (KD), Diabetes damaging renal filtration, glomerular disease or as an adverse effect of some medications Treatment related to removing the cause (tumor, medication) 20XX PRESENTATION TITLE 2 20XX PRESENTATION TITLE 3  HYPERTENSION Pre-hypertension Systolic blood pressure of 120 to 139 mmHg or a diastolic blood pressure of 80-89 mm Hg Prolonged, untreated or poorly controlled HTN -> Peripheral vascular disease primarily affecting heart, brain, eyes, and kidneys Increased risk with increased blood pressure Hypertrophy of the left ventricle: heart pumps against resistance caused by the HTN Health Promotion and Disease Prevention Lifestyle modification to prevent CVD Maintain BMI less than 30 DM patients – keep glucose within a recommended range Limit caffeine and alcohol intake Stress-management Stop smoking Engage in exercise Limit sodium and fat intake 20XX PRESENTATION TITLE 4  HYPERTENSION Four bodily mechanisms regulate BP Arterial baroreceptors Baroreceptors are located in the carotid sinus, aorta and left ventricle Stretch receptors that are stimulated by distortion of the arterial wall when pressure changes Control BP by altering the HR Also cause vasoconstriction and vasodilation Regulation of body-fluid volume Kidney function: retain fluid when hypotensive and excrete when hypertensive Renin-angiotensin-aldosterone system Renin -> angiotensin II Causes vasoconstriction and controls aldosterone release Causing the kidneys to reabsorb sodium and inhibit fluid loss End result: control sodium and water balance, influence BP and volume Vascular autoregulation Intrinsic capacity, to dilate or constrict in response to dynamic perfusion pressure changes, maintain blood flow relatively consistent Consistent levels of tissue perfusion 20XX PRESENTATION TITLE 5 20XX PRESENTATION TITLE 6  HYPERTENSION – RISK FACTORS Essential HTN Positive family history Excessive sodium intake Physical inactivity Obesity High alcohol consumption African American Smoking Hyperlipidemia Stress Age greater than 60 or postmenopausal (dec estrogen -> dec metabolic rate -> shift fat stores -> arteries become less flexible and narrow) Secondary HTN Kidney disease Cushing’s disease Primary aldosteronism Pheochromocytoma Brain tumors, encephalitis Medication Pregnancy 20XX PRESENTATION TITLE 7  HYPERTENSION Assessment When BP reading is elevated, take it in both arms Levels of HTN Elevated: Systolic 120-129 mm Hg and Diastolic less than 80 State 1 HTN: Systolic 130-139 mm Hg or diastolic 80 to 89 mm Hg Stage II HTN: Systolic greater than or equal to 140 mm Hg or diastolic greater than or equal to 90 mm Hg Lab Tests No lab tests to dx HTN Lab tests can identify the cause of secondary HTN and target organ damage BUN/ Creatinine: elevation indicative of Kidney disease Elevated blood corticoids: indicate Cushing’s disease Blood glucose and cholesterol: contributing factors related to blood vessel changes Diagnostic Procedures ECG: Tall R-waves are often seen with left-ventricular hypertrophy Chest X-ray: Left-ventricular hypertrophy 20XX PRESENTATION TITLE 8  HYPERTENSION Medication Added to treat HTN that’s not responsive to lifestyle changes Diuretics: often first line medication Combination of medications to control HTN Diuretics Thiazide diuretics: hydrochlorothiazide Inhibit water and sodium reabsorption, increase potassium excretion Loop diuretics (furosemide) Decrease sodium reabsorption and increase potassium excretion (need more potassium in your body: bananas!) Monitor potassium level, watch for hypokalemia (muscle weakness, irregular pulse) dehydration Monitor electrolyte imbalance (hyponatremia, hyperkalemia) Potassium-sparing diuretics (spironolactone) Affect distal tubule and prevent reabsorption of sodium in exchange for potassium 20XX PRESENTATION TITLE 9  HYPERTENSION Calcium Channel Blockers (Verapamil, Amlodipine, Diltiazem) Alter mvmt of calcium ions through the cell membrane, causing vasodilation and lowering blood pressure Monitor BP and pulse, change position slowly Verapamil: Constipation can occur, need more fiber Decrease or increase in HR and atrioventricular (AV) block can occur (irregular pulse rate) Avoid grapefruit juice, potentiates the medication’s effect, increased risk of toxicity, hypotensive effects Angiotensin-Converting Enzymes (ACE) inhibitor (lisinopril, enalapril) Prevents conversion of angiotensin I to angiotensin II, which prevents vasoconstriction Common adverse effect: Hypotension Can cause heart and kidney complications: watch for HF (e.g., edema) Report a cough Angioedema (life-threatening obstruction) 20XX PRESENTATION TITLE 10 20XX PRESENTATION TITLE 11 20XX PRESENTATION TITLE 12  HYPERTENSION Angiotensin-II receptor antagonists; Angiotensin-receptor blocks (ARBs) Valsartan, losartan Option for clients taking ACE inhibitors who report a cough or have hyperkalemia Block the effects of angiotensin II at the receptor and decrease peripheral resistance Do not require a dosage adjustment for older adult client (renal failure) Alter mvmt of calcium ions through the cell membrane, causing vasodilation and lowering blood pressure Aldosterone-receptor antagonists (ephlerenone, spironolactone) Block aldosterone action (aldosterone = increase in salt and water reabsorption into bloodstream) Promotes retention of potassium and excretion of sodium and water Monitor Kidney function Hyponatremia, hyperkalemia Potassium level every 2 weeks for the first few months, and every 2 months thereafter Avoid potassium supplements or potassium-sparing diuretics 20XX PRESENTATION TITLE 13  HYPERTENSION Beta Blockers (metoprolol, atenonol) Block the sympathetic nervous system (beta adrenergic receptors), produce a slower heart rate and lower BP Can cause fatigue, weakness, depression, and sexual dysfunction Do not suddenly stop: rebound HTN Reduce some manifestations of hypoglycemia, such as tachycardia Central-Alpha 2 Agonists (clonidine) Reduce peripheral vascular resistance Decrease BP by inhibiting the reuptake of norepinephrine Education: adverse effects: sedation, orthostatic hypotension, impotence Alpha-adrenergic Antagonists (prazosin, doxazosin) Reduce BP by causing vasodilation Start low, go slow 20XX PRESENTATION TITLE 14 20XX PRESENTATION TITLE 15  HYPERTENSION Education Watch for electrolyte imbalance Importance of adhering to the medication regimen Know adverse effect Monitor BP at home Orthostatic hypotension Lifestyle changes Less sodium Diet low in fat, saturated fat and cholesterol Limit alcohol consumption Dietary Approaches to Stop Hypertension Weight reduction and maintenance Exercise at least 3 times a week Stress reduction 20XX PRESENTATION TITLE 16  HYPERTENSION Hypertensive crisis Manifestation Severe HA Extremely high BP (Systolic > 180 mm Hg, diastolic > 120 mm Hg) Blurred vision, dizziness, and disorientation Epistaxis Administer IV antihypertensive therapies Nitroprusside, nicardipine, labetalol Goal: lower BP by 20-25% the first hour but not to drop BP to less than 140/90 mm Hg Slow and steady approach: Lowering BP too abruptly can lead to inadequate cerebral, renal and coronary blood flow Monitor BP before, during and after IV antihypertensive, every 5 min Neurologic status Pupil, level of consciousness, muscle strength for Cerebrovascular change 20XX PRESENTATION TITLE 17 20XX PRESENTATION TITLE 18 20XX PRESENTATION TITLE 19 THANK YOU 20XX PRESENTATION TITLE 20