chapter 27 caring for clients with hypertension

bp = co (cardiac output) x pr (peripheral resistance)

1. the ability of the arteries to stretch and fill with blood
2. the efficiency of the heart as a pump
3. volume of circulating blood

1. age
2. body size
3. diet
4. activity
5. emotions
6. pain
7. position
8. gender
9. time of day
10. disease states

110/60 - 119/79

1. autonomic nervous system
2. kidneys
3. various endocrine glands

1. age
2. arteriosclerotic & atherosclerotic changes in blood vessels
3. diabetes
4. renal dysfunction

1. heart failure
2. renal failure
3. stroke

1. older adults
2. african americans
3. clients with diabetes

determined by the force and volume of blood that the left ventricle ejects during systole and the ability of the arterial system to distend at the time of ventricular contraction

loss of arterial elasticity

reflects arterial pressure during ventricular relaxation. It depends on the resistance of the arterioles and the diastolic filling times

hypertensive disease

120/80 - 139/89

stage 1 hypertension
140/90 - 159/99
stage 2 hypertension
160/100 or higher

when elevated bp causes a cardiac abnormality

when vascular damage is present without heart involvement

when both heart disease and vascular damage accompany hypertension

essential (primary: idiopathic) and secondary

95% of cases, is sustained elevated bp with no known cause

is eleveated bp that results from or is secondary to some other disorder

elevated bp that develops during evaluation by medical personnel, who traditionally have worn a white coat, taken again before pt leaves

elevated serum sodium level increases blood volume,which raises bp

may cause sodium retention as the kidneys try to maintain a balanced number of cations (positively charged electrolytes in body fluid

a hormone produced by the heart, results in an elevation of bp because its role is to promote the excretion of sodium by the kidneys

a tumor of the adrenal medulla

increased secretion of mineralcorticoid by the adrenal cortex

weight control drugs
caffeine

1. kidney disease
2. pheochromocytoma
3. hyperalosteronism
4. atherosclerosis
5. use of cocaine or cardiac stimulants
6. use of oral contraceptives

1. eyes
2. brain
3. heart
4. kidneys

retina may cause marked visual disturbances or blindness

hemorrhage or occlusion of a blood vessel in the brain

occlusion of a branch of a coronary artery

renal failure

at least every 6 months

1. angina
2. dyspnea

vascular changes in the eyes, retinal hemorrhages, or edema of the optic nerves

a sustained elevation of one or both bp measurements, bounding pulse, maybe overweight, flushed face, peripheral edema possiblly, eye exam

1. ekg, echo, chest xray
2. muga
3. bun and creatinine
4. urography
5. flueorescein angiography
6. ophthalmologic

lower the bp and prevent major complications

1. non pharmacologic
2. wt reduction
3. decreased salt intake
4. moderate exercise
5. stop smoking
6. stop drinking alcohol

reduce systolic below 140...ususally if you get it to 140, the diastolic will lower as well

the goal is to reduce the systolic to 130 or below

thiazide diuretic, then they add two or more antihypertensive meds to reduce their bp to targe level, if two dont do it a third or forth may do it

often resolves by treating the cause

consume less than 2300mg per day or no more than 1500 who are salt sensitive, one teaspoon of salt = 2300 mg of sodium 20% of sodium is too high

postural hypotension, which can lead to falls. teaching should include tips for managing syncope and dizziness

renal or hepatic impairment and older adults, a sudden drop in bp may occur during the first 1 to 3 hours after the initial dose of an ace inhibitor, administration of iv normal saline may manage the hypotensive episode

a persistant cough until the medication is discontinued

1. wt reduction
2. dash eating plan
3. low sodium
4. aerobic exercise
5. limit alcohol

bmi
18.5-24.9
reduces
5-20mmhg/10kg

diet rich in fruits, vegetables, low fat dairy, with reduced content of fats, red meat, sweets and sugared beverages

hypokalemia from diuretic drugs, lower doses of potassium wasting diuretics or the use of potassium sparing diuretics can control hypertension and minimize the risk of hypokalemia

tilt test
take bp in both arms
supine, sitting, standing
ask if they are dizzy

1. thiazide diuretics
2. beta blockers
3. ace inhibitiors
4. ARB
5. ALDO ANT

1. beta blockers
2. ace inhibitors
3. ALDO ANT

1. thiazide diuretics
2. betta blockers,
3. ace inhibitors
4. calcium channel blockers

1. thiazide diuretics
2. beta blockers
3. ace inhibitors
4. arb
5. calcium chanel blockers

1. ace inhibitors
2. arb

1. thiazide diuretics
2. ace inhibitiors

markedly elevated bp, accompanied by hemorrhages and exudates in the eyes, if untreated it can progress to malignant hypertension

describes dangerously elevated bp accompanied by papilledema, this is fatal unless bp is quickly reduced, even with treatment, the kidneys, brain, heart may be permanently damaged