115-NCLEX-RN Review Made Incredibly Easy, Fifth Edition (Incredibly Easy...

Polish up on client care 49

ASSESSMENT FINDINGS Asymptomatic Cerebral ischemia Dizziness Elevated blood pressure Headache Heart failure Left ventricular hypertrophy Papilledema Renal failure Vision disturbances, including blindness

DIAGNOSTIC TEST RESULTS Blood chemistry tests show elevated sodium, BUN, creatinine, and cholesterol levels. Blood pressure measurements result in sustained readings higher than 140/90 mm Hg. Chest X-ray reveals cardiomegaly. ECG shows left ventricular hypertrophy. Ophthalmoscopic examination shows retinal changes, such as severe arteriolar nar-rowing, papilledema, and hemorrhage. Urinalysis shows proteinuria, RBCs, and WBCs.

NURSING DIAGNOSES Excess fluid volume Deficient knowledge (disease process and treatment plan)

Imbalanced nutrition: More than body requirements

TREATMENT Activity changes: regular exercise to reduce weight, if appropriate (see Treating hypertension: Step-by-step) Dietary changes: establishing a low-sodium diet and limiting alcohol intake (see Dash into dietary changes, page 50)

Drug therapy ACE inhibitors: captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil) Antihypertensives: methyldopa, hydralazine, prazosin (Minipress), doxazosin (Cardura) Beta-adrenergic blockers: propranolol (Inderal), metoprolol (Lopressor), carteolol (Cartrol), penbutolol (Levatol) Calcium channel blockers: nifedipine (Procardia), verapamil (Calan), diltiazem (Cardizem), nicardipine (Cardene) Diuretics: furosemide (Lasix), spironolac-tone (Aldactone), hydrochlorothiazide (Microzide), bumetanide (Bumex) Vasodilator: nitroprusside (Nitropress)

INTERVENTIONS AND RATIONALES Assess cardiovascular status, including vital signs to detect cardiac compromise.

Treating hypertension: Step-by-stepThe National Institutes of Health recommend a stepped-care approach for treating primary hyper-tension.

STEP 1The first step involves lifestyle modifications, including weight reduction, moderation of alcohol intake, reduction of sodium intake, and smoking cessation.

STEP 2If the client fails to achieve the desired blood pressure, continue lifestyle modifications and begin drug therapy. Preferred drugs include thiazide-type diuretics, angiotensin-converting enzyme (ACE) inhibitors, or beta-adrenergic blockers. If these drugs arent effective or acceptable, angiotensin receptor blockers or calcium channel blockers may be used.

STEP 3If desired blood pressure still isnt achieved, drug dosage is increased, another drug is substi-tuted for the first drug, or a drug from a different class is added.

STEP 4 If the client fails to achieve the desired blood pressure or make significant progress, add a second or third agent or a diuretic (if one isnt already prescribed). Second or third agents may include vasodilators, alpha1-antagonists, periph-erally acting adrenergic neuron antagonists, ACE inhibitors, and calcium channel blockers.

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