Hypertension

“the silent killer”

Regulation of Blood Pressure

Arterial baroreceptor system Regulation of body fluid volume Renin-angiotensin-aldosterone system Vascular autoregulation

Essential Hypertension No known cause Associated risk factors

1. Age >60, family history

2. Excessive calorie consumption, physical inactivity

3. Excessive alcohol intake

4. Hyperlipidemia

5. African ethnicity

6. High intake salt/caffeine

7. Reduced intake of potassium/calcium/magnesium

8. Obesity, smoking, stress

Risk FactorsModifiable & Non-modifiable

Vessel Wall Build-up

Complications of Hypertension Myocardial infarction Cerebrovascular accident Peripheral vascular disease Renal failure

Lifestyle Interventions Hypertension Sodium restriction Heart healthy diet Moderation of alcohol intake Exercise Relaxation techniques Smoke cessation Drug therapy

Sodium Restriction

Heart Dealthy Diet

Moderation of Alcohol

Exercise

Relaxation Techniques

Quit smoking

Supporting Smokers Who Want to Quit

• 70% of smokers want to quit

• 1/3 make a serious quit attempt each year

• There are effective treatments

• Nurses play a significant role in smoke cessation support

Nicotine Addiction

• Smokers are rapidly addicted to nicotine

• 7 of 10 adults regret smoking and would like to stop (70%)

• 98% relapse in one year in not “program”

• It takes 14-20 seconds for heroin to reach addiction centers when given IV

• It takes 7-10 seconds for nicotine to reach addiction centers when smoked

Immediate and long term benefits of quitting

> 20 mins BP and P go down to normal

Body temp returns to normal

> 8 hrs Carbon monoxide drops,O2 increases

>24 hrs Chance of MI goes down

> 48 hrs Food tastes and smells better

> 2 weeks Coughing, congestion, tiredness, SOB

Overall energy

> 1 year Risk of heart disease by 50%

> 10-15 yr Risk of dying prematurely = non smoker

Pharmacological Methods

• Nicotine replacement therapy (NRT)– Gum– Patch– Inhaler

• Bupropion (Zyban)

• Varenicline (Champix)

A slip is not a fall!

Advise to the client:

• Treat it like an emergency – get away from the trigger, get rid of the smokes

• Think about what happened, what went wrong and identify the triggers

• Remember the signs next time

• Feel good about how far you have come, picture yourself a non-smoker

• Diuretics Beta-adrenergic

blocking agents Calcium channel-

blocking agents Angiotensin-

converting enzyme inhibitors (ACE inhibitors)

Angiotensin II receptor antagonists (ARB)

Central alpha agonists

Vasodilators Alpha-adrenergic

receptor agonists

Drug Therapy Hypertension

Drug Therapy (related)

• Statins

• Anticoagulants

Classification

Diruretic

Generic/Trade Name

Effect on K+ Side/adverse effects

Nrsg Response

Loop Diuretic

Thiazide and Thiazide-like diuretics

Spironolactone

(Aldactone)

Secondary Hypertension

Related to specific disease states and medications

Diseases: Medications:

Secondary Hypertension Clinical manifestations

1. Symptomless

2. Headaches, dizziness, fatigue

3. Vascular changes in the retina

4. Abdominal bruits

5. Tachycardia

6. Sweating/pallor

7. Delayed/absent femoral pulses Nursing diagnosis

1. Deficient knowledge

2. Risk for ineffective therapeutic regimen management

3. Ineffective tissue perfusion

Malignant Hypertension Severe elevated B/P Rapidly progressive Symptoms:

1. Morning headaches

2. Blurred vision

3. Dyspnea/uremia

4. Diastolic B/P >150 mm Hg (130 mm Hg)

5. Untreated = renal failure, left ventricular failure, stroke

Hypotension/Shock

• Stages of shock

Type of shock Cause Patho S & S

hypovolemic

cardiogenic

Distributive• neurogenic

• septic

• chemical

Obstructive

Anaphylactic