HYPERTENSION

HYPERTENSION

1. Risk Factors

   • Increasing age, family history, ethnicity, gender & genetics
     • (Lewis, Heitkemper, Dirksen, & Bucher. 2014)
   • Obesity, tobacco use, sedentary lifestyle, metabolic syndrome, heavy alcohol consumption
     • (Lopez, Stuckey & Mallory, 2016)
   • Increase fat and sodium intake, Inadequate potassium and calcium intake
     • (Lewis, Heitkemper, Dirksen, & Bucher. 2014)
   • Socioeconomic and psychological status
     • (Doyle-Cox, Brousseau, Tulloch, Mielniczuk, Davies, Sherrard, & Clark, 2016)

2. Diagnostic/Labs

   • BP: SBP>140mmHg DBP>90mmHg
     • (Merai, Siegel, Rakotz, Basch, Wright, Wong, & Thorpe. 2016)
   • Sodium, Potassium & Creatinine Levels
     • (Copstead, & Banasik. 2013)
   • Serum total cholesterol, ECG, Pulmonary edema, Presence of abdominal bruit

3. Clinical Manifestations

   • Scenario #1: SBP>140mmHg, DBP>90mmHg, forceful apical pulse, left ventricular hypertrophy, abnormal heart sounds, orthostatic change in blood pressure and pulse
     • Nursing Diagnosis: Ineffective cardiac ouput
       • Medical Diagnosis: Cardiac pump effectiveness
         • Nursing Interventions: Monitor vital signs, administer medications, monitor cardiac rhythm, monitor fluid balance
           • (Merai, Siegel, Rakotz, Basch, Wright, Wong, & Thorpe. 2016)
       • (Lewis, Heitkemper, Dirksen, & Bucher. 2014)
   • Scenario #2: Fatigue, dyspnea, decreased LOC, palpitations, angina, headache, stupor, coma, confusion, anxiety, seizure
     • Nursing Diagnosis: Ineffective cerebral perfusion
       • Medical Diagnosis: Stable LOC
         • Nursing Interventions: Frequent neurological assessment of LOC, papillary size and reaction, movement of extremities, reaction to stimuli
           • Good sleep and relaxation also key!
           • (Lewis, Heitkemper, Dirksen, & Bucher. 2014)
   • Scenario #3: Abnormal serum electrolytes/creatine/glucose and cholesterol, elevation and evidence of ischemic heart disease and left ventricular hypertrophy
     • Nursing Diagnosis: Ineffective self-health management
       • Medical Diagnosis: Hypertension management (knowledge)
         • Nursing Interventions: Asses knowledge about HTN, explain pathophysiology, required lifestyle changes, health teaching about medications, asses level of understanding and comprehension
           • (Park, & Kim. 2015)
       • (Lewis, Heitkemper, Dirksen, & Bucher. 2014)
   • (Copstead, & Banasik. 2013)

4. Collaborative Care

   • Blood pressure monitoring, ECG monitoring,regular exercise, stress management, weight reduction, dietary changes
     • (Lopez, Stuckey & Mallory, 2016)

5. Medication

   • Thiazide diuretics, ACE I's, ARB's, Long-acting CCB's, Beta-blockers
     • (Copstead, & Banasik. 2013)