Hypertension

Hypertension

1. Risk Factors/co-mobidities

   • Ethnicity
   • Gender
   • Socioeconomic Status
   • Sedentary Lifestyle
   • Obesity
   • Stress
   • Diabetes Mellitus
   • Elevated serum lipids
   • Age
   • Excess dietary sodium
   • Family History
   • Tobacco Use
   • Alcohol

2. Medications

   • Diuretics
     • Thiazide and related diuretics:  Inhibit NaCl reabsorption in the distal convoluted tubule (Chrolothiazide, Hydrochlorothiazide) Loop diuretics: Inhibit NaCl reabsorption in the ascending limb of the loop of Henle (Lasix and Bumex) Potassium Sparing Diuretics: Reduce K+ and Na+ exchange in the distal and collecting tubule (amiloride, triamterene) Aldosterone Receptor Blockers:  Inhibit the Na+ retaining and K+ excreting effects of aldosterone in the distal and collecting tubules (spironolactone, eplereone).
   • Calcium Channel blockers
     • Non-Dihydropyridines: Inhibit movement of Ca++ across cell membrane, resulting in vasodilation.  Cardioselective resulting in decrease in heart rate and slowing of AV conduction (diltiazem, verapamil) Dihydropyridines: Cause vascular smooth muscle relaxation resulting in decreased SVR and arterial BP (amlodipine, nifedipine)
   • Direct Vasodilators
     • Activates dopamine receptors, resulting in systemic and renal vasodilation, reduces SVR and BP by direct arterial vasodilation (fenoldopam, hydralazine).
   • Angiotensin inhibitors ACE/ARB
     • Angiotensin-Converting Enzyme inhibitors:  Inhibit ACE, reduce conversion of angiotensin 1 to angiotensin 2 (Lisinopril, enalapril) Angiotensin 2 receptor blockers: Prevent action of A-2 and produce vasodilation and increased Na+ and water excretion (losartan, valsartan)
   • Adrenergic Inhibitors agents
     • Central-Acting alpha adrenergic agonist: Reduce sympathetic outflow from CNS (Clonidine, clonidine patch). Peripheral-Acting alpha adrenergic Agonist: Depletes central and peripheral store of norepinephrine (Reserpine) alpha 1 adrenergic blockers: Block alpha adrenergic effects, producing peripheral vasodilation (doxazosin, prazosin). Beta adrenergic blockers: *Cardioselective agents block beta adrenergic receptors (metoprolol, nebivolol). *Non-cardioselective blockers: Nonselective agents block beta 1 and beta 2 adrenergic recpetors (nadolol, propanolol). Mixed alpha and beta blockers: alpha 1, beta 1, and beta 2 adrenergic blocking properties producing peripheral vasodilation and decreased heart rate
   • Renin Inhibitors
     • Renin inhibitors:  Directly inhibits renin, thus reducing conversion of angiotensingen to angiotensin 1 (aliskiren).

3. Clinical Manifestations/diagnostics/labs

   • Classification of Hypertension
     • Category .     SBP .             DBP Normal .        <120 .           <80 Pre-hyper .     120-139 .     80-89 Stage 1 .        140-159 .     90-99 Stage 2          >=160          >=100
     • Category . SBP . DBP Normal . <120 . <80 Pre-hyper . 120-139 . 80-89 Stage 1 . 140-159 . 90-99 Stage 2 >=160 >=100
   • "Silent Killer" . Asymtomatic
     • Symptoms secondatry to target organ disease
       • fatigue
       • dizziness
       • palpitations
       • Angina
       • dyspnea
   • Routine Urinalysis
   • BUN
   • Serum creatinine levels
   • Electrolytes
   • Blood glucose
   • Target Organ Disease
     • Cardiac
       • Coronary Artery Diesease Left Ventricular Hypertrophy Heart Failure
     • Renal
       • Nephrosclerosis
     • Periperal Vascular Disease
     • Cerebrovascular
       • Artherosclerosis, Atherosclerotic plaques.
     • Retinopathy

4. Plan of Care

   • Nursing Diagnosis
     • Risk for decreased cardiac tissue perfusion
     • Risk for ineffective cerebral tissue perfusion
     • Risk for ineffective renal perfusion
     • Potential Complications: MI, Stroke
     • Sexual Dysfunction related to side effects of antihypertensive medication
     • Anxiety related to complexity of management regimen
     • Ineffective health management related to lack of knowledge of pathology, complications, and management of hypertension
   • Expected Outcomes
     • acheive and maintain the goal BP
     • manage and cope with condition
     • follow the therapeutic plan, including apts with HCP
     • experience minimal side effects of therapy
   • Nursing Interventions
     • Health Promotion
       • DASH diet
       • Tobacco Cessation
       • Reduced Alcohol intake
     • Blood pressure measurements
     • Individual Patient Evaluation
       • Education