Hypertension

  1. General information
    1. According to the World Health Organization, hypertension is a persistent elevation of the systolic blood pressure above 140 mm Hg and of the diastolic above 90 mm Hg.
    2. Types
      1. Essential (primary, idiopathic): marked by loss of elastic tissue and arteriosclerotic changes in the aorta and larger vessels coupled with decreased caliber of the arterioles
      2. Benign: a moderate rise in blood pressure marked by a gradual onset and prolonged course
      3. Malignant: characterized by a rapid onset and short dramatic course with a diastolic blood pressure of more than 150 mm Hg
      4. Secondary: elevation of the blood pressure as a result of another disease such as renal parenchymal disease, Cushing's disease, pheochromocytoma, primary aldosteronism, coarctation of the aorta
    3. Essential hypertension usually occurs between ages 35 and 50; more common in men over 35, women over 45; African-American men affected twice as often as white men/women
    4. Risk factors for essential hypertension include positive family history, obesity, stress, cigarette smoking, hypercholesteremia, increased sodium intake
  2. Medical management
    1. Diet and weight reduction (restricted sodium, kcal, cholesterol)
    2. Life-style changes: alcohol moderation, exercise regimen, cessation of smoking
    3. Antihypertensive drug therapy (see Table 2.17, in Unit 2)
  3. Assessment findings
    1. Pain similar to anginal pain; pain in calves of legs after ambulation or exercise (intermittent claudication); severe occipital headaches, particularly in the morning; polyuria; nocturia; fatigue; dizziness; epistaxis; dyspnea on exertion
    2. Blood pressure consistently above 140/90, retinal hemorrhages and exudates, edema of extremities (indicative of right-sided heart failure)
    3. Rise in systolic blood pressure from supine to standing position (indicative of essential hypertension)
    4. Diagnostic tests; elevated serum uric acid, sodium, cholesterol levels
  4. Nursing interventions
    1. Record baseline blood pressure in three positions (lying, sitting, standing) and in both arms.
    2. Continuously assess blood pressure and report any variables that relate to changes in blood pressure (positioning, restlessness).
    3. Administer antihypertensive agents as ordered; monitor closely and assess for side effects.
    4. Monitor intake and hourly outputs.
    5. Provide client teaching and discharge planning concerning
      1. Risk factor identification and development/implementation of methods to modify them
      2. Restricted sodium, kcal, cholesterol diet; include family in teaching (see Related Links: Special Diets)
      3. Antihypertensive drug regimen (include family); see Table 2.17, in Unit 2
        1. names, actions, dosages, and side effects of prescribed medications
        2. take drugs at regular times and avoid omission of any doses
        3. never abruptly discontinue the drug therapy
        4. supplement diet with potassium-rich foods if taking potassium-wasting diuretics
        5. avoid hot baths, alcohol, or strenuous exercise within 3 hours of taking medications that cause vasodilation
      4. Development of a graduated exercise program
      5. Importance of routine follow-up care

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