11/04/2013

Do You Know?

HYPERTENSION
Alfrina Hany

Topics
Definition
Etiology
Classification
Clinical Manifestation
Diagnostic Tests
Complication

Hypertension
Hyper excessive / high
Tension Pressure
Hypertension High blood pressure
Williams & Hopper, 2007

The most common primary diagnosis in the United States, 50 million American
affected.
Only 70% are aware they have HTN, only 50% are being treated.
Only 25% of all hypertensive patients have their BP under control
Cardiovascular risk increases two-fold for each 20mm/Hg rise in systolic pressure or
each 10mm/Hg rise in diastolic pressure
Indonesia best 3, 7% mortality

What is Blood Pressure?

The force of blood against the wall of the
arteries.
Systolic- as the heart beats
Diastolic - as the heart relaxes
Written as systolic over diastolic in mm Hg
Williams & Hoppers, 2007

Why is High Blood Pressure Important?

Makes the Heart work too hard.
Makes the walls of arteries hard.
Increases risk for heart disease and
stroke.
Can cause heart failure, kidney
disease, and blindness. Heart
disease and stroke are the 1st and 3rd
leading causes of death in the U.S.

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Hypertension Defined

Hipertensi
keadaan bertahan dari kenaikan TD arterial

Hypertension (HTN)
is defined as
sustained abnormal
elevation of the
arterial blood
pressure (Brashers,
2006, p.1).

sistemik, ditandai dengan kenaikan curah

jantung /c.o dan tahanan periferal
vaskular/svr melibatkan multifaktorial
Brunner & Suddarth, 2009

Cardiac output

Factors Controlling BP

4.9 L/min

70 mls

70 bpm

Etiology
tidak dapat dihindari (heriditer, etnik, jenis kelamin, usia)
dapat dihindari (gaya hidup, diet, alkohol, obesitas)

Klasifikasi JNC VII (2003)

Category

Systolic

Diastolic

Normal

<120

and

<80

Pre-hypertension

120-139

or

85-89

Stage 1
hypertension

140-159

or

90-99

Stage 2
hypertension

>160

or

>100

penyakit penyebab (DM; CKD)

(Brashers, 2006, p.1)

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Klasifikasi berdasarkan tahapan

High Blood Pressure
Stage 1
Stage 2
Stage 3

140159 /9099
160179 /100109
180 /110

Klasifikasi berdasarkan penyebab (1)

Primary Hypertension
Is usually of gradual onset
Usually develops between the ages of
30 and 50
Tends to remain asymptomatic for 10
to 20 years
Essential or Primary-Underlying
pathophysiologic alteration of unknown
cause
95% of cases of HTN

Klasifikasi berdasarkan penyebab (2)

Contributing factors for Primary HTN:
Psychological stress, high-sodium intake,
and alcohol intake over 1 ounce per day
Increased activity of:
sympathetic nervous system (SNS)
Renin-angiotensin-aldosterone system (RAA)

Defects in natriuretic hormone function

Inflammation
Obesity
Endothelial dysfunction
Insulin resistance

Klasifikasi berdasarkan kegawatan

Hipertensi emergensi
TD diastolik>120 mmHg, kerusakan organ
target, keterlambatan kematian
Hipertensi urgensi
TD Diastolik > 120 mmHg, tanpa kerusakan
organ, harus diturunkan 24 jam

Secondary Hypertension

Secondary-Resulting from a
specific
cause such as renal
or endocrine
disorders;
Medications
5% of cases

Manifestasi Klinis
Silent killer symptoms free mild hypertension
Kelelahan, konfusi, nausea, vomit, ansietas, keringat
berlebihan, tremor, nyeri dada, epiktaksis,
pandangan kabur, nokturia, azotemia severe
hypertension

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Diagnostic Tests

Diagnostic Tests

Laboratorium:

Penunjang Lain:

HB nilai viskositas dan indikator faktor risiko (anemia, hiperkoagulability)

Leukosit infeksi/kegagalan sumsum tulang
BUN/Kreatinin perfusi/faal ginjal
Glukosa hiperglikemi
Kolesterol predisposisi terbentuknya plak
Serum aldosteron aldosteronisme primer
Asam urat faktor risiko
Elektrolit kalium, natrium, kalsium
Urine analisa darah, protein, glukosa, identifikasi fungsi renal

Tekanan darah sistemik

Web of Causation
Genetik,
gerontologi,
obesitas

DM

CT Scan emboli pada otak

Rontgen dada edema paru, kardiomegali
EKG kardiomegali, gangguan konduksi jantung
Phaechromecytoma kolesterol dalam darah dan urin
Echocardiogram: shows a graphic outline of the hearts movement

Pelepasan renin

Stress, cemas, takut

Merokok

Asetil kolin ke PD

Nikotin

PD Otak

Beban jtg

Angiotensin I
Hipertropi ventrikel

Mediator nyeri

Angiotensin II

Perubahan
struktur & Fgs PD

Norepineprin

Elastisitas PD

epineprin

Katekolamin

CO

Penurunan CO

Iskemi

Kelelahan

Aldosteron
Retensi Na & K

Pompa jantung

Vasokonstriksi PD

Aliran darah perifer

Tekanan sistemik

HypertensionComplication
Over long time, high bp damages arterial walls
Sclerosis, decreased lumen
Wall may dilate, tear
Aneurysm

Areas most frequently damaged:

Kidneys, brain, retina

Nyeri kepala
Nyeri akut/kronis

Ggn Perfusi Jar Intoleransi

aktivitas
Vol.intravaskuler
BUN & Cr

Filtrasi ginjal

Kelebihan Vol.Cairan

How Does It Effect the Body?

The Brain
High blood pressure is the most important risk
factor for stroke.
Can cause a break in a weakened blood vessel
which then bleeds in the brain.

End result of poorly controlled hypertension:

Chronic kidney disease

Stroke
Loss of vision
CHF

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The Heart
High Blood Pressure is a major risk factor for
heart attack.
Is the number one risk factor for Congestive
Heart Failure.

The Kidneys
Kidneys act as filters to rid the body of wastes.
High blood pressure can narrow and thicken the
blood vessels.
Waste builds up in the blood, can result in kidney
damage.

The Role of the Kidney

Renin is made by the juxtaglomerular cells of the kidney
Renin transforms plasma angiotensinogen to
angiotensin I which is converted to angiotensin II by
ACE
Angiotensin II alters BP by increasing both PVR and
blood volume by causing vasoconstriction and by
stimulating the secretion of aldosterone which increases
the reabsorption of sodium

The Kidney cont.

Angiotensinogen
Renin

Angiotensin I
ACE

vasoconstriction

Angiotensin II

Inc. PVR

aldosterone (inc. reabsorp of Na)

Inc. blood volume

The Eyes
Can eventually cause blood vessels to break
and bleed in the eye.
Can result in blurred vision or even blindness.

The Arteries
Causes arteries to harden.
This in turn causes the kidneys and heart to work
harder.
Contributes to a number of problems.

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Penatalaksanaan non Farmakologi

Life Style Changes
Following a healthy eating pattern.
Maintaining a healthy weight.
Being Physically Active.
Limiting Alcohol.
Quitting Smoking.

Tips for Reducing Sodium

Buy fresh, plain frozen or canned no added salt
veggies.
Use fresh poultry, lean meat, and fish.
Use herbs, spices, and salt-free seasonings at
the table and while cooking.
Choose convenience foods low in salt.
Rinse canned foods to reduce sodium.

Be Physically Active
Helps lower blood pressure and lose/
maintain weight.
30 minutes of moderate level activity on
most days of week. Can even break it
up into 10 minute sessions.
Use stairs instead of elevator, get off
bus 2 stops early, Park your car at the
far end of the lot and walk!

Maintain Healthy Weight

Blood pressure rises as weight rises.
Obesity is also a risk factor for heart
disease.
Even a 10# weight loss can reduce
blood pressure.
35-55% higher risk compared to
those maintaining ideal weight
BMI > 30 kg / m2 or waist girth > 100
cm (39.4 inches)

Limit Alcohol Intake

Alcohol raises blood pressure and can
harm liver, brain, and heart
What counts as a drink?
12 oz beer
5 oz of wine
1.5 oz of 80 proof whiskey

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Quit Smoking
Injures blood vessel walls
Speeds up process of hardening of the
arteries.
Current or quit within past 6 months
Stimulate E & NE => raise HR +
pheriperal vasoconstriction

Farmakologi
Vasodilator
Mengembangkan PD
arteri, kurangi
tahanan perifer
Diazoxide, Minoxidil,
Prozasin

Farmakologi
ACE Inhibitor
Diuretik
Hambat renin,
Turunkan volume
angiotensin,
plasma, retensi
vasodilatasi, turunkan
perifer
vol.darah
Furosemid, Thiazide
Captopril, Elanapril,
Ramipril

=ASKEP=Pengkajian
Tn.K, Usia 55 thn
Sangat pusing sekali
Usaha harus tutup
3 bulan ini pusing,
jarang OR, sering
makan malam hari
TB 170cm, BB 93kg
(BBI 63 kg, BMI 39,8)

Pengusaha rumahmakan
Nadi 60x/mnt regular
TD190/110mmHg,T36,7
Tangan dan kaki pucat
terut.saat elevasi, kulit
dingin dan lembab
CRT ekstremitas 3 dtk
Kolesterol total 245

Kalsium Antagonis
Hambat masukan ion
kalsium ke dalam sel
dan turunkan
afterload
Diltiazem, Nifedipin

Farmakologi
Beta Bloker
Kurangi impuls ke
jantung dan PD

Nervous system
inhibitors
slow nerve impulses
to the heart.

Askep=Analisa Data
Usia 55 tahun
Pengusaha RM
Sering makan di
malam hari
TB 170cm, BB 93 kg
BBI 63 kg, BMI
Total serum kolesterol
245 mg/dL.

Ketidakseimbangan
Nutrisi lebih dari
kebutuhan tubuh
intake makanan
berlebihan akibat
kebutuhan metabolik

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Askep=Analisa Data
Sering makan di
malam hari
Jarang berolahraga
Sebelumnya merasa
penyakit belum parah
sehingga tidak perlu
periksa

Inefective health
maintenance koping
individu yang tidak
efektif dengan gaya
hidup yang tidak sehat

Askep=Analisa Data
Sangat sibuk dengan Kurang Pengetahuan
usahanya
kurangnya paparan
informasi
Kadang pusing 3
bulan ini tapi tidak
pernah periksa
Klien suka makanan
berlemak dan merasa
hal tersebut biasa
dalam keluarganya

DAFTAR DIAGNOSA KEP

Ketidakseimbangan
Nutrisi lebih dari
kebutuhan tubuh
intake makanan
berlebihan
Inefective health
maintenance
(ketidakefektifan
pemeliharaan
kesehatan) gaya
hidup tidak sehat

Ketidakefektifan perfusi
jaringan perifer
hipertensi
Kurang pengetahuan
kurang informasi tentang
pengobatan
Risiko penurunan perfusi
jaringan jantung
Ketidaknyamanan
proses penyakit (HT)

Askep=Analisa Data
Mengatakan sakit kepala
Nadi 60x/mnt regular, TD
(duduk): 190/110 mmHg
Tangan dan kaki pucat
terutama saat elevasi,
CRT ekstremitas 3 detik
Kulit teraba dingin dan
lembab

Ketidakefektifan perfusi
jaringan perifer
proses penyakit
(hipertensi)

Askep=Analisa Data
Kepala sangat pusing
sekali

Ketidaknyamanan
proses penyakit

Diagnosa 1 Nutrisi
Dalam 4 minggu,
kelebihan nutrisi klien
dapat mencapai
indikator 3 pada
NOC : nutritional
status

Intake nutrient : diet seimbang : KH, Prot,

Lemak, Mineral indikator 3
Food intake : DASH bertahap mulai diet
HT 1 indikator 3
Energy : olahraga 30 menit sehari
indikator 3
Weight/height ratio : BBI dan BMI
menurun bertahap indikator 3

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Diagnosa 1 intervensi
Domain: Nutrition
1.1 Identifikasi pilihan
support
makan klien
Nutrition management 1.2 anjurkan intake
kalori yang sesuai
2.1 yakinkan perlunya
diet DASH
2.2 kolaborasi diet
DASH diet HT
sesuai klien

Conclusion
Cardiovascular disease is the number one killer.
Hypertension is a very controllable disease, with
drastic consequences if left uncontrolled.
It is highly preventable and controllable with diet
and exercise.
Good resource: www.americanheart.org ;
www.nhlbi.nih.gov

Thanks
Good Luck and see you around