Presented by Asmaa abdelhameed ahmed

outlines
1. 2. 3. 4. 5. 6. 7. 8. Definition of hypertension. Classification of hypertension. Pathophysiology of hypertension. Etiology and risk factor of hypertension. Signs and symptoms of hypertension. Diagnostic evaluation of hypertension. Medical management of hypertension. Nursing management of hypertension

Definition of hypertension
Hypertension
refers to a state where a persons blood pressure remains at an elevated level at all times. This condition is formally known as arterial hypertension and is popularly called high blood pressure OR Hypertension is a disorder characterized by consistently high blood pressure as a systolic blood pressure greater than 140mmhg and a diastolic blood pressure greater than 90mmhg and called silent killer

Types of hypertension
Primary hypertension. 90 % to 95% of cases is unknown causes. Secondary hypertension. 5 % to 10% of cases is caused related to other diseases.
Kidney Abnormalities Narrowing of certain arteries Rare tumors Adrenal gland abnormalities Pregnancy

Risk factors of hypertension Modifaible Controllable Risk Risk Factors Factors

Increased salt intake Obesity Alcohol Stress Lack of exercise

Risk factors of hypertension

Uncontrollable Risk Factors Heredity Age
Men between age 35 and 50 Women after menopause

Race
-Higher incidence African Americans

Women with high blood pressure Birth Control Pill Pregnancy Overweight After Menopause African Americans

Risk Factors DiabeteMellitus Family History Advance age Obesity- Lifestyle Stress-Smoking

Pathophysiology

Kidney release RENIN into the bloodstream RENIN helps convert angiotensin I in liver Angiotensin I is converted to angiotensin II ( a potent vasoconstrictor) in lungs Angiotensin II

Aldosterone: Cause NA and water retension

Retained NA and Water Increased Blood Volume

Arteriolar constriction Increased Peripheral vascular resistance

Increased Blood Pressure and Vascular Resistance to Hypertension

Signs and symptoms

The onset of hypertension considered of "silent killer "often is gradual. Client may identify symptoms such as headache. Dizziness ,fatigue Insomnia ,nervousness Nose bleeding and blurred vision.

Signs and symptoms

Confusion, Vision problems Angina-like chest pain Cyanosis Dizziness, nausea, vomiting Fatigue Edema Dyspnea

Diagnostic evaluation
* Chest X-rays may reveal an enlarged left ventricular. Urinalysis, creatinine clearance Serum electrolytes, glucose BUN and serum creatinine Serum lipid profile ECG Echocardiogram

Pharmological treatments
Diuretics ("water pills") increase the amount of sodium and water excreted into the urine by the kidneys. It is thought that they lower blood pressure mainly by reducing the volume of fluid in the blood vessels. Furosemide - Lasix Aldactone Beta-blockers Beta blockers block the effect of adrenaline on the cardiovascular system, slow the heart rate, and reduce stress on the heart and the arteries. Penbutolol - Levatol Propranolol - Inderal

 Calcium Channel Blockers Calcium channel blockers can reduce blood pressure by dilating the arteries and, in some cases, reducing the force of the heart's contractions. Norvasc, and Lotrel Isoptin, and Covera Angiotensin Converting Enzyme Inhibitors The angiotensin converting enzyme inhibitors (the "ACE inhibitors") can lower blood pressure by dilating the arteries. Lotensin -Zestril Captopril Capoten - Monopril

 Angiotensin II Receptor Blockers The angiotensin II receptor blockers (the "ARBs") also reduce blood pressure by dilating the arteries. Candesartan - Atacand Losartan Cozaar Combination Drugs For Hypertension - Capozide - Lotrel - Hyzaar

Non pharmacological treatment

Lifestyles, Fitness and Rehabilitation

Blood pressure can be controlled not cured Decrease salt intake Eat for heart health Discuss the use of oral contraceptives with your doctor Discuss the use of some medications with your doctor\

-blood pressure checked regularly -Dont smoke cigarettes

Loose weight if your overweight Get regular physical activity

Home blood pressure monitoring

Mercury sphygmomanomete
Aneroid equipment Automatic equipment

Nursing diagnosis Decreased Cardiac Output related to increased afterload , vasoconstriction, myocardial ischemia, ventricular hypertrophy Pain: headache related to increased cerebral vascular pressure Ineffective Tissue perfusion : cerebral, renal, cardiac related to circulatory disorder Knowledge Deficit related to lack of information about the disease process and selfcare

Hypertension Nursing Interventions

Decreased Cardiac Output related to increased afterload, vasoconstriction, myocardial ischemia, ventricular hypertrophy Nursing Intervention for Hypertension *Monitor blood pressure *Note the central and peripheral pulse quality * Auscultation of heart and breath sounds *Observe skin color, moisture, temperature and capillary filling time *Observe the general edema Provide quiet environment, comfortable *Suggest to reduce activity. *Help perform self-care activities as needed Perform actions such as a comfortable back and neck massage *Encourage relaxation techniques *Give fluid restriction and sodium diet as indicated.

Hypertension Nursing Interventions

Risk for Ineffective Tissue Perfusion: Peripheral, Renal, Gastrointestinal, Cardiopulmonary related to impaired circulation Nursing Intervention for Hypertension Maintain bed rest, elevate head of bed Assess blood pressure at admission in both arms, sleeping, sitting with arterial pressure monitoring if available Maintain fluid and drugs. Observe the sudden hypotension. Monitor electrolytes, BUN, creatinine. Ambulation according to ability; avoid fatigue

Hypertension Nursing Interventions

Acute pain (headache) related to an increase in cerebral vascular pressure
Objective: Cerebral vascular pressure, not increased Nursing interventions: a. Maintain bed rest, quiet neighborhood, a little light b. Minimize environmental disturbances and stimulation c. Limit activity d. Avoid smoking or using the use of nicotine e. Give analgesia and sedation drugs to order f. Give a fun action according to indications such as ice packs, the position of comfort, relaxation techniques, guidance imagination, avoid constipation

Complication
1. 2. 3. 4. 5. 6. 7. Ischemic heart disease. pulmonary edema. Heart failure. Stroke. Neuropathy. Retinopathy. Peripheral artery disease.

Reference
WWW.Google.Com ( Nancy E. Smith and Barbara K. Timby 2007) Introductory medical surgical 9th Ed.