Hypertension “the silent killer”
Jan 14, 2016
Hypertension
“the silent killer”
Regulation of Blood Pressure
Arterial baroreceptor system Regulation of body fluid volume Renin-angiotensin-aldosterone system Vascular autoregulation
Essential Hypertension No known cause Associated risk factors
1. Age >60, family history
2. Excessive calorie consumption, physical inactivity
3. Excessive alcohol intake
4. Hyperlipidemia
5. African ethnicity
6. High intake salt/caffeine
7. Reduced intake of potassium/calcium/magnesium
8. Obesity, smoking, stress
Risk FactorsModifiable & Non-modifiable
Vessel Wall Build-up
Complications of Hypertension Myocardial infarction Cerebrovascular accident Peripheral vascular disease Renal failure
Lifestyle Interventions Hypertension Sodium restriction Heart healthy diet Moderation of alcohol intake Exercise Relaxation techniques Smoke cessation Drug therapy
Sodium Restriction
Heart Dealthy Diet
Moderation of Alcohol
Exercise
Relaxation Techniques
Quit smoking
Supporting Smokers Who Want to Quit
• 70% of smokers want to quit
• 1/3 make a serious quit attempt each year
• There are effective treatments
• Nurses play a significant role in smoke cessation support
Nicotine Addiction
• Smokers are rapidly addicted to nicotine
• 7 of 10 adults regret smoking and would like to stop (70%)
• 98% relapse in one year in not “program”
• It takes 14-20 seconds for heroin to reach addiction centers when given IV
• It takes 7-10 seconds for nicotine to reach addiction centers when smoked
Immediate and long term benefits of quitting
> 20 mins BP and P go down to normal
Body temp returns to normal
> 8 hrs Carbon monoxide drops,O2 increases
>24 hrs Chance of MI goes down
> 48 hrs Food tastes and smells better
> 2 weeks Coughing, congestion, tiredness, SOB
Overall energy
> 1 year Risk of heart disease by 50%
> 10-15 yr Risk of dying prematurely = non smoker
Pharmacological Methods
• Nicotine replacement therapy (NRT)– Gum– Patch– Inhaler
• Bupropion (Zyban)
• Varenicline (Champix)
A slip is not a fall!
Advise to the client:
• Treat it like an emergency – get away from the trigger, get rid of the smokes
• Think about what happened, what went wrong and identify the triggers
• Remember the signs next time
• Feel good about how far you have come, picture yourself a non-smoker
• Diuretics Beta-adrenergic
blocking agents Calcium channel-
blocking agents Angiotensin-
converting enzyme inhibitors (ACE inhibitors)
Angiotensin II receptor antagonists (ARB)
Central alpha agonists
Vasodilators Alpha-adrenergic
receptor agonists
Drug Therapy Hypertension
Drug Therapy (related)
• Statins
• Anticoagulants
Classification
Diruretic
Generic/Trade Name
Effect on K+ Side/adverse effects
Nrsg Response
Loop Diuretic
Thiazide and Thiazide-like diuretics
Spironolactone
(Aldactone)
Secondary Hypertension
Related to specific disease states and medications
Diseases: Medications:
Secondary Hypertension Clinical manifestations
1. Symptomless
2. Headaches, dizziness, fatigue
3. Vascular changes in the retina
4. Abdominal bruits
5. Tachycardia
6. Sweating/pallor
7. Delayed/absent femoral pulses Nursing diagnosis
1. Deficient knowledge
2. Risk for ineffective therapeutic regimen management
3. Ineffective tissue perfusion
Malignant Hypertension Severe elevated B/P Rapidly progressive Symptoms:
1. Morning headaches
2. Blurred vision
3. Dyspnea/uremia
4. Diastolic B/P >150 mm Hg (130 mm Hg)
5. Untreated = renal failure, left ventricular failure, stroke
Hypotension/Shock
• Stages of shock
Type of shock Cause Patho S & S
hypovolemic
cardiogenic
Distributive• neurogenic
• septic
• chemical
Obstructive
Anaphylactic