Melinda Sanders MSN,RN CARE OF PATIENTS WITH HYPERTENSION AND PERIPHERAL VASCULAR DISEASE 1
Pressure Exerted by Blood on Walls of Blood Vessels Determined by Cardiac Output, Peripheral Vascular Resistance (PVR), Vessel Stretch, Blood Viscosity, Blood Volume Systolic- contraction of the ventricles Diastolic- pressure of the ventricles at rest Hypertension is a condition in which the BP is above prehypertension levels Chart 18-1 Be familiar with these Blood Pressure 2
Hypertension Incidence 2011–2012: 29% U.S. Adults > 18 Years of Age Increases with Age Non-Hispanic Blacks: 42.1% Non-Hispanic Whites: 28% Mexican Americans: 26% 3
Classification of Hypertension Normal: SBP: <120 DBP: <80 Prehypertension SBP: 120-139 DBP: 80-89 Stage 1 Hypertension SBP: 140-159 DBP: 90-99 Stage 2 Hypertension SBP: ≥160 DBP: ≥100 Average of two or more readings on different dates Highest Reading Determines Category 4
Follow-Up Care Normal BP 2 Years Pre-hypertension 1 Year Stage 1 Hypertension 2 Months Stage 2 Hypertension 1 Month >180/110 mm Hg: Immediate Treatment 5
Primary Hypertension Unknown Cause, but have common contributing factors Secondary Hypertension Known Cause Isolated Systolic Hypertension SBP >140 mm Hg Pathophysiology of Hypertension 6
Risk Factors/Common Contributing Factors for Primary Hypertension Nonmodifiable: Age Gender Genetics Modifiable Alcohol intake Smoking Diabetes Stress Cholesterol High salt diet Decreased kidney function 7
Hypertension Signs/Symptoms None “Silent Killer” Rare Headache, Bloody Nose, Anxiety, Dyspnea Target Organ Disease Damage to Blood Vessels of Heart, Kidney, Brain, Eyes
Silent Killer: no signs or symptoms 9
Diagnosis of Hypertension History... Don’t forget Family History Signs and Symptoms Kidney or Heart Disease Medications Blood Pressure Readings Home Blood Pressure Measurements EKG, Echo, and stress test may be ordered to determine if damage to heart muscle has occurred
Hypertension Treatment No/Low Risk Hypertensive Lifestyle Changes Goal of Hypertension Treatment 60 years or older: <150/90mmHg 30 – 59 years old: < 90mmHg diastolic Other adults: <140/90mmHg Chronic kidney disease or diabetes: <140/90mmHg
Thiazide Diuretics Increase urine output by promoting NA, and H2O excretion HydrochloroTHIAZIDE (Hydrodiuril) HCTZ chloroTHIAZIDE (Diuril) Thiazide Like Diuretics indapmide (Lozol) Metolazone (Zaroxolyn) *Cause loss of K , NA, and MG *Causes Sun sensitivity *Careful with patients on Digoxin
Loop Diuretics Acts on the ascending loop of Henle in kidney to cause Na and H2O loss furosemIDE (Lasix) bumetanIDE (Bumex) torsemIDE (Demadex) *Causes loss of K, MG, and Ca *Don‘t give with Sulfa Allergy *Encourage to take with food *Causes Sun Sensitivity **Check BP prior to giving
Potassium-Sparing Diuretics YAY..We get to keep the K!
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- Fall '19