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Signs & Symptoms Headache, dizziness,
102 SimpleNursing.com 82% on Your Next Nursing Test blurred vision, nausea and vomiting, and chest pain and shortness of breath. Heart attack Heart failure Stroke or transient ischemic attack (TIA) Kidney failure Eye damage with progressive vision loss Peripheral arterial disease causing leg pain with walking (claudication) Outpouchings of the aorta, called aneurysms Nursing Assessment Nursing Intervention Rationale Goal Risk for prone behavior related to lack of knowledge about the disease INDEPENDENT: Define and state the limits of desired BP. Explain hypertension and its effect on the heart, blood vessels, kidney, and brain. ¨ Assist the patient in identifying modifiable risk factors like diet high in sodium, saturated fats and cholesterol. ¨ Reinforce the importance of adhering to treatment regimen and keeping follow up appointments. ¨ Suggest frequent position changes, leg exercises when lying down. ¨ Help patient identify sources of sodium intake. ¨ Encourage patient to decrease or eliminate caffeine like in tea, coffee, cola and hocolates. ¨ Stress importance of accomplishing daily rest periods. COLLABORATIVE: ¨ Provide ¨ Provides basis For understanding elevations of BP, and clarifies misconceptions and also understanding that high BP can exist without symptom or even when feeling well. ¨ These risk factors have been shown to contribute to hypertension. ¨ Lack of cooperation is common reason for failure of antihypertensive therapy. ¨ Decreases peripheral venous pooling that may be potentiated by vasodilators and prolonged sitting or standing. ¨ Two years on moderate low salt diet may be sufficient to control mild hypertension. ¨ Caffeine is a cardiac stimulant and may adversely affect cardiac function. ¨ Alternating rest and activity increases tolerance the patient was able to verbalize understanding of the disease process and treatment regimen.
103 SimpleNursing.com 82% on Your Next Nursing Test information Regarding community resources, and support patients in making lifestyle changes. to activity progression. ¨ Community resources like health centers programs and check ups are helpful in controlling hypertension. Hyperlipidemia (high cholesterol) Pathophysiology Hyperlipidemia is an excess of fatty substances called lipids, largely cholesterol and triglycerides, in the blood. It is also called hyperlipoproteinemia because these fatty substances travel in the blood attached to proteins. This is the only way that these fatty substances can remain dissolved... Signs & Symptoms Nursing Assessment Nursing Intervention Rationale Goal Myocardial Infarction Pathophysiology In an MI, inadequate coronary blood flow rapidly results in myocardial ischemia in the affected area. The location and extent of the infarct determine the effects on cardiac function. Ischemia depresses cardiac function and triggers autonomic nervous system responses that exacerbate the imbalance between myocardial oxygen supply and demand. Persistent ischemia results in tissue