◦ Alcohol restriction ( Alcohol intake should not exceed one serving of liquor, wine, or beer for women per day or two servings for men per day ). ◦ Exercise ( Aerobic exercise of 30 to 45 minutes most days of the week is recommended ). ◦ Low-fat diet ◦ Stress control Stepped-Care Approach
Second step ◦ Antihypertensive Third step ◦ More medications Stepped-Care Approach
Complementary and Alternative Therapies
Drugs work by decreasing blood volume, cardiac output, or peripheral resistance See Table 19-3 and Box 19-1 for common drugs Elderly pt’s on antihypertensives should have BP taken sitting and standing to monitor for orthostatic HYPOtension HTN (cont.) Antihypertensives
Rise slowly from a lying to a sitting position; do not hold your breath as you arise. Sit for 1 minute before standing; stand slowly holding onto a stable object. Stand for 1 minute before walking While seated, flex and rotate the feet several times before attempting to stand; have feet firmly planted on the floor before standing Preventing Falls for Patients with Orthostatic Hypotension
When walking, do not turn your head or body abruptly When feeling unsteady while standing, call for assistance before walking Report lightheadedness or sudden dizziness Use the bathroom before meals and try to avoid getting up for 30 to 60 minutes after meals. Preventing Falls for Patients with Orthostatic Hypotension (cont).
Malignant HTN: Rapidly progressive moderate to severe HTN that is difficult to control Diastolic pressures range from 140 to 170 Unless effectively treated, pt. may suffer damage to eyes, heart, kidneys, and brain Hypertensive emergency: Life-threatening. BP rises higher than 180/120 and there is target organ damage. Symptoms include HA, blurred vision, seizures, nausea change in LOC. May occur if pt. stops taking meds HTN (cont.) Complications
Hardening of the arteries Occurs w/aging, especially in small arteries and arterioles Characterized by thickening of artery walls that progresses to hardening as calcium deposits form. Vessel elasticity is lost Thickening and calcification reduce the diameter of vessels, causing slowing of flow May lead to ischemia and necrosis of various tissues Arteriosclerosis
Hypertension can cause damage to arteries, making them less elastic. This places an increased workload on the heart. This may cause myocardial infarction, left ventricular hypertrophy, and congestive heart failure Small vessel damage to the brain disrupts circulation and may lead to transient ischemic attacks (TIAs) and stroke Complications of Uncontrolled Hypertension
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- Spring '14
- Nursing, Cont, Venous Disorders, (HTN)