lect 1 cardiovascular disorders
TRANSCRIPT
ANATOMY & PHYSIOLOGY OF THE HEART: A QUICK REVIEW
HYPERTENSION
DEFINITION & STAGES
Hypertension is defined as systolic blood pressure ≥140 mmHg or
diastolic blood pressure ≥90 mmHg.
Hypertension is divided into two stages.
BP classification Systolic BP (mmHg) Diastolic BP (mmHg)
Normal <120 <80
Prehypertension 120–139 80–89
Stage 1 hypertension 140–159 90–99
Stage 2 hypertension or ≥160 ≥100
There is another Classification according to causes:
•Essential ( primary) hypertension, of unknown cause.
•Secondary hypertension, due to specific causes as renal disease,
medications, adrenal disease and hypertension in pregnancy.
Risk factors
•Genetic
•High sodium, cholesterol and saturated fat intake
•Increased alcohol intake
•Smoking
•Psychological and environmental stressors
•Old age
CAUSES OF HYPERTENSION
Clinical manifestation
•It can be asymptomatic
•When symptoms appear, they usually indicate vascular damage
with specific manifestations related to the organ systems served by
the involved vessels
•Coronary artery disease with angina
•Left ventricular hypertrophy
•Left ventricular failure
•Pathologic changes in the kidneys may be manifested by
nocturia and azotemia
Diagnosis of hypertension Blood pressure measurement Condition of the patient
Posture • Sitting pressures are usually adequate for routine measurement of blood pressure.
Circumstance
•A quiet warm setting is required.
•No caffeine, smoking or alcohol for preceding 30 minutes.
•Question about the most recent meal or evacuation of bowels or bladder. Distended abdominal viscera
cause blood pressure elevation presumably because of anxiety, sympathetic stimulation and pain.
•Older persons typically have lower blood pressure post-prandially.
•No exogenous adrenergic stimulants e.g. nasal decongestants or eye drops for papillary dilatation.
Blood pressure measurement
•Take THREE readings (ignore the first) on THREE SEPARATE occasions unless there is
evidence of end organ damage
• Use an efficient DEVICE ONLY i.e. mercury device & NOT an anaeroid one
• Ensure that an appropriate sized cuff is used for overweight patients
• Measure BP in both arms as part of the initial assessment to detect stenosis / occlusion of
a large artery. A difference of >20 mmHg is significant and may indicate a stenosis in the
arm with the lower BP. The arm with the higher BP reading should be used subsequently
INVESTIGATIONS ROUTINELY INDICATED: (FIRST VISIT)
•• Urinalysis for protein / blood
•• Serum electrolytes, bicarbonate and creatinine
•• Random plasma glucose – if elevated, repeat with fasting sample
•• Random lipid profile (including total cholesterol, HDL, LDL and triglyceride levels)
•• ECG
•For selected patients:
•• Echocardiography
•• Plasma renin level
•• Plasma aldosterone level - especially if the renin is low
Management
Goal: To achieve and maintain an arterial blood pressure below 140/90 mm
Hg whenever possible.
Non pharmacologic approaches:
•Weight reduction
•Restriction of sodium, tobacco and alcohol
•Exercise
•Relaxation
Medications:
•Diuretics
•Beta blockers
1. Assessment
•Monitor blood pressure at frequent intervals then at routine
schedule intervals.
•Nosebleeds
•Anginal pain
•Shortnees of breath
•Alteration in vision
•Vertigo, headache
•Rate and rhythm of apical and peripheral pulse
2. Nursing diagnosis
•Knowledge deficit regarding the relationship between the treatment
regimen and control of the disease process
•Potential noncompliance to the self-care program related to side
effects of prescribed therapy
3. Planning and intervention
Goal: Understanding the disease process and its treatment, compliance
with the self-care program, and absence of complication
•Patient/Family Education in Hypertension
General information
• Information on the disease process, the disease promoting factors and
the complications,
• Assistance to recognize personal risk factors
• Explanation of what BP is
• Explanation of the systolic and diastolic BP, teaching BP reading and
interpretation.
Symptoms which must be reported
• Chest pain,
• Dyspnea,
• Edema (weight gain of 1-2 kg/day or 3-5 kg/week),
• Epistaxis,
• Vision changes,
• Headache (in the morning, at the occipital region),
• Vertigo,
• Palpitation.
Specific Education
• Explaining the aim of the treatment of hypertension
• • Instructions on how and when to measure BP at home:
Daily at the same time,
Reading and recording BP,
Avoiding eating and activities before the measurements,
Informing the physician or the nurse if BP is high
Specific Education
• Explanation of necessary life-style changes (dieting, exercising,
coping with stress, controlling BP, regular medication)
• Explaining the necessity of stop all tobacco products,
• Explaining the necessity of preventing obesity.
DRUGS
• Activity
• Walking rapidly for 30-45 minutes, at least 3-4 times per week
• Avoid isometric exercises (lifting or pushing heavy weights, opening jars or
windows)
• The aim, dose, administration times and routes
• The necessity of taking drugs on time and of reporting side effects are
emphasized.
DIET
Water retentive effects of salt and
ways of minimizing intake of salt
• Foods with high salt content (fast
foods) are avoided
• Salt cellar is removed from the table.
• Alcohol intake is restricted
• Care is taken to ingest potassium
with diet including fresh fruits and
vegetables,
• Diet is planned by consulting the
dietitian.