SESSION 12: NURSING

CARE OF A PATIENT
WITH HYPERTENSION
STEVE FM
120’
Learning Tasks
• At the end of this session each learner is expected to be able to:
• Define hypertension
• Explain causes of hypertension
• Explain risk factors for hypertension
• Explain the pathophysiology of hypertension
• Outline sign and symptoms of hypertension
• Describe complications of hypertension
• Give care to a patient with hypertension and hypertensive
complications
Definition

• Hypertension is a systolic blood pressure greater than 140

mmHg and a diastolic pressure greater than 90 mmHg over a
sustained period, based on the average of two or more blood
pressure measurements taken in two or more contacts with
the health care provider after an initial screening.
• There are two major classification of hypertension namely
essential and secondary hypertension
Causes of Hypertension
• The causes of hypertension
• The causes for essential hypertension are not known but
multiple risk factors are involved including alcohol
consumption, stress, obesity, and genetic.
• Secondary hypertension may be caused by any primary
condition that affects fluid volume or renal function or
causes arterial vasoconstriction eg. Renal vascular diseases,
endocrine problems, vascular problems, over the counter
medications, genetic problems.
Risk Factors for Hypertension
• The following are the risk factors for hypertension:
• Age (older adult) BP tends to increase with age most likely from
arteriosclerotic and atherosclerotic changes in blood vessels
• Gender (more common in men)
• Client with chronic diseases such as diabetes mellitus and renal
dysfunction
• Ethnic group (Essential hypertension affects African Americans at a
higher rate than it does other ethnic groups).
Risk factors…
• Genetic and family history of hypertension
• Obesity or being overweight
• Less of physical activity
• Sedentary lifestyle
• Smoking (tobacco use)
• Excessive alcohol intake
Risk factors…
• Ineffective stress management
• High dietary intake of saturated fats or sodium
• Insufficient calcium, potassium, and magnesium
consumption
• Adrenal and thyroid problems or tumors
• Hormonal contraceptive use
Pathophysiology of
Hypertension
• Several theories help to explain the development of hypertension. It’s
thought to arise from:
• Changes in the arteriolar bed that cause increased resistance
• Abnormally increased tone in the sensory nervous system that originates in
the vasomotor system centres, causing increased peripheral vascular
resistance
• Increased blood volume resulting from renal or hormonal dysfunction
• Increased arteriolar thickening caused by genetic factors, leading to
increased peripheral vascular resistance
• Abnormal renin release, resulting in the formation of angiotensin II, which
constricts the arterioles and increases blood volume
• The pathophysiology of secondary hypertension is related to the
underlying disease.
• The most common cause is chronic renal disease. Insult to the kidney
from chronic glomerulonephritis or renal artery stenosis can interfere
with sodium excretion, the renin-angiotensin-aldosterone system, or
renal perfusion. This in turn causes blood pressure to rise.
• Other diseases can also underlie secondary hypertension. In Cushing’s
syndrome, increased cortisol levels raise blood pressure by increasing
renal sodium retention, angiotensin II levels, and vascular response to
norepinephrine.
• In primary aldosteronism, increased intravascular volume, altered
sodium concentrations in vessel walls, or very high aldosterone levels
cause vasoconstriction (increased resistance).
• Pheochromocytoma is a secreting tumor of chromaffin cells, usually
of the adrenal medulla. It causes hypertension by increasing
epinephrine and norepinephrine secretion. Epinephrine functions
mainly to increase cardiac contractility and rate; norepinephrine,
mainly to increase peripheral vascular resistance
signs and symptoms
• The following are signs and symptoms of hypertension
• Blood pressure measurements of more than 140/90 mm Hg
on two or more readings taken at two or more visits after an
initial screening
• Throbbing or pounding headache
• Dizziness
• Fatigue
• Insomnia
• Nervousness
• Nosebleeds
• Blurred vision or double vision
• Nausea.
• Palpitation
• Angina pain or dyspnea
• Myocardial infarction
• Clients may be overweight.
• They may have a flushed face from engorgement of
superficial blood vessels.
• Peripheral edema may be present.
• An ophthalmic examination may reveal vascular changes in
the eyes, retinal hemorrhages, or edema of the optic nerves,
known as papilledema
Complications of Hypertension
• The following are complications of hypertension:
• Cardiomegaly
• Left ventricular hypertrophy
• Heart failure:
• To pump blood against the higher pressure in the vessels, the heart
muscle thickens. Eventually, the thickened muscle may have a hard
time pumping enough blood to meet body’s needs, which can lead to
heart failure
• Myocardial ischemia (client experiences angina)
Complications…
• Aneurysm:
• Increased blood pressure can cause the blood vessels to weaken and
bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-
threatening.
• Haemorrhage of tiny arteries in the retina may cause marked visual
disturbances or blindness.
• A cerebrovascular accident (stroke) may result from hemorrhage or
occlusion of a blood vessel in the brain.
Complications…
• Myocardial infarction (MI) may result from occlusion of a
branch of a coronary artery
• Glomerular injury
• Peripheral arterial disease
• Impaired circulation to the kidneys may result in renal
failure.
Care of a Patient with
Hypertension
• Care of a patient with hypertension
• The main goal of treatment for hypertension is to lower
blood pressure to less than 140/90 or even lower in some
groups such as people with diabetes, and people with
chronic kidney diseases. High blood pressure may be treated
medically and by changing lifestyle factors, or a combination
of the two.
• Lifestyle modification:- Teach the patient on the importance of
changing lifestyle including:
• Weight reduction
• Limit alcohol intake
• Increase aerobic physical activity
• Reduce sodium intake (table salt)
• Maintain adequate intake of dietary potassium, calcium and magnesium,
• Stop cigarette smoking
• Reduce intake of dietary saturated fat and cholesterol
• Carefully monitoring of the blood pressure at frequent intervals
• Drug therapy:- Emphasize patient on the importance of
adherence to drug regime
• Drug therapy should be considered only if the diastolic blood
pressure checked at least three occasions over 6 months in spite of
change of lifestyle. Drug therapy is recommended in moderate and
or severe hypertension. Recommended drugs of choice includes
the following steps
• Step one
• Bendrofluazide 2.5 – 5 mg daily.
• Hydrochlorthiazide 12.5 – 25 daily.
• Step two
• Hydrochlorothiazide 25 mg daily plus methyldopa 250 mg two
or three times a day or
• Propranolol 160-320 mg once daily or
• Atenolol 50 – 100 mg once daily or
• Nifedipine modified release 20-30 mg once daily.
• Step three
• Captoril 12.5 – 25 mg every 8 hours.
• Nursing care:
• Monitor for vital signs and cardiac rhythms
• Monitor patient for fluid overload
• Monitor input and output (urine output)
• Administer antihypertensive agents as prescribed
• Establish IV access
• Give oxygen whenever necessary
• Monitor for possible adverse effect of all antihypertensive
drugs including postural hypotension, which can lead to
falls
• Teach the patient on adherence to the treatment regimen
by implementing necessary lifestyle changes, taking
medications as prescribed, and scheduling regular follow-
up appointments with the health care provider to monitor
progress of the disease