HYPERTENSION

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Presentation Transcript

HYPERTENSION : 

HYPERTENSION

DEFINITION : 

DEFINITION Hypertension (high BP) is a disease of vascular regulation in which the mechanisms that control arterial pressure within the normal range are altered. Predominant mechanisms of control are the central nervous system (CNS), the renal pressor system (renin-angiotensin-aldosterone system), and extracellular fluid volume.

TYPES OF HYPERTENSION : 

TYPES OF HYPERTENSION PRIMARY HYPERTENSION SECONDARY HYPERTENSION ACCELERATED HYPERTENSION

CLASSIFICATION OF BLOOD PRESSURE FOR ADULTS : 

CLASSIFICATION OF BLOOD PRESSURE FOR ADULTS

PRIMARY HYPERTENSION : 

PRIMARY HYPERTENSION Also called as Essential Hypertension Approx. 95% of patients Diastolic -- 90 mm of Hg Systolic -- 140 mm of Hg or more

CAUSES : 

CAUSES Idiopathic Hyperactivity of sympathetic vasoconstricting nerves Presence of vasoactive substance on smooth muscle Increased cardiac output, followed by arteriole constriction Excessive dietary sodium intake, sodium retention, insulin resistance, and hyperinsulinemia Familial (genetic) tendency

ISOLATED SYSTOLIC HYPERTENSION : 

ISOLATED SYSTOLIC HYPERTENSION Systolic BP elevation in the absence of elevated diastolic BP is termed isolated systolic hypertension

SECONDARY HYPERTENSION : 

SECONDARY HYPERTENSION Occurs in approx. 5% of patients with hypertension Renal pathology: Congenital anomalies, pyelonephritis, renal artery obstruction, acute and chronic glomerulonephritis Reduced blood flow to kidney causes release of renin. Renin reacts with serum protein in liver Coarctation of aorta Endocrine disturbances: Pheochromocytoma Adrenal cortex tumors Cushing’s syndrome Hyperthyroidism Medications such as estrogens, sympathomimetics, antidepressants, NSAIDs, steroids

Consequences of Hypertension : 

Consequences of Hypertension Prolonged hypertension damages blood vessels in the brain, eyes, heart, and kidneys and increases the risk of stroke, angina, MI, blindness, and heart and kidney failure Blood vessel damage occurs through arteriosclerosis in which smooth muscle cell proliferation, lipid infiltration, and calcium accumulation occur in the vascular epithelium Damage to heart, brain, eyes, and kidneys is termed target organ disease; this is the major object of prevention in patients with high BP

Risk Factors : 

Risk Factors Increase in incidence is associated with the following risk factors :- Age:- between 30 and 70 Race:- Black Overweight, sleep apnea Family history Smoking Sedentary lifestyle Diabetes mellitus Metabolic syndrome

RESEARCH EVIDENCE : 

RESEARCH EVIDENCE Prevalence Black -30% Non-hispanic whites-25% Mexicans-Americans-22% Recent data have shown that only 70% of adults with hypertension are aware of it, 59% receive treatment, and only 34% reach BP control (less than 140/90 mm Hg).

CLINICAL MANIFESTATIONS : 

CLINICAL MANIFESTATIONS Usually asymptomatic May cause headache, dizziness, blurred vision when greatly elevated BP readings more than 140/90 mm of Hg

DIAGNOSTIC EVALUATION : 

DIAGNOSTIC EVALUATION ECG Chest X-ray Proteinuria, elevated serum blood urea nitrogen (BUN), and creatinine levels Serum potassium Urine (24-hour) for catecholamines Renal scan Renal duplex imaging Outpatient ambulatory BP measurements

MANAGEMENT(lifestyle modifications) : 

MANAGEMENT(lifestyle modifications) Lose weight if body mass index is greater than or equal to 25. Limit alcohol Get regular aerobic exercise equivalent to 30 to 45 minutes of brisk walking most days. Cut sodium intake to 2.4 g or less per day Include recommended daily allowances of potassium, calcium, and magnesium in diet. Smoking cessation Reduce dietary saturated fat and cholesterol Consider reducing coffee intake

CONTD… : 

CONTD… If, despite lifestyle changes, the BP remains at or above 140/90 mm Hg over 3 to 6 months, drug therapy should be initiated If BP extremely elevated or in presence of cardiovascular risk factors, single drug therapy may be given

CONSIDERATIONS IN SELECTING THERAPY : 

CONSIDERATIONS IN SELECTING THERAPY Race:- Blacks respond well to diuretic therapy; Whites respond well to ACE inhibitors Age:- some adverse effects may not be tolerated well by elderly people Concomitant diseases and therapies:- some agents also treat migraines, benign prostatic hyperplasia, heart failure Quality of life impact:- tolerance of adverse effects Economic considerations:- newer agents very expensive

ANTI-HYPERTENSIVE DRUG GROUPS : 

ANTI-HYPERTENSIVE DRUG GROUPS Diuretics Beta-adrenergic blockers Alpha-receptor blockers Central alpha agonists Peripheral adrenergic agents Combined alpha and beta-adrenergic blockers ACE inhibitors Angiotensin receptor blockers Calcium antagonists Direct vasodilators

BEST MANAGEMENT OF HYPERTENSION : 

BEST MANAGEMENT OF HYPERTENSION To use the fewest drugs at the lowest doses while encouraging the patient to maintain lifestyle changes. After BP has been under control for at least 1 year, a slow, progressive decline in drug therapy can be attempted. However, most patients need to resume medication within 1 year.

PATIENT EDUCATION GUIDELINES : 

PATIENT EDUCATION GUIDELINES Following the DASH eating plan DASH Dietary Approaches to Stop Hypertension Based on 2,000 calories per day diet Depending on patient’s caloric needs, the number of daily servings may vary For more information, log on to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash.

DASH : 

DASH

COMPLICATIONS : 

COMPLICATIONS

CONTD… : 

CONTD…

CONTD… : 

CONTD…

NURSING ASSESSMENT : 

NURSING ASSESSMENT Nursing History Family history of high BP Previous episodes of high BP Dietary habits and salt intake Cigarette smoking Episodes of headache, weakness, muscle cramp, tingling, palpitations, sweating, vision disturbances Medication that could elevate BP Hormonal contraceptives, steroids NSAIDs, Nasal decongestants, appetite suppressants

NURSING ALERT : 

NURSING ALERT The finding of an isolated elevated BP does not necessarily indicate hypertension. However, the patient should be regarded as at risk for high BP until further assessment through history taking, repeat BP measurements, and diagnostic testing either confirms or denies the diagnosis

NURSING DIAGNOSES : 

NURSING DIAGNOSES Deficient Knowledge regarding the relationship between the treatment regimen and control of the disease process Ineffective Therapeutic Regimen Management related to medication adverse effects and difficult lifestyle adjustments

NURSING INTERVENTIONSProvide basic education : 

NURSING INTERVENTIONSProvide basic education Explain the meaning of high BP, risk factors Stress that there can never be total cure, only control can be done Stress the fact that there may be no correlation between high BP and symptoms Have the patient recognize that hypertension is chronic and requires persistent therapy and periodic evaluation.Effective treatment improves life expectancy

CONTD… : 

CONTD… Explain the pharmacologic control of hypertension:- Explain that the drugs used for effective control of elevated BP will likely produce adverse effects. Warn the patient of the possibility that orthostatic hypotension may occur initially with some drug therapy Instruct the patient to get up slowly to offset the feeling of dizziness Encourage the patient to sit or lie down immediately if he feels faint Alert the patient to expect initial effects, such as anorexia, light-headedness, and fatigue, with many medications

GERONTOLOGIC ALERT : 

GERONTOLOGIC ALERT Polypharmacy, cognitive changes, and sensory deficits in the elderly may make dosage adjustment and control of BP difficult. Work with the patient, family, and home care nurse to devise a simple method for the patient to take the proper medications. Elderly patients are also more sensitive to therapeutic levels of drugs and may demonstrate adverse effects while on an otherwise average dosage.They may be more sensitive to postural hypotension and should be cautioned to change positions with great care.

ACCELERATED HYPERTENSION : 

ACCELERATED HYPERTENSION

DEFINITION : 

DEFINITION Also called as Malignant Hypertension Occurs when B.P. elevates extremely rapidly Threatens one or more target organs like brain, heart & kidney.

PATHOPHYSIOLOGY : 

PATHOPHYSIOLOGY

CLINICAL MANIFESTATIONS : 

CLINICAL MANIFESTATIONS Brain effects: Encephalopathy Stroke Progressive headache, stupor, seizures Kidney effects: Decreased blood flow, vasoconstriction BUN elevated Plasma renin activity increased Urine specific gravity lowered Proteinuria Renal failure Cardiac effects: Left-sided heart failure Acute MI Right-sided heart failure

MANAGEMENT : 

MANAGEMENT Immediate hospitalization and treatment if the following are present Seizures Abnormal neurologic signs Severe occipital headache Pulmonary edema The patient is hemodynamically monitored in the ICU Antihypertensive agents are administered parenterally. Agents include: Vasodilators Adrenergic inhibitors short-acting calcium antagonist Diuretics

NURSING ALERT : 

NURSING ALERT BP should be reduced gradually and wide pressure variations avoided because lowered BP may not be adequate to perfuse vital organs

NURSING INTERVENTIONS : 

NURSING INTERVENTIONS Record BP frequently Monitor for adverse effects of medications: headache, tachycardia, orthostatic hypotension Measure urine output accurately Observe for hypokalemia, especially if patient is placed on diuretic therapy. Monitor for ventricular dysrhythmias

THANKS : 

THANKS