This presentation is about hypertension, with a summary about pathology, and nursing practise, with assessment and interventions.

1. • THEORETICAL CONCEPTS
• NURSING PRACTISE
Mónica Roque
Adult Nurse
February 2014

2. • High blood pressure
•Cardiac output
The product of the heart
rate multiplied by the
stroke volume.
determined by:
The pressure exercised by
blood on the walls of the
blood vessels
•Peripheral vascular
resistance
The ability of the
vessels to stretch.
•Viscosity (Thickness)
• The amount of
circulating blood volume
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3. Measurement should be done in both arms at first visit
The patient should be seated for at least 5 minutes, relaxed
and not moving or speaking
Remove tight clothing, support arm at heart level, ensure
arm relaxed and avoid talking during the measurement
Thepatient should not have exercised, eaten or smoked for at
least half na hour prior to taking blood pressure.
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4. Indication
Width (cm)
Length (cm)
Child/Small adult
10-12
18-24
Standard Adult
12-13
23-35
Large Adult
12-16
35-40
Adult Tight Cuff
20
42
Bladder too large:
Underestimation of BP
Bladder too small:
Overestimation of BP
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5. Palpate the brachial
pulse along the inner
upper arm.
Explanation: Where the
stethoscope will be
placed when listening
Korotkoff sounds.
Choose the correct
cuff and apply it to
the upper arm. The
centre of the bladder
must be in line with
the brachial artery.
Explanation: the cuff
needs to be positioned
to allow the stethoscope
diaphragm clear access
to the brachial artery.
Place the diaphragm
of the stethoscope
over the brachial
artery, near to cubital
fossa.
Close the control
valve
on the
sphygmomanometer
Inflate the cuff, so
that the dial reads
30mmHg above your
earlier
estimated
Systolic
pressure
(150mmHg,
approximately).
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6. Gently open the valve for a slow controlled release of air from the cuff.
The Korotkoff sounds are quite faint, but distinctive, when recognized. Listen carefully for the
first ‘Bump’, note the associated dial reading. This is the real Systolic pressure (measures the
pressure in the arteries when the heart beats).
The last sound that listen is the Diastolic pressure (measures the pressure in the arteries
between beats).
Open the air valve fully, to rapidly deflate the cuff. Release the patient from the equipment.
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7. CATEGORY
SYSTOLIC (MMHG)
DIASTOLIC (MMHG)
Optimal
<120
<80
Normal
120-129
80-84
High normal
130-139
85-89
Stage 1 Hypertension
140-159
90-99
Stage 2 Hypertension
160-179
100-109
Stage 3 Hypertension
≥180
≥110
CAUTION: The systolic and diastolic pressures are measured in millimetre of mercury (mmHg).
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8. Family history
• More common in men
than women.
•Women are more likely to
develop
hypertension
after menopause.
More common in black.
Age
Gender
Race and Ethnicity
Diabetes Mellitus disease
• High cholesterol;
• Kidney diseases;
• Sleep apnea.
Other chronic diseases
The probability to have
hypertension increases
with age.
• Two third of adults who
have diabetes also have
hypertension.
• The risk of developing
hypertension
when
someone has a familiar
background of diabetes
and obesity is 2 to 6
times great than a
person without this family
history.
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9. Overweight or obesity
Weight
• Tobacco (chemicals in
tobacco can damage the
lining of the artery walls)
• Alcohol (the regular
consumption
of
3-4
alcoholic drinks per day,
increases the risk of
hypertension and reduce
the
action
of
antihypertensive
therapy.)
Stress
Unhealthy Diet
Addictions
(If we have higher body
mass index, our body need
more blood to supply
nutrients and oxygen to
the tissues. As the blood
volume in circulation
increases, it will increase
the pressure in artery
walls.)
• Sodium intake;
•Low potassium intake
(Potassium
helps
to
balance the amount of
sodium in cells.);
• High-fat diet.
Sedentary life
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10. Primary Hypertension
• Chronic elevation of blood pressure from an unknown cause.
• 90%-95% of all cases
Secondary Hypertension
• Signify high blood pressure from an identified cause (e.g.
kidney disease)
• 5%-10% of all cases
Systolic Isolated Hypertension
• It’s a high value of systolic pressure, and a normal value of
diastolic pressure.
• It’s rare.
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11. • Headache
• Bloody nose
Kidney
Brain
• Blurred vision
• Dizziness
•Fatigue, activity intolerance
• Palpitations
• Blood spots in the eyes
Heart
Target
organ
diseases
Eyes
• Facial flushing
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12. Medical background:
• Food habits (alcohol use, salt and fat intake, weight gain/loss)
• Elimination (nocturia)
• Activity (fatigue, activity intolerance, dyspnoea on exertion, palpitation, angina, chest
pain, intermittent claudication, muscle cramps, )
• Addictions
• Cognitive/perception (blurred vision, paresthesia)
• Coping/stress (stressful life events, noncompliance)
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13. MAIN GOALS:
•Maintain
or
enhance
cardiovascular
functioning.
•Prevent complications.
•Provide information about disease process,
prognosis, and therapy.
•Support active client control of condition.
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14. •DIET:
 reduce salt and sodium intake;
diet rich in fruits, vegetables, proteins, potassium
and calcium;
Teaching
•REGULAR PHYSICAL ACTIVITY – 20 to 30 minutes of
moderate activity 4/5 days a week
•WEIGHT REDUTION (in cases of overweight or obesity)
•SMOKING CESSATION
Therapy
Adherence
•STRESS
MANAGEMENT
–
use
non-pharmacologic
strategies, like yoga or relaxing training
•LIMIT ALCOHOL CONSUMPTION – for men, no more than
2 drinks per day, and for women, no more than 1 drink per
day
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15. Health
Promotion
•Hypertension’s pathology
•Correct blood pressure measurement
Therapy
Adherence
•Drug therapy
• Inform about support groups and
Community support
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16. •Explain
Health
Promotion
the
importance
about
therapy adherence.
Teaching
•In case of Non-adherence:
Understand the patient’s reasons;
Adjust clinical treatment according
to the patients’ cultural beliefs and
individual attitudes
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17. •Blood pressure measurements devices. V. 2.1. MHRA. (2013)
• Brunner, Standard. Textbook of Medical-Surgical Nursing. Lippincott Williams &
Wilkins; Twelfth, North American Edition (November 24, 2009)
•Marilynn E. Doenges, Mary Frances Moorhouse, Alice C. Murr. Nursing care
plans : guidelines for individualizing client care across the life span. Ed. 8. David
Plus (2010)
•NICE clinical guideline 127 Hypertension: clinical management of primary
hypertension in adults. NHS. (2011)
•WHO – A global brief on hypertension. (2013)
•Williams, S., Hopper, P. – Understanding medical-surgical nursing. Ed. 2. F. A.
David Company – Philadelphia (2003)
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