Republic of the Philippines Western Mindanao State University COLLEGE OF NURSING Zamboanga City

GRANDSTAND
Rotation 9 January 28- 30, 2014

Submitted by: BIEL, JOEZERK JHON ANGLES, MITZI JOY BITOON, VON DEXTER BOLOTAOLO, JESTONI BUYO, GRAZEL

Submitted to: MADIHA JIKIRON, RN, MN

BSN IV

Republic of the Philippines Western Mindanao State University COLLEGE OF NURSING Zamboanga City

HYPERTENSION
Definition High Blood Pressure Classification -Normal less than 120 mm Hg/less 80mm Hg -Prehypertension: systolic blood pressure (SBP) 120 to 139mm Hg or diastolic blood pressure (DBP) 80-89mmHg -Stage1: SBP 140 to 159 mm Hg or DBP 90 to 99 mm Hg -Stage2: SBP greater than or equal to 160mm Hg or DBP greater than or equal to 100 mm Hg Causes Primary Hypertension- Unknown etiology Secondary hypertension-Results from another disorder -Renal disease -Pheochromocytoma -Cushings disease -Diabetes mellitus -Coronary artery disease Pathophysiology Blood pressure = Cardiac output x peripheral resistance Narrowing of the arterioles, which increases peripheral resistance Increased force to circulate blood, which elevates blood pressure Assessment findings Asymptomatic Elevated blood pressure reading Headache Vision Disturbance Left ventricular hypertrophy Renal failure Dizziness Papilledema Heart failure Cerebral ischemia Diagnostic test findings Blood pressure: sustained reading greater 140/90 mm Hg ECG left ventricular hypertrophy Chest X-ray: cardiomegaly Opthalmoscopic examination: retinal changes, such as severe vasoconstriction, papilledema, and retinopthy Medical management Diet: low-sodium, low calorie, low cholesterol, and low fat; restrict alcohol and caffeine Weight reduction Activity is tolerated

Republic of the Philippines Western Mindanao State University COLLEGE OF NURSING Zamboanga City
Smoking cessation Monitoring vital signs ECG, and I/O Laboratory Studies: Sodium, Potassium, cholesterol Thiazide diurectics: chlorothiazide (diuril), hydrochlorothiazide (HydroDIURIL) Loop diurectics : furosemide (lasix), bumetanide (bumex) Potassium- spacing diurect: spironolactone (aldactone) Antihypertensive: methyldopa (Aldomet), hydralazine (apresoline), prazosin (minipress), doxasozin (cardura) Calcium channel blocker; amlodipine (norvasc), nifedepine (procardia), varpamil (calan), diltiazem , (cardizem), nacardipine (cardene) Beta-adrenergic blockers: propranolol (Inderal) , metoprolol (lepressor), carteolol (cartrol), labetolol (normodyne) Angiotensin- converting enzymes (ACE) inhinitors: captopril (capoten), enalapril (vasotec), lisinopril (pinvil) Angiotensin 2 receptors blockers (ARBs): candesartans (atacand), irbesartan (avapro), Iosartan (cozaar), valsartan (doivan) Vasodilator: nitroprusside (Nipride), used for hypertensive crisis

Nursing interventions Assess cardiovascular status Monitor and record vital signs, I/O, laboratory studies, and daily weights Monitor clients daily dose of medication and the response Administer medications, as prescribed, and evaluate effects Maintain the patients prescribed diet Encourage the patient to express feelings about daily stress Maintain a quiet environment Provide information about the American heart association Take an average of two or more blood pressure reading rather than relying on one single abnormal reading Individualize home care instructions (for more information about teaching, see patients with cardiovascular disorder and its implication Encourage to avoid cigarette smoking and restrict alcohol intake Encourage to exercise, if advised by physician Encourage to limit sodium intake to minimal as prescribed. Complications Coronary artery disease (CAD) Transient ischemic attack (TIA) Myocardial Infarction Stroke Vision Changes/ Blindness due to ruptured vessels Renal failure Heart failure Pulmonary edema Hypertensive crisis Possible surgical interventions For Primary Hypertension: None For Secondary Hypertension:

Republic of the Philippines Western Mindanao State University COLLEGE OF NURSING Zamboanga City
Diet DASH diet: Dietary Approaches to Stop Hypertension Fluids restriction, as indicated Low salt intake potassium, calcium and magnesium o Kanin, tinapay, at mga cereal, mais o Gulay kangkong, pechay, repolyo, kamatis, patatas, malunggay, talbos ng kamote o Prutas saging, dalandan, suha, pinya, mansanas, mangga, santol o Low-fat milk, non-fat yogurt o Manok, isda o Asukal at matatamis