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Objectives: After the discussion the nursing students will be able to: Define hypertension. Differentiate primary hypertension to secondary hypertension. Define the 2 classes of hypertensive crisis. Explain the classification of Blood Pressure according to severity. Identify the risk factors for Cardiovascular Problems in hypertensive patients. Identify different lifestyle modifications to prevent and manage hypertension. Enumerate different assessments. Name the hypertensive related diagnostic procedure. State the different diagnosis related to hypertension. Enumerate the different nursing interventions or the medical management. Recall medications related to hypertension.

Hypertension 28%-31% US adults have hypertension. (2004) 1 out of 4 Filipinos have HTN or 11.5M (2011) Silent killer 1999-2000 -31% US population unaware of their elevated BP Abnormally high blood pressure. It is diagnosed when BP is above 140 mmHg systolic or above 90 mmHg diastolic. Primary HTN or Essential hypertension is that when no obvious cause is known for high BP. -90% - 95% of the hypertensive US population has this. Secondary HTN when high BP is due to kidney or other diseases usual complications of constant high BP may be retinopathy, heart failure and kidney damage. -5% - 10% of the hypertensive US population has this. 2 CLASSES OF HYPERTENSIVE CRISIS Hypertensive emergency - when BP is extremely elevated ( > 180/120 mmHg) it must be lowered immediately to prevent damage to the target organ. Hypertensive urgency -BP is elevated but there is no evidence of target organ damage. Classification of BP according to severity BP Classification Normal Prehypertension Systolic BP (mmHg) <120 120-139 Diastolic BP (mmHg) <80 80-89

Stage 1 HTN Stage 2 HTN

140-159 > or equal 160

90-99 > or equal 100

The risk factors for Cardiovascular Problems in hypertensive patients: a. smoking b. dyslipidemia c. diabetes mellitus d. impaired renal function e. obesity f. physical inactivity g. age (>55yrs old for men and >65yrs old for women) h. family history Lifestyle modifications to prevent and manage hypertension: a. weight reduction b. adopt DASH c. dietary sodium reduction d. physical activity e. moderation of alcohol consumption Assessment: Blood pressure History of angina pain, shortness of breath, altered speech, vision or balance, nosebleeds, headaches, dizziness or nocturia. Rate, rhythm and character of apical pulse and peripheral pulses. Diagnostic procedures: a. urinalysis b. blood chemistry c. ECG d. BUN e. creatinine clearance Nursing Diagnosis: Deficient knowledge related to the relation between the treatment regimen and control of the disease process. Risk for decreased cardiac output occurs as a response to HTN. Anxiety and pain can be a nursing diagnosis also.

Nursing Interventions or medical management: Monitor vital signs especially BP. Monitor intake and output. Collect and assess laboratory data as ordered. Low fat, low salt diet. Administer antihypertensive drugs (if ordered). Antihypertensive medications: Thiazide diuretics Loop diuretics Potassium Sparing Diuretics Beta blockers Angiotensin converting enzyme inhibitors Calcium channel blockers