NIGHTINGALE INSTITUTE OF NURSING,

NOIDA

SEMINAR
ON

HYPERTENSION

(Subject-Medical Surgical Nursing)

SUBMITTED TO: SUBMITTED BY:

MS. SIBI SAMUEL Ms. MEDOVINO

KHATSO

ASSISTANT PROFESSOR M.Sc. (N) 1st YEAR

NIN, NOIDA NIN, NOIDA

INTRODUCTION:
Hypertension ̶ or elevated blood pressure ̶ is a serious medical condition that significantly
increases the risks of heart, brain, kidney and other diseases.
An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension,
Hypertension is a major cause of premature death worldwide. Hypertension is generally an
asymptomatic condition. Individuals who remain undiagnosed and untreated for hypertension
present the greatest challenge and opportunity for health care providers. It is the most
important modifiable risk factor for stroke and has been estimated that 40% of cases of acute
MI or stroke are attributable to hypertension.
Measurement of Blood Pressure.  The most widely used methods of blood pressure found
in many clinical settings is the Auscultatory method using a sphygmomanometer.
Sphygmomanometer – An instrument for indirectly measuring blood pressure in the
arteries,especially one consisting of a pressure gauge and a rubber cuff that wraps around the
upper arm and inflates to constrict the arteries.
Blood Pressure: Blood pressure is the force that a person’s blood exerts against the walls
of their blood vessels. This pressure depends on the resistance of the blood vessels .
Top number (systolic pressure): It measures the pressure in your arteries when your
heart beats ie. 120 mmHg (16KPa)
Bottom number (diastolic pressure): It measures the pressure in your arteries when
heart rests in between the beats ie. 80mmHg (11KPa)
Normal blood Pressure 120/80mmHg

DEFINITION:
•Hypertension (high blood pressure) is a condition in which the force of the blood against the
artery
walls is consistently too high.
•Hypertension is defined as a systolic blood pressure greater than 140 mm Hg, or diastolic
pressure
greater than 90 mmHg, or taking antihypertensive medication.

“The 2017 American College of Cardiology (ACC)/American Heart Association (AHA)

Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure
was released.”
Five categories define blood pressure readings for adults by AHA:
The new guideline eliminates the category of prehypertension. The new
blood pressure categories are:

 Normal/Healthy: A healthy blood pressure reading is less than 120/80

millimeters of mercury (mm Hg).
 Elevated: The systolic number is between 120 and 129 mm Hg, and the
diastolic number is less than 80 mm Hg. Doctors usually don’t treat
elevated blood pressure with medication. Instead, your doctor may
encourage lifestyle changes to help lower your numbers.
 Stage 1 hypertension: The systolic number is between 130 and 139 mm
Hg, or the diastolic number is between 80 and 89 mm Hg.
 Stage 2 hypertension: The systolic number is 140 mm Hg or higher, or
the diastolic number is 90 mm Hg or higher.
 Hypertensive crisis: The systolic number is over 180 mm Hg, or the
diastolic number is over 120 mm Hg. Blood pressure in this range
requires urgent medical attention. If any symptoms like chest pain,
headache, shortness of breath, or visual changes occur when blood
pressure is this high, medical care in the emergency room is needed.

CAUSES/TYPES/ ETIOLOGY of Hypertension:

1.Primary/Essential/Idiopathic Hypertension (90-95%)
It is due to unknown causes or without systemic cause.
Essential hypertension is also called primary hypertension. This kind of hypertension
develops over time.
A combination of factors typically play a role in the development of essential hypertension:
 Genes or Family history: Some people are genetically predisposed to hypertension.
This may be from gene mutations or genetic abnormalities inherited from your
parents.
 Age: Individuals over 65 years old are more at risk for hypertension more than 55 for
men
 Race: Black non-Hispanic (African Americans) indiviuals have a higher incidence of
hypertension.
 Sex: Men and Postmenopausal women.
 Obesity: BMI >30 and weight gain
 Smoking/ alcohol consumption: Women who habitially have more than one drink
per day, and men who have more than two drinks per day, may be at an increased risk
for hypertension.
 High sodium intake:
There’s a small association between daily high sodium intake (more than 1.5g a day)
and hypertension.
 Living a very sedentary lifestlye: Lowered levels of fitness have been connected to
hypertension, inactivity.
 Unhealthy eating habits : Having high cholesterol diet, high lipid diet, low
consumption of fruits.
  Living with coexisting disorders (diabetes or metabolic syndrome):Individuals
diagnosed with either diabetes or metabolic syndrome are at a higher risk of
developing hypertension.
 Psychosocial Stress: Sympathetic activation

2.Secondary Hypertension (5-10%)

It is due to pathological conditions or having identified cause.
Some people have high blood pressure caused by an underlying condition. This type of high
blood pressure, called secondary hypertension, tends to appear suddenly and cause higher
blood pressure than does primary hypertension. Various conditions and medications can lead
to secondary hypertension, including:

 RENAL ( 80%) :
(Parynchymal) Glomerulonephritis, Diabetic Nephropathy, Polycystic kidney
disease.
Renal artery stenosis, Vasculitis, Fibromuscular Dysplasia.

 ENDOCRINE:
Hyperaldosteronism , Cushing Syndrome, Phaeochromocytoma

 THYROID:
Hyperthyroidism, Hypothyroidism, Hyperparathyroidsm

 EXOGENOUS HORMONES:
Oral Contraceptive pills , Glucocorticoids.

 OTHERS:
Coarctation of Aorta, Pregnancy Induced Hypertension, Sleep Apnea Syndrome.

3.Borderline Hypertension:
It is defined as intermittent elevation of B.P. with normal readings.

4.Malignant Hypertension:
It is a Syndrome of markedly elevated blood pressure (above 140 mm of hg).

5.Benign Hypertension:
Also known as uncomplicated hypertension, usually of long duration and mild to moderate
severity, may be Primary or Secondary.

6.White Coat Hypertension:

It is due to anxiety only at a time of measuring blood pressure by doctor or nurse in hospital
or clinic.

PATHOPHYSIOLOGY:-
There are three control system play a major role in monitoring blood pressure.

Arterial baroreceptor: They are found in carotid sinus and walls of ventricles.
Baroreceptors help to maintain B.P.

Regulation of body fluid volumeChange in body fluid that affect systemic arterial
pressure↓
Abnormalities in transport of Na+ ion and water
↓Increase Na, K, H20 in blood↓Increase blood volume↓Increase blood pressure

The renin-angiotensin system

Angiotensin-I↓Angiotensin-II/III↓Increases sympathetic nervous system activity↓Inhibit
sodium excretion↓Increases blood pressure

SIGNS AND SYMPTOMS:-

Morning occipital headacheFatigueDizzinessBluring visionproteinuriaHaematuria
(blood in urine)Cardiac asthmaAnginal PainEpistaxis (Nose
bleeding)PalpitationTinnitus (Ringing in ears)Breathlessness.
BIBLIOGRAPHY
BOOKS:
 Tomey, A.M., (1994). Nursing Theorists and Their Work. 3rd ed. Missouri: Mosby
 Ruth F. et al, Fundamentals of Nursing: Human Health and Function, 2003, pp.56
 Barbara Kozier et al, Fundamentals of Nursing: Concepts, Process and Practice,
Second Edition, 2004, p.38
JOURNAL:
 George, J. (1995). Nursing Theories: The Base for Professional Nursing Practice. (4th
edition). Norwalk, CT: Appleton & Lange.
INTERNET:
 Neelam Yadav, Florence Nnightingale Theory of Nursing , Slideshare, content
available at - https://www.slideshare.net/neelamyadav7161/florence-nightingales-
environmental-theory-of-nursing
 Josephine Ann Neecor, Florence Nightingale’s Environmental Theory , slideshare,
content available at- https://www.slideshare.net/JosephineAnnNecor/01-florence-
nightingales-environment-theory
 Angelo Gonzalo, Florence Nightingale’s Environmental Theory, Nurses labs, conent
available at- https://nurseslabs.com/florence-nightingales-environmental-theory/