高血压英文ppt精品课件nursingcareofpatientswith

Nursing Care of Patients with Hypertension,Reading assignment: Chapter 22 (Williams & Hopper) Warm up: What do we already know about hypertension? Taking Accurate BPs: Review box 22.1 (p. 414),Nursing Care of Patient with Hypertension: Objectives,At the completion of the unit, the student will: Explain the pathophysiology, causes, and risk factors associated with hypertension (HTN). Describe the signs and symptoms, treatments, and nursing care associated with HTN. List common complications associated with HTN. Define each classification (stage) of HTN and hypertensive emergency,Nursing Care of Patients with Hypertension: The Statistics,29% of American adults have HTN 7% have HTN between 18 & 39 years of age 67% have HTN aged 60 or older 41% of adult non-hispanic blacks are hypertensive,Nursing Care of Patients with Hypertension: HTN Redefined,In 2004 the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure redefined normal and abnormal BP to establish more aggressive community screening and treatment guidelines,Nursing Care of Patients with HTN: BP Categories & Measures,Utilize table 22.1 to complete the The table on the next slide,Pathophysiology of HTN,Heart pumps blood through the vessels of the body Pressure exerted on the walls of blood vessels = BP,Pathophysiology of HTN,Define each of the three terms (p. 415): Blood pressure is determined by 1) Cardiac Output 2) Peripheral Vascular Resistance 3) Blood Viscosity,Pathophysiology of HTN: Influences,Central Nervous System Regulation Sympathetic Nervous system HR, cardiac output & vasoconstriction 2) Baroreceptors: sense pressure in vessels and send messages to the CNS,Pathophysiology of HTN: Influences,Kidney Regulation blood flow to kidney renin secretion angiotension arteriole vasoconstriction Angiotension II aldosterone secretion from the adrenal cortex reabsorption of na+ ions Water retention,Pathophysiology of HTN: Influences,Fluid Volume vs Vessel Diameter,Pathophysiology of HTN: Influences,Emotional & Physical Influences 1) Anything that effects oxygen demand and metabolic rate will effect BP. 2) The cardiovascular system responds to these demands.,Pathophysiology of HTN: Classifications,Define each of the types of HTN (p.415): 1) Primary (essential) HTN 2) Secondary HTN 3) Isolated Systolic HTN,Signs & Symptoms of Hypertension,Hypertension is a silent killer,Signs & Symptoms of HTN,Usually diagnosed when BP is taken routinely Symptoms occasionally reported: Headache Bloody nose Severe anxiety Shortness of breath,Diagnosis of HTN,Average resting (seated) blood pressure above prehypertensive levels on two or more occasions When diagnosed with HTN: routine screening for vessel &/or organ involvement ECG, Lipid profile, Electrolytes, HCT Glucose levels, Kidney function labs,Risk Factors for HTN,1) List nonmodifiable (genetic) risk factors 2) List modifiable risk factors (utilize pages 416-418 to complete this exercise),Risk Factors for HTN,1) Complete the critical thinking exercise (Ms. Miller) on p. 419 2) a) List foods that are included in a DASH diet (box 22.5) b) List foods that should be avoided to promote cardiovascular health and prevent HTN 3) Review “Learning Tip” on p. 423,Therapeutic Measures for HTN,For Pre-hypertension & Stage I HTN: Lifestyle modifications are tried first Stage II or high-risk for target-organ damage: Both drug and lifestyle modifications are started immediately. Goal: SBP 140 & DBP 90 mmHg Those at risk for target-organ damage (i.e.: diabetes, renal disease): SBP 130 & DBP 80 mmHg,Therapeutic Measures for HTN: Pharmacology,Medications used to Treat HTN 1) Loop Diuretics 2) Thiazide and Thiazide-like Diuretics 3) Potassium-sparing Diuretics 4) Beta Blockers 5) Alpha Blockers 6) Angiotension-Converting Enzyme Inhibitors 7) Calcium Channel Blockers 8) Direct Vasodilators,Therapeutic Measures for HTN: Pharmacology,* For each of the medication classifications used to treat hypertension, please design a table identifying the actions, side-effects, and nursing implications. Utilize table 22.3 to complete this activity. * Read and review box 22.6: “Gerontological Issues”,Therapeutic Measures for HTN: Pharmacology,Nursing Alert BP should be well controlled before invasive and surgical procedures Greater risk for: CVA, MI, kidney failure, & pulmonary edema Medications should be taken up to the time of the procedure and resumed ASAP after the procedure.,Complications of Hypertension Target-Organ Diseases,Coronary artery disease Atherosclerosis Myocardial infarction Heart Failure CVA (cerebral vascular changes) Left Ventricle hypertrophy Eye (retinal) Damage Renal disease,Hypertensive Emergency,Populations at Risk: Untreated HTN, non-compliance, stopped taking medications abruptly DXed when SBP 180 mmHg and DBP 120 mmHg & target organ dysfunction is present Treatment goals: *Immediate gradual reduction of BP *Prevent or limit target-organ damage Drug of choice: IV nitroprusside (Nipride),Hypertensive Urgency,Significant HTN is present, but without progression of target-organ dysfunction. Treated with oral medications and out-patient follow up.,Nursing Process for Patients with HTN: Nursing Diagnoses,I. Knowledge deficit related to disease process and treatment regimen *Assess readiness to learn *Provide information,Nursing Process for Patients with HTN: Nursing Diagnoses,II. Ineffective Self-Health Ma