HYPERTENSION

NUR 114 – SUMMER 2024

BETSY B. CUTHBERTSON, MSN, RN

*OPENS IN NOTES VIEW*

STUDENT LEARNING OUTCOMES

1. Describe the physiological process in the development of arteriosclerosis.

2. Differentiate between modifiable and non-modifiable cardiac risk factors.
3. Identify the nursing role in the promotion of therapeutic lifestyle changes in
clients at risk for heart disease.
4. Discuss nutritional therapy in clients with high cholesterol.
5. Compare and contrast stable angina and unstable angina.
6. Describe the pathophysiology of heart failure.
7. Compare and contrast left-sided and right-sided heart failure.
READING ASSIGNMENTS
 FA Davis Med-Surg Textbook  Conceptual Clinical Cases
 Chapter 28, pages 539 – 559  Chapter 6, pages 61 – 72
 Chapter 31, pages 623 – 629

 Conceptual Review Guide

 Saunders NCLEX Textbook  Chapter 6, page 75
 Chapter 52, pages 696 – 704; 727 – 729
 Chapter 10, pages 123 – 124
 Chapter 53, pages 741 - 747

 FA Davis Nursing Care Plans Textbook

 Chapter 2, pages 26 – 37
HYPERTENSION: PATHOPHYSIOLOGY
BP is controlled by Cardiac Output (CO)
CO = HR x Stroke Volume
Changes in HR and Stroke Volume affects BP
Increased sodium intake
Renin-angiotensin-aldosterone system (RAAS)
Aldosterone
Sympathetic nervous system
RENIN-ANGIOTENSIN-
ALDOSTERONE SYSTEM
ALDOSTERONE
SECRETION
HYPERTENSION: RISK FACTORS
 Age
 Race
 Gender
 Socioeconomic
status
 Cigarette
smoking
 Obesity
 Physical inactivity
 Excessive alcohol
use
 Stress
CHECK YOURSELF #1
A nurse is establishing health
promotion goals for a female client
who smokes cigarettes, has
hypertension, and has a BMI of 26.
Which goal should the nurse
include?
A. The client will list foods that are high
in calcium, which should be avoided.
B. The client will walk for 30 minutes, 5
days per week.
C. The client will increase calorie intake
by 200 calories per day.
D. The client will replace cigarettes with
smokeless tobacco products.
HYPERTENSION: TYPES
Essential (Primary) Secondary Hypertension
Hypertension  Elevations in BP due to a
 No identifiable medical specific cause
cause  See Table on p. 624 in
 Family history is a Med-Surg Text
predisposing factor
HYPERTENSION: CLASSIFICATIONS
CHECK YOURSELF #2
A nurse is providing teaching
to a client who has a family
history of HTN. The nurse
should inform the client that
his BP of 124/79 mmHg places
him in which of the following
categories?
A. Within the expected reference
range.
B. Elevated.
C. Stage I HTN
D. Stage 2 HTN
HYPERTENSION: SIGNS & SYMPTOMS

Headaches
Chest pain
Vision changes
Shortness of breath
Renal dysfunction
Dizziness
Fatigue
Nosebleeds
HYPERTENSION: LABS TO KNOW
System Diagnostic Test Expected Findings if Target
Affected Organ Damage Present

Renal Urinalysis Proteinuria

BUN and Creatinine Elevated BUN and Creat

Endocrine Sodium Elevated Na+

Potassium Elevated K+
Thyroid-Stimulating Hormone Elevated TSH

Metabolic Fasting Glucose > 100mg/dL

HYPERTENSION: PRIORITY NURSING ASSESSMENTS

Blood Visual
Neuro
pressure changes or Auscultate
assessmen
and heart disturbanc for bruits
t
rate es
Obtain BMI
Palpate for Palpate Monitor and waist
edema pulses labs circumfere
nce
  Lifestyle changes targeted on
modifiable risk factors
 Medications
 Diuretics
HYPERTENSIO  Antihypertensives
 Ca Channel Blockers
N: MEDICAL  ACE Inhibitors
 Angiotensin II Receptor
MANAGEMENT Blockers
 Beta Blockers
 Combined Alpha and Beta
Blockers
 Vasodilators
 Central Agonists
HYPERTENSION: MEDICATIONS

+
ACE Beta Blocker Calcium Diuretics
Channel Blocker
ARB
MEDICATION: ACE-INHIBITORS
NURSING IMPLICATIONS:
 Obtain baseline and monitor labs (Na, K,
BUN, Creat)
 Monitor BP
 Notify HCP of cough
 Do not use in pregnancy
 Avoid potassium supplements or K-
sparing meds

PATIENT EDUCATION:
 Avoid foods high in K (leafy, green
veggies)
 Avoid NSAIDs (reduces effectiveness)
CHECK YOURSELF #3
A nurse is providing teaching to
a client who has HTN and a new
prescription for captopril.
Which instruction will the nurse
will provide?
A. Do not use salt substitutes while
taking this medication.
B. Take medication with food.
C. Count your pulse rate before
taking the medication.
D. Expect to gain weight while
taking this medication.
 SIDE EFFECTS OF

MEDICATION: ARBS ARBs

Low BP
 ACTION: Blocks binding of
Other: Fatigue,
angiotensin II to HA

angiotensin I receptor, Swelling in

hands & feet
which stops hypertension
Allergic Rxn
 Suffix: “-sartan”
Raised
 Prototype Drug: Losartan Potassium

 Nursing Implications: Teratogenic

Sama as ACEi Acute Kidney

Injury

 Patient Teaching: Same Nasal

Congestion
as ACEi
MEDICATION: BETA-BLOCKERS
CHECK YOURSELF #4
A nurse caring for a client who has
HTN and asks the nurse about a
prescription for propranolol. The
nurse should inform the client that
this medication is contraindicated
in clients who have a history of
which of the following conditions?
A. Asthma
B. Glaucoma
C. Depression
D. Migraines
MEDICATION: CALCIUM CHANNEL
BLOCKERS

ALWAYS
MEDICATION:
ALL 3 Similarities:
DIURETICS
used for hypertension
rids body of sodium and water
decreases circulating blood Acts in
volume distal
Thiazide tubule.
can cause hyponatremia,
dehydration

Are not potassium

sparing, can cause
dehydration, Loop Potassium
hypokalemia, Acts in Loop Sparing
hyponatremia, of Helene Can cause
hyperuricemia,
hyperkalemia
hypomagnesemia,
hyperlipidemia, and
hyperglycemia, hearing
CHECK YOURSELF #5
A nurse is providing teaching to
a client who has HTN and a new
prescription for
hydrochlorothiazide. Which
instruction should the nurse
include?
A. Weigh weekly to monitor
therapeutic effects.
B. Take medication on an empty
stomach.
C. Take medication early in the day.
D. Muscle pain is an expected
HYPERTENSION: PRIORITIZE HYPOTHESES

 Risk for decreased cardiac output r/t altered afterload AEB

[any s/s of HTN]
 Overweight r/t lack of physical activity AEB BMI greater than
25 kg/m2
 Ineffective coping r/t ineffective tension release strategies
AEB reports inability to deal with situations
 Ineffective health management r/t economically
disadvantaged AEB failure to adhere to medication regimen
HYPERTENSION: PRIORITY NURSING
INTERVENTIONS

Administer medications as ordered

• Diuretics: furosemide (Lasix)

• Beta-blockers: metoprolol (Lopressor)
• ACE inhibitors: lisinopril (Zestril)
• ARBs: losartan (Cozaar)
• Calcium channel blockers: amlodipine (Norvasc)
• Vasodilators: nitroglycerin (Nitrostat)

Provide Education on DASH Diet – 1600 mg Na

• Dietary Approaches to Stop Hypertension

• High in fruits, vegetables, and low-fat dairy
HYPERTENSION: COMPLICATIONS
 Systolic dysfunction
 Dilated cardiomyopathy
 Renal failure
 Stroke
 Hypertensive crisis
 Vascular Ulcers
  Adhere to antihypertensive
medication regimen
 Suggest lifestyle changes
 DASH diet and sodium
HYPERTENSIO restriction
 Moderate exercise (150
N: minutes of moderate
activity per week)
CLIENT/FAMILY  Limit alcohol

TEACHING  Stress reduction

 Smoking cessation
 Monitor BP at home
 S/S of target organ damage
and stroke
CHECK YOURSELF #6
A nurse is providing teaching
about a heart healthy diet to a
group of clients with HTN. Which
of the following statements by one
of the clients indicates a need for
further teaching?
A. I can eat 10 ounces of lean protein
each day.
B. Fresh fruits make a good snack
option
C. I will replace table salt with dried
herbs.
D. I can thicken gravies with cornstarch
as I cook.