Hypertension Review Notes for NCLEX Review

Hypertension review notes for nursing school and NCLEX exam. In nursing school, you will study hypertension and will need to know how to care for a patient with this condition. As the nurse you must know the causes of HTN, signs and symptoms, nursing interventions, and the pharmacological management of hypertension. The NCLEX exam loves to ask you about educating patients about hypertension, risk factors, and (most importantly) the common side effects excepted with hypertension medications. After you review these notes, don’t forget to take the hypertension NCLEX quiz.

Hypertension

Definition: The amount of resistance of blood pumping through the body/arteries. Normal: <120/80 (looking at systolic & diastolic) Prehypertension: 120-139/80-89 Stage 1 HTN: 140-159/90-99 Stage 2 HTN: >160/>100 *Per JNC7 guidelines (Joint National Committee) Unfortunately, HTN is known as the SILENT KILLER. When a patient starts to have signs and symptoms with hypertension, major organs have already been affected (a person can have it for years without knowing it).

NCLEX Review Video on Hypertension

To remember organs in involved: “Can’t eat your CAKE and have it too.” Cardiac system: congestive heart failure (due to the overworking of the heart muscle which makes it become enlarged) brAin: stroke (increase pressure weakens blood vessels which can cause a clot to form or for them to rupture) Kidneys: renal failure (weakens and narrows the arteries to the kidneys and the kidneys don’t receive proper perfusion) Eyes: visual changes (damages blood vessels to the retina…blurred vision..can’t focus images)

ECG/EKG Study Guide and Workbook for Nursing Students

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“ECG/EKG Interpretation Study Guide and Workbook by Nurse Sarah”. This book contain 100 pages of content featuring 26 ECG rhythm break downs, 51 ECG rhythm analysis practice problems, 100 comprehensive ECG practice questions, worksheets, chart summaries, and more.

You can get an eBook version here: “Nurse Sarah ECG Book” or a physical copy here: “ECG/EKG Interpretation Study Guide by Nurse Sarah“.

Causes of Hypertension

Primary/Essential Hypertension: Unknown causes….look at the “risk factors”…know the risk factors for HTN (test questions come from this section) Race (black males) Increased consumption of salt/alcohol Smoking/stress K+ level and vitamin d level low Family health Advanced aged Cholesterol high Too much caffeine intake Obese Restricting activity Sleep apnea Secondary Hypertension: Caused by a pre-existing issue….there is something causing the person to have high blood pressure:

Pregnancy, Cushing Syndrome,
Chronic Renal Failure
Diabetes
Hypo/hyperthyroidism
Pheochromocytoma (tumor on adrenal gland which cause adrenaline/noradrenaline to be secreted increase BP)
Coarctation of the aorta (congenital defect main artery of the body is super narrow and this leads to high blood pressure)

Nursing Assessment of Hypertension

Remember silent killer…probably be without symptoms

Headache*
Blurry vision*
Chest Pain*
Nose bleeds
Ringing in the ears
Dizzy

*Most common symptoms

Nursing Interventions for Hypertension

Assess: measure blood pressure (obtain in both arms…make sure patient has been in a resting position for 5 minutes, no smoking…causes vasoconstriction), ask about family history, and if they have any sensory changes Evaluate: blood pressure reading, dietary intake, body mass index (overweight) ****Educate: limiting sodium, alcohol and caffeine in diet, quit smoking (vasoconstriction), start an exercise program (cardiovascular) for weight loss, importance of medication compliance (some patients think if their blood pressure reading are good they don’t need to take their medication anymore), measuring blood pressure regularly and keeping a record of it and bringing it to the doctor’s office. ****Pay attention to education part…asked on exams

Pharmacology for Hypertension

Typically, non-pharmalogical techniques are implemented for about 1 to 3 months while monitoring the patient’s blood pressure, and then if not controlled, medications are started. Thiazide Diuretics: End in “iazide” HCTZ (hydrochlorothiazide), Diuril (Chlorothiazide)

Work by removing water and sodium through the kidneys WATCH BUN and CREATININE Levels.
Not for patients in renal failure
Watch patients who are taking Lithium (increases chances of Lithium toxicity)
WASTE POTASSIUM…educate about potassium supplement compliance, and photosensitivity

ACE Inhibitors (Angiotension -Converting Enzyme Inhibitors): End in “PRIL” Lisinopril

Prevent vasoconstriction by blocking Angiotension 1 and 2
Educate pt about a dry cough/taste changes
Avoid potassium substitutes or supplement…this drug causes potassium retention
Compliance very important due to rebound hypertension
Captopril (increased risk of bleeding) and Moexipril…take 1 hour BEFORE a meal

ARBS (Angiotension Receptor Blockers): drugs that end in “sartan” ex: Losartan (may be prescribed in place of ACE inhibitors if patient can’t tolerate ACE Inhibitor)

Works by causing vasodilation by blocking aldosterone and Angiotension
Same side effects as ACEI (except dry cough)
Increase k+ level

CCB (Calcium Channel Blockers): end in “dipine” Amlodipine, and Cardizem, Verapamil

Slow the heart rate to decrease the work load on the heart and cause vasodilation which lowers blood pressure
Watch HR: bradycardia
Watch pts who have CHF or AV blocks

BB: Beta blockers: end in “olol” ex: Labetalol, Metoprolol

Affects epinephrine and norepinephrine which blocks the sympathetic nervous system of the heart and this keeps the heart rate nice and low which helps dilates vessel which lowers blood pressure
Not for patients with asthma and COPD because this medication blocks the receptors in the lungs and causes bronchoconstriction
Monitor Glucose levels in diabetics because it conceals the signs of hypoglycemia
Monitor heart rate and for orthostatic hypotension

Quiz on Hypertension