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.
Definition: The amount of resistance of blood pumping through the body/arteries.
Normal: <120/80 (looking at systolic & diastolic)
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)
Causes of 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
K+ level and vitamin d level low
Too much caffeine intake
Caused by a pre-existing issue….there is something causing the person to have high blood pressure:
- Pregnancy, Cushing Syndrome,
- Chronic Renal Failure
- 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
- Blurry vision*
- Chest Pain*
- Nose bleeds
- Ringing in the ears
*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