HYPERTENSION

HYPERTENSION, the “silent killer”, as we often call it is a very common cardiovascular disease world wide. It is called “silent” because it is asymptomatic, making it difficult to detect.
Hypertension is defined as a disease of vascular regulation resulting from malfunction of arterial pressure control mechanisms. The two major types of hypertension are primary (essential) hypertension and the secondary hypertension.
In a healthy adult, normal blood pressure is calculated as 120/80 mmHg. If the diastolic pressure is 90 mmHg or higher and systolic pressure is 140 mmHg or higher in absence of other causes of hypertension, it is called primary hypertension. Secondary hypertension is results primarily from renal disease, endocrine disorders coarctation of the aorta.
HYPERTENSION is one of the most prevalent chronic diseases in the Philippines. According to a survey by the Food and Nutrition Research Institute, one in every four Filipino adults (25.3%) has hypertension or a blood pressure reading equal to or higher than 140/90 mmHg.
It also shows that 11 in every 100 Filipinos (10.8%) have pre-hypertension or a BP reading in the range of 130-139/85-89 mmHg. High BP increases from 40-49 y/o, it said.
However, HYPERTENSION is a disease with which treatment is available. With due management hypertension can be controlled but still a major contributor to morbidity and mortality in our society
Signs and Symptoms
Hypertension includes the 32 symptoms listed below:
* No symptoms – many people are unaware they have hypertension until it is accidentally found at a doctor visit or they develop complications of hypertension
* Non-specific symptoms – symptoms of hypertension may be mild and vague
* Headache
* Morning headache
* Tinnitus – ringing or buzzing in ears
* Dizziness
* Confusion
* Papilloedema
* Many symptoms occur from complications of hypertension
* High blood pressure
* Usually asymptomatic
* Fatigue
* Shortness of breath
* Convulsion
* Changes in vision
* Nausea
* Vomiting
* Anxiety
* Increased sweating
* Nose bleeds
* Heart palpitations
* General feeling of unwellness
* Increased urination frequency
* Blurred vision
* Double vision
* Flushed face
* Pale skin
* Red skin
* Chest pains
* Very high blood pressure

Nursing Considerations
Nursing Consideration
Rationale
monitor BP every 1-2 hours, or every 5 minutes during active titration of vaso active drugs
changes in BP may indicates changes in patient status requiring prompt attention
encourage patient to decrease intake of caffeine, cola and chocolates
caffeine is a cardiac stimulant and may adversely affect cardiac function
observe skin color, temperature, capillary refill time and diaphoresis
peripheral vasoconstriction may result in pale, cool, clammy skin with prolonged capillary time due to cardiac dysfunction and decreased cardiac output
instruct client and family on fluid and diet requirements and restrictions of sodium
restrictions can assist with decrease in fluid retention and hypertension, thereby improving cardiac output
observe for complaints of blurred vision, tinnitus or confusion
may indicate cyanide toxicity from increasing intracranial pressure
assist the patient in identifying modifiable risk factors like diet high in sodium, saturated fats and cholesterol.
these risk factors have been shown to contribute to hypertension

suggest frequent position changes, leg exercises when lying down.
decreases peripheral venous pooling that may be potentiated by vasodilators and prolonged sitting or standing
Stress importance of accomplishing daily rest periods
alternating rest and activity increases tolerance to activity progression
monitor for sudden onset of chest pain
may indicate dissecting aortic aneurysm
administer medicines as prescribed by the physician
to promote wellness

reinforce the importance of adhering to treatment regimen and keeping follow up appointments
lack of cooperation is common reason for failure of antihypertensive therapy
observe for complaints of blurred vision, tinnitus or confusion
may indicate cyanide toxicity from increasing intracranial pressure
provide information regarding community resources, and support patients in making lifestyle changes
community resources like health centers programs and check ups are helpful in controlling hypertension
instruct client in signs/symptoms to report to physician such as headache upon rising increased blood pressure, chest pain, shortness of breath, increase heart rate, visual changes, edema, muscle cramps and nausea and vomiting
promotes knowledge and compliance with treatment. Promotes prompt detection and facilitates prompt intervention

Pathophysiology

Juxtaglomerular apparati (kidneys) liver

Renin Angiotensinogen

Angiotensinogen + renin

Removal of amino acid by Angiotensin Converting Enzyme

Angiotensin II Angiotensin III

Aldosterone

Vasoconstriction Na and fluid retention Risk factors

Inc peripheral resistance Inc cardiac output

Elevation in Blood Pressure