Chapter-34--Hypertension课件.ppt

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1、Chapter 33:HypertensionOverview of BP Pg.507Force produced by the volume of blood within the walls of arteries.Measured pressure reflects the ability of arteries to stretch and fill with blood,efficiency of heart as a pump and the volume of circulating bloodOverview of BPAffected by age,body size,di

2、et,activity,emotions,pain,position,gender,time of day and disease states*Use of Birth Control Pills*Overview of BPStudies of healthy persons show that blood pressure can fluctuate within a wide range and still be normal.It is important to obtain several measurements for comparison.*A diastolic eleva

3、tion is more serious,reflecting pressure on arterial wall during the resting phase of the cardiac cycle*Systolic BPSystolic is determined by the force and volume of blood ejected from left ventricle during systole and the ability of arterial system to distend at the time of contractionSystolic BPThe

4、 walls of the arteries are normally elastic&yield to the force&volume of ventricular contractionIn older Pts,the SBP may be due to the loss of arterial elasticity(arteriosclerosis)Systolic BPNarrowing of the arterioles,either by arteriosclerosis or some other mechanism that causes vasoconstriciton,p

5、eripheral resistance,which in turn SBP.This resistance is compared to the narrowing of a tube,such as a drinking straw or a garden hose.The narrower the lumen,the the pressure needed to move air or liquid through it.Diastolic BPIf arterioles are resistant(constricted)blood is under greater pressureH

6、ypertensive Disease Pg.508HTN=sustained of SBP 140 or DBP 90 or both.Essential&Secondary HypertensionEssential Hypertension is sustained elevation of BP without any known cause-95%of casesSecondary hypertension is an elevation that results from or is secondary to some other disorderEssential HTN can

7、 be related to unknown cause and secondary is due to a known causePathophysiology Hypernatremia increases blood volume and increases BPLow serum potassium may cause Na retention because the kidneys try to maintain a balanced number of cations(positive chargePathophysiologySecondary HTN may accompany

8、 any primary condition that affects fluid volume or renal function or causes arterial vasoconstriction.Kidney disease,pheochromocytoma(tumor of adrenal gland),hyperaldosteronism,atherosclerosis and use of cocaine or other cardiac stimulants such as weight control drugs and caffeine and oral contrace

9、ptivesPatho-Effects of Hypertension Eyes,brain,heart and kidney are all affected by hypertensionHemorrhage of tiny arteries of retina can cause blindnessCVA can occurMI and renal failure can occurSigns and Symptoms Pg 509May be asymptomatic.Called the“silent killer”May have throbbing or pounding hea

10、dacheDizziness,fatigue,insomnia,nervousnessNosebleeds and blurred visionAngina or shortness of breath may be 1st symptom of hypertensive heart diseaseSigns and SymptomsPulse may be boundingFlushed face from engorgement of of superficial blood vesselsPeripheral edemaVascular changes in eyes,retinal h

11、emorrhages or a bulging optic diskTreatmentSee table 33-1 page 508 for recommendations for BP checksNon-pharmacological interventions used first-wt.reduction,moderate exercise,decreased Na,no smoking or alcohol,diet low in fatDrugs for HTN Table 33-1Pg 511-refer&make sure you go over the nursing con

12、siderations!Accelerated HTN Pg 513Markedly elevated BP,accompanied by hemorrhages&exudates in the eye.If untreated,may progress to malignant HTN.Malignant HTNDangerously elevated BP accompanied by papilledema(swelling of the optic nerve at its point of entrance into the eye)Malignant Hypertension Pa

13、tho Have an abrupt onset&if untreated,are followed by severe symptoms and complications.Fatal unless quickly reduced.Even with intensive tx the kidneys,brain,and heart may be permanently damagedDangerously high and papilledema(swelling of optic nerve.Retinal hemorrhage leads to blindnessStroke,renal

14、 failure,left ventricular failure with pulmonary edema or MI if not loweredEmergency Treatment of MalignantIn true emergency goal is to lower BP within 1 to 2 hoursNitropress,nitroglycerine,Normodyne IV given if criticalIf not critical,Procardia,verapamil,captopril,minipress given orally.Oxygen give

15、n to reduce hypoxia-induced tachycardiaNursing care Pg.514Give meds using pump,check rate hourlyAutomatic BP cuff if arterial line not usedRestrict activity/bedrestReport 160/115 statMonitor for neurologic,cardiac and renal complicationsCrash cart in roomHTN:Complications4CsCHF(congestive heart failure)CVA(cerebrovascular accident)CAD(coronary artery disease)CRF(chronic renal failure)Interactive Crash Cart Tutorial(FYI)scroll down link to view