Hypertension NCLEX Review

Introduction

• Presenter: Sarah from RegisteredNurseRN.com
• Topics Covered: Causes, nursing management, and pharmacology of hypertension
• Recommendation: Visit the website for a free quiz related to this lecture

Definition

• Hypertension Definition: Resistance of blood pumping through the body/arteries
• Mechanism: Narrowing of arteries increases blood pressure, similar to squeezing a water hose
• Impact: Over time, high blood pressure can damage organs

Blood Pressure Ranges (Joint National Committee)

• Normal: Systolic < 120, Diastolic < 80
• Pre-Hypertension: Systolic 120-139, Diastolic 80-89
• Stage 1 Hypertension: Systolic 140-159, Diastolic 90-99
• Stage 2 Hypertension: Systolic ≥ 160, Diastolic ≥ 100

Affected Organs

• Silent Killer: Often asymptomatic until organ systems are affected
• Mnemonic: “Can't eat your cake and have it too” (C.A.K.E)
  • Cardiovascular: Congestive heart failure due to overworking of the heart muscle
  • Brain: Stroke due to weakened or ruptured arteries
  • Kidneys: Renal failure due to weakened arteries and decreased perfusion
  • Eyes: Blurred vision due to hard blood flow affecting retinal vessels

Causes of Hypertension

• Two Types: Primary (essential) and Secondary
• Primary Hypertension: Unknown cause, but risk factors include (Mnemonic: RISK FACTORS)
  • R: Race (black males at higher risk)
  • I: Increased intake of sodium or alcohol
  • S: Smoking or stress
  • K: Low potassium or Vitamin D levels
  • F: Family history
  • A: Advanced age
  • C: High cholesterol levels
  • T: Too much caffeine
  • O: Obesity
  • R: Restricting activity (sedentary lifestyle)
  • S: Sleep apnea
• Secondary Hypertension: Caused by pre-existing conditions such as pregnancy, Cushing syndrome, chronic renal failure, diabetes, thyroid disorders

Nursing Management

• Typical Symptoms: Usually asymptomatic, but can include blurred vision, headache, chest pain, nosebleeds, dizziness, ringing in ears
• Nursing Roles: Assess, evaluate, and educate
  • Measure blood pressure in both arms
  • Examine family history and sensory changes
  • Calculate BMI
  • Report high blood pressure to the physician
  • Ensure medication compliance

Patient Education

• Limit sodium, alcohol, and caffeine intake
• Smoking cessation
• Encourage exercise (especially cardiovascular)
• Teach how to measure blood pressure at home
• Maintain a record of blood pressure readings

Pharmacological Management

Non-Pharmacological Techniques (Initial 1-3 Months)

• Lifestyle changes: Diet, exercise, limit sodium and alcohol

Medications

1. Thiazide Diuretics
   • Examples: Hydrochlorothiazide, Chlorothiazide
   • Action: Remove water and sodium through kidneys (caution for renal issues)
   • Education: Consume enough potassium, watch lithium levels, photosensitivity
2. ACE Inhibitors
   • Examples: Drugs ending in -pril (e.g., Lisinopril)
   • Action: Prevent vasoconstriction
   • Education: Dry cough, avoid potassium substitutes, never stop abruptly
3. ARBs (Angiotensin Receptor Blockers)
   • Examples: Drugs ending in -sartan (e.g., Losartan)
   • Action: Block aldosterone and angiotensin receptors
   • Education: Similar to ACE inhibitors but without the dry cough
4. Calcium Channel Blockers
   • Examples: Amlodipine, Diltiazem, Verapamil
   • Action: Lower heart rate, decrease workload, vasodilation
   • Caution: Watch for bradycardia, CHF, AV blocks
5. Beta Blockers
   • Examples: Drugs ending in -olol (e.g., Metoprolol)
   • Action: Block sympathetic system, slowing heart rate
   • Education: Caution for asthma, COPD, diabetes (mask hypoglycemia symptoms), watch for orthostatic hypotension

Conclusion

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