Overview
This lecture reviews hypertension for NCLEX, covering its definition, causes, affected organs, risk factors, nursing management, patient education, and main pharmacological treatments.
Definition and Blood Pressure Ranges
- Hypertension is increased resistance in arteries, leading to higher blood pressure.
- Normal BP: ≤120/80 mmHg; Pre-hypertension: 120–139/80–89 mmHg.
- Stage 1: 140–159/90–99 mmHg; Stage 2: ≥160/100 mmHg.
Organs Affected by Hypertension (Mnemonic: CAKE)
- Cardiovascular system: can cause congestive heart failure from overworking the heart.
- Brain: increased risk of stroke due to weakened/ruptured arteries.
- Kidneys: risk of renal failure from damaged arteries affecting perfusion.
- Eyes: retina damage causing blurry vision and focus issues.
Causes and Risk Factors
- Primary (essential) hypertension: idiopathic, focus on risk factors.
- Secondary hypertension: due to another condition (e.g., pregnancy, Cushing’s, renal failure, diabetes, thyroid disorders).
- Major risk factors: Black race, high sodium/alcohol intake, smoking/stress, low potassium/vitamin D, family history, advanced age, high cholesterol, caffeine, obesity, inactivity, sleep apnea.
Nursing Management and Patient Assessment
- Most patients are asymptomatic; symptoms, if present: blurred vision, headaches, chest pain, nosebleeds, dizziness, ringing in ears.
- Assess BP in both arms, review family history, ask about sensory changes, calculate BMI, check medication compliance.
- Report high BP to physician and review regular medication use.
Patient Education
- Limit sodium, caffeine, and alcohol intake.
- Encourage smoking cessation, regular exercise, and weight control.
- Teach home BP monitoring and maintaining a record.
Pharmacological Treatments
- Thiazide diuretics (e.g., HCTZ): promote sodium and water loss, monitor potassium, avoid in renal patients, watch lithium levels, photosensitivity precautions.
- ACE inhibitors (e.g., lisinopril): prevent vasoconstriction, may cause dry cough, avoid potassium supplements, risk of rebound hypertension if stopped abruptly, take before meals.
- ARBs (e.g., losartan): block aldosterone/angiotensin receptors, used if ACE inhibitors not tolerated, similar side effects except no dry cough.
- Calcium channel blockers (e.g., amlodipine): reduce HR, cause vasodilation, monitor for bradycardia and avoid in CHF/AV block.
- Beta-blockers (e.g., metoprolol): slow HR and reduce workload, contraindicated in asthma/COPD, can mask hypoglycemia in diabetics, can cause orthostatic hypotension.
Key Terms & Definitions
- Hypertension — high blood pressure due to increased arterial resistance.
- Primary hypertension — high BP with no identifiable cause.
- Secondary hypertension — high BP caused by another medical condition.
- Thiazide diuretics — medications that help eliminate sodium and water via urine.
- ACE inhibitors — drugs that block angiotensin-converting enzyme to lower BP.
- ARBs — drugs that block angiotensin II receptors to lower BP.
- Calcium channel blockers — drugs that relax blood vessels by affecting heart and vessel muscle contraction.
- Beta-blockers — drugs that slow heart rate and reduce BP by blocking adrenaline effects.
Action Items / Next Steps
- Visit registernursern.com and complete the free hypertension quiz.
- Review patient education strategies and memorize risk factors and drug classes for exams.