Question

Case Study, Chapter 31, Assessment and Management of Patients With Hypertension 1. Joan Smith, 55 years of age, is a female patient who presents to the intensive care unit with the diagnosis of intracranial hemorrhage. The patient stopped taking her antihypertensives suddenly because of the cost of the medications and she recently lost her job to outsourcing. The patient is slightly drowsy and complains of a headache and blurred vision. The patient’s blood pressure is 220/130 mm Hg upon presentation. (Learning Objective 6) a. According to the definitions set by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7), which type of hypertensive crisis is the patient currently experiencing? b. Describe the treatment goals for handling the hypertensive crisis and apply the goals to the case study. Determine the current mean arterial pressure (MAP) and the goals for treatment. The physician prescribes nicardipine hydrochloride (Cardene) 25 mg/250 mL, NS for peripheral IV starting at 2.5 mg/hr, and titrate by 2.5 mg/hr every 15 minutes to reach the goal for the first hour, which is to achieve 25% reduction of the initial MAP. • Call the physician if the dosing range of 15 mg/hr has been reached and the MAP is still not at target goal for the first hour of treatment, or up to four dose increases • Lower the BP within 6 hours to 160/100 mm Hg • Adjust the IV rate so that the IV fluids plus the nicardipine IV drip are equal to 100 mL/hr, in total. Call the physician if the IV fluids must go above 100 mL/hr to provide the nicardipine c. Explain what rate to set initially for both the nicardipine drip and the NS maintenance fluids. d. Explain the process of titrating the nicardipine drip for the first hour to achieve the final MAP goal of 25% reduction of the original MAP. 2. The community health nurse is preparing a program about hypertension for a local community center. The focus of the program is on the reduction of risk factors and compliance for those who have been diagnosed with high blood pressure. The target population includes older adults. (Learning Objectives 1 to 4) a. The nurse focuses on primary hypertension because it accounts for 90% to 95% of hypertension in the United States. What risk factors does the nurse include for this population? b. The nurse prepares to discuss the changes in how the JNC 7 defines hypertension. What ranges and descriptions should the nurse include? c. Because this is a gerontologic audience, the nurse needs to review why blood pressure increases with age. Explain how the structural and functional changes of aging contribute to higher blood pressure in the older adult. d. What information does the nurse include about lifestyle modifications that may decrease risk of hypertension (or complications associated with diagnosed hypertension)

Answer 1

6) a. According to the definitions set by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC. Which type of hypertensive crisis is the patient currently experiencing?

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" offers a new guideline for hypertension prevention and management. The following are the key messages(1) In folks older than 50 years, systolic blood stress (BP) of more than one hundred forty mm Hg is a a good deal extra important cardiovascular ailment (CVD) chance issue than diastolic BP; (2) The threat of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for growing hypertension; (3) Individuals with a systolic BP of a hundred and twenty to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg ought to be considered as prehypertensive and require health-promoting lifestyle modifications to forestall CVD; (4) Thiazide-type diuretics have to be used in drug therapy for most sufferers with undemanding hypertension, either by myself or mixed with drugs from different classes. Certain high-risk conditions are compelling symptoms for the preliminary use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or greater antihypertensive medications to gain goal BP (patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration ought to be given to initiating therapy with 2 agents, 1 of which generally have to be a thiazide-type diuretic; and (7) The most tremendous remedy prescribed via the most careful clinician will manage hypertension only if sufferers are motivated. Motivation improves when patients have high-quality experiences with and trust in the clinician. Empathy builds have confidence and is a mighty motivator. Finally, in presenting these guidelines, the committee recognizes that the accountable physician's judgment remains paramount.

Describe the treatment goals for handling the hypertensive crisis and apply the goals to the case study.

Treatment & Care

Treating high blood pressure can take a multi-pronged approach including diet changes, medication, and exercise. Learn about hypertension treatment options here.

1. Hypertension TreatmentTreatment for hypertension comes in many forms, from lifestyle changes to medication. Learn more from this overview about how to lower blood pressure.
2. High Blood Pressure DrugsYour doctor has hundreds of different high blood pressure drugs to choose from. These medications work in a variety of ways to lower blood pressure.
3. Calcium Channel BlockersCalcium channel blockers are drugs used to lower blood pressure. They work by slowing the movement of calcium into the cells of the heart and blood vessel walls, which makes it easier for the heart to pump and widens blood vessels.
4. ACE InhibitorsAngiotensin converting enzyme (ACE) inhibitors are high blood pressure drugs that widen or dilate your blood vessels to improve the amount of blood your heart pumps and lower blood pressure.
5. Angiotensin II Receptor Blockers (ARBs)Angiotensin II receptor blockers (ARBs) have the same effects as ACE inhibitors, another type of blood pressure drug, but work by a different mechanism.
6. Diuretics (Water Pills)Diuretics, commonly known as "water pills," help your body get rid of unneeded water and salt through the urine. Getting rid of excess salt and fluid helps lower blood pressure and can make it easier for your heart to pump.
7. Beta-BlockersBeta-blockers are drugs used to treat high blood pressure. They block the effects of the sympathetic nervous system on the heart.
8. Alternative Treatmens for HypertensionThere are many types of complementary and alternative treatments believed to be effective for treating hypertension. Get the facts on your options.
9. Omega-3 Fish Oil SupplementsDietary fish and fish oil supplements have benefits for healthy people and people with high blood pressure and heart disease alike.

The nurse focuses on primary hypertension because it accounts for 90% to 95% of hypertension in the United States. What risk factors does the nurse include for this population?

High blood pressure has many risk factors, including:

• Age. The risk of high blood pressure increases as you age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
• Race. High blood pressure is particularly common among people of African heritage, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in people of African heritage.
• Family history. High blood pressure tends to run in families.
• Being overweight or obese. The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
• Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
• Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk.
• Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
• Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don't get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.

• Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure.

  If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.

• Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
• Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnea.