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NUR-634 Advanced Health Assessment and Diagnostic Reasoning With Skills Lab
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Chapter 17 – anti hypertensive Hypertension is defned as a sustained systolic bp greater then 140 and diastolic greater than 90. HTN results in increased peripheral vascular arteriolar smooth muscle tone, leads to increased arteriolar resistance and reduced capacitance oF the venous system. Cause is unknown. It’s a common disorder e±ecting 30% oF adults – some have no symptoms, but can lead to heart disease and heart Failure. Etiology – may occur secondary to other disease processes, more than 90% have essential hypertension (no known cause). ²amily hist oF htn increases likely hood pt will have htn. Increases with age, decreases with education and income level. Non-hispanic blacks have a higher incidence oF htn. Ppl with diabeties, obesity or disability status – environmental Factors, stressFul liFestyle, high dietary intake oF sodium and smoking. Mechanism – Purpose oF arterial bp is to assure adequate perFusion oF tissues w/out causing issues to vascular system – arterial bp proportional to cardiac output and peripheral resistance (p. 227) Baroreceptors and the sympathetic nervous system – changing the activity oF the sympathetic nervous system. This causes rapid, movement-to-movement – Fall in bp causes pressure-sensitive neurons – baroreceptors are in the aortic arch and carotid sinuses – resulting in vasoconstriction and increased cardiac ouput. Renin-angiotensin-aldosterone system – kidney provides long-term control oF bp by altering blood volume – Baroreceptors in the kidney respond to reduced arterial pressure – low sodium intake and greater sodium loss causes renin release – renin converts angiotensinogen to angiotensin 1, converted in turn to angiotensin II – ACE causes constriction oF arterioles and veins – increase in BP. Treatment – goal is to reduce cardiovascular and renal morbidity and mortality – Prehypertension – recognizes importance oF lowering bp – According to book – thiazide diuretic, ace inhibitior, angiotensin receptor (ARB JNC – non-black with diabeties – thiazide, CCB, ACEI or ARB AFrican Americans with diabeties – thiazide or CCB CKD – ACEI and ARB
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ASH – nonblack – ACEI or ARB 2 nd – CCB or thiazide, 3 rd CCB plus ACEI or ARB plus thiazide Nonblack 60 years of age and older – Frst CCB or thiazide preferred, 2 nd CCB, thiazide, ACEI or arb, 3 rd CCB plus ACEI, or ARB plus thiazide African American – CCB or thiazide, second ACEI or ARB, 3 rd CCB plus ACEI or ARB plus thiazide Treatment Strategies – reduce cardiovascular and renal morbidity and mortality – Individualized care – treat with coexisting conditions – p 228 –example diabeties– rec bp lower then 140/80. Pt with CKD and proteinuria – goals of 130/80 elderly less stri
NUR-634 Advanced Health Assessment and Diagnostic Reasoning With Skills Lab
