Published on February 21, 2014
• THEORETICAL CONCEPTS • NURSING PRACTISE Mónica Roque Adult Nurse February 2014
• High blood pressure •Cardiac output The product of the heart rate multiplied by the stroke volume. determined by: The pressure exercised by blood on the walls of the blood vessels •Peripheral vascular resistance The ability of the vessels to stretch. •Viscosity (Thickness) • The amount of circulating blood volume 2
Measurement should be done in both arms at first visit The patient should be seated for at least 5 minutes, relaxed and not moving or speaking Remove tight clothing, support arm at heart level, ensure arm relaxed and avoid talking during the measurement Thepatient should not have exercised, eaten or smoked for at least half na hour prior to taking blood pressure. 3
Indication Width (cm) Length (cm) Child/Small adult 10-12 18-24 Standard Adult 12-13 23-35 Large Adult 12-16 35-40 Adult Tight Cuff 20 42 Bladder too large: Underestimation of BP Bladder too small: Overestimation of BP 4
Palpate the brachial pulse along the inner upper arm. Explanation: Where the stethoscope will be placed when listening Korotkoff sounds. Choose the correct cuff and apply it to the upper arm. The centre of the bladder must be in line with the brachial artery. Explanation: the cuff needs to be positioned to allow the stethoscope diaphragm clear access to the brachial artery. Place the diaphragm of the stethoscope over the brachial artery, near to cubital fossa. Close the control valve on the sphygmomanometer Inflate the cuff, so that the dial reads 30mmHg above your earlier estimated Systolic pressure (150mmHg, approximately). 5
Gently open the valve for a slow controlled release of air from the cuff. The Korotkoff sounds are quite faint, but distinctive, when recognized. Listen carefully for the first ‘Bump’, note the associated dial reading. This is the real Systolic pressure (measures the pressure in the arteries when the heart beats). The last sound that listen is the Diastolic pressure (measures the pressure in the arteries between beats). Open the air valve fully, to rapidly deflate the cuff. Release the patient from the equipment. 6
CATEGORY SYSTOLIC (MMHG) DIASTOLIC (MMHG) Optimal <120 <80 Normal 120-129 80-84 High normal 130-139 85-89 Stage 1 Hypertension 140-159 90-99 Stage 2 Hypertension 160-179 100-109 Stage 3 Hypertension ≥180 ≥110 CAUTION: The systolic and diastolic pressures are measured in millimetre of mercury (mmHg). 7
Family history • More common in men than women. •Women are more likely to develop hypertension after menopause. More common in black. Age Gender Race and Ethnicity Diabetes Mellitus disease • High cholesterol; • Kidney diseases; • Sleep apnea. Other chronic diseases The probability to have hypertension increases with age. • Two third of adults who have diabetes also have hypertension. • The risk of developing hypertension when someone has a familiar background of diabetes and obesity is 2 to 6 times great than a person without this family history. 8
Overweight or obesity Weight • Tobacco (chemicals in tobacco can damage the lining of the artery walls) • Alcohol (the regular consumption of 3-4 alcoholic drinks per day, increases the risk of hypertension and reduce the action of antihypertensive therapy.) Stress Unhealthy Diet Addictions (If we have higher body mass index, our body need more blood to supply nutrients and oxygen to the tissues. As the blood volume in circulation increases, it will increase the pressure in artery walls.) • Sodium intake; •Low potassium intake (Potassium helps to balance the amount of sodium in cells.); • High-fat diet. Sedentary life 9
Primary Hypertension • Chronic elevation of blood pressure from an unknown cause. • 90%-95% of all cases Secondary Hypertension • Signify high blood pressure from an identified cause (e.g. kidney disease) • 5%-10% of all cases Systolic Isolated Hypertension • It’s a high value of systolic pressure, and a normal value of diastolic pressure. • It’s rare. 10
• Headache • Bloody nose Kidney Brain • Blurred vision • Dizziness •Fatigue, activity intolerance • Palpitations • Blood spots in the eyes Heart Target organ diseases Eyes • Facial flushing 11
Medical background: • Food habits (alcohol use, salt and fat intake, weight gain/loss) • Elimination (nocturia) • Activity (fatigue, activity intolerance, dyspnoea on exertion, palpitation, angina, chest pain, intermittent claudication, muscle cramps, ) • Addictions • Cognitive/perception (blurred vision, paresthesia) • Coping/stress (stressful life events, noncompliance) 12
MAIN GOALS: •Maintain or enhance cardiovascular functioning. •Prevent complications. •Provide information about disease process, prognosis, and therapy. •Support active client control of condition. 13
•DIET: reduce salt and sodium intake; diet rich in fruits, vegetables, proteins, potassium and calcium; Teaching •REGULAR PHYSICAL ACTIVITY – 20 to 30 minutes of moderate activity 4/5 days a week •WEIGHT REDUTION (in cases of overweight or obesity) •SMOKING CESSATION Therapy Adherence •STRESS MANAGEMENT – use non-pharmacologic strategies, like yoga or relaxing training •LIMIT ALCOHOL CONSUMPTION – for men, no more than 2 drinks per day, and for women, no more than 1 drink per day 14
Health Promotion •Hypertension’s pathology •Correct blood pressure measurement Therapy Adherence •Drug therapy • Inform about support groups and Community support 15
•Explain Health Promotion the importance about therapy adherence. Teaching •In case of Non-adherence: Understand the patient’s reasons; Adjust clinical treatment according to the patients’ cultural beliefs and individual attitudes 16
•Blood pressure measurements devices. V. 2.1. MHRA. (2013) • Brunner, Standard. Textbook of Medical-Surgical Nursing. Lippincott Williams & Wilkins; Twelfth, North American Edition (November 24, 2009) •Marilynn E. Doenges, Mary Frances Moorhouse, Alice C. Murr. Nursing care plans : guidelines for individualizing client care across the life span. Ed. 8. David Plus (2010) •NICE clinical guideline 127 Hypertension: clinical management of primary hypertension in adults. NHS. (2011) •WHO – A global brief on hypertension. (2013) •Williams, S., Hopper, P. – Understanding medical-surgical nursing. Ed. 2. F. A. David Company – Philadelphia (2003) 17
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