Reference no: EM133845375
Overview
Hypertension, or high blood pressure, is defined as a persistent systolic blood pressure (SBP) greater than or equal to 140 mm Hg, diastolic blood pressure (DBP) greater than or equal to 90 mm Hg, or current use of antihypertensive medication. Primary (essential or idiopathic) hypertension accounts for 90% to 95% of all cases of hypertension. Although the exact cause of primary hypertension is unknown, there are several contributing factors. Secondary hypertension is elevated BP with a specific cause that often can be identified and corrected.
The hemodynamic hallmark of hypertension is persistently increased systemic vascular resistance. Although this increased vascular resistance causes few, if any, symptoms, damage to target organs is quietly occurring. Pathophysiologic changes contributing to hypertension and its consequences include (1) water and sodium retention, (2) altered renin-angiotensin mechanism, (3) stress and increased sympathetic nervous system activity, (4) insulin resistance and hyperinsulinemia, and (5) endothelial cell dysfunction.
The most common target organs affected by hypertension include the heart (hypertensive heart disease), brain (cerebrovascular disease), peripheral vessels (peripheral vascular disease), kidney (nephrosclerosis), and eyes (retinal damage). Lifestyle modification and/or drug therapy are essential to control hypertension and prevent long-term complications.
Even in people with mild hypertension, the risk of stroke is four times higher than in normotensive people. Stroke occurs when there is ischemia to a part of the brain or hemorrhage into the brain that results in death of brain cells. Clinical manifestations vary depending on the artery involved and area of the brain that it supplies. Motor activity, bladder and bowel elimination, intellectual function, spatial-perceptual alterations, personality, affect, sensation, swallowing, and communication can be affected. Treatment differs according to the type of stroke and changes as the patient progresses from the acute to the rehabilitation phase.
Case Study
E.M. is a 63-year-old Hispanic woman who has a 10-year history of primary hypertension and hyperlipidemia. E.M's daughter and three teenage grandchildren live with her and her husband. At her last clinic visit, 2 months ago, her vital signs were BP 162/104, pulse 86, respirations 20. She weighed 198 lb (90 kg) and is 5'3" (160 cm) tall. At that time, the nurse practitioner stressed the importance of taking her medications and maintaining lifestyle changes to decrease her weight and blood pressure. The nurse practitioner also discussed the organ damage that can occur from uncontrolled hypertension despite the fact that she may not have any symptoms.
E.M.'s mother died of a stroke at age 60, and she lost contact with her father years ago. She has never smoked but has always struggled with obesity as an adult. She does not exercise regularly other than maintaining her home.
Her current drug therapy includes Aldactazide 50/50 (hydrochlorothiazide 50 mg in combination with spironolactone 50 mg) daily, metoprolol (Toprol XL) 100 mg daily, and simvastatin 10 mg daily.
Today E.M. comes to the clinic for a scheduled follow-up visit to recheck her blood pressure and monitor adherence to her medical treatment plan.
Questions
1. Identify risk factors for hypertension and stroke.
2. Describe relevant assessment data for a patient with hypertension.
3. Discuss interprofessional care of a patient with hypertension.
4. Formulate a patient teaching plan for a patient with hypertension.
5. Prioritize nursing care for a patient presenting with clinical manifestations of an acute stroke.
6. Appropriately delegate nursing care during an emergent situation.
7. Discuss interprofessional care of a patient with a stroke.