1. What are the types of hypertension?

Give the differences

TYPES
Primary Hypertension
Secondary Hypertension
Malignant Hypertension
EXPLANATION
Also known as essential hypertension, the
most common hypertension. The people
with this type of hypertension feel no
different from those who have normal blood
pressure.
An elevation without specific cause
Results from another source or other organs
such as: renal failure and liver disease. Also
with the use of certain medicines.
With an specific cause
Also known as accelerated hypertension, it
is either primary hypertension or secondary
hypertension that is severe

2. Identify what type of hypertension and explain.

Classification of Blood Pressure

Systolic Diastolic
Normal <120 <80
Prehypertension 120-139 80-89
Stage 1 Hypertension 140 – 159 90 – 99
Stage 2 Hypertension >160 >100

 The classification of blood pressure shows that Ruth Marie has stage-2
hypertension.

3. Appropriate diet for HTN

TYPES OF DIET
DASH (dietary approaches
to stop hypertension) diet
Dietary sodium reduction
 Grains and grain products 7-8 per/day
 Vegetables (green leafy) 4-5 per/day
 Fruits 4-5 per/day
 Low fat or fat free dairy foods 2-3 per/day
 Meat, fish, poultry
 Nuts, seeds, and dry beans 2-5 per/week
 Increase water intake and dietary fiber to
decrease BP
 Reduce dietary sodium intake to no more
than 100 mmol/day (2.4g sodium or 6 g
NaCl)
4. Risk factors
 Smoking
 Dyslipidemia (elevated LDL or low HDL cholesterol)
 Diabetes mellitus
 Impaired Renal function ( GFR <60 mL/min or microalbuminuria)
 Obesity (BMI >30 kg/m2)
 Physical inactivity
 Age (older than 55 years for men, 65 years for women)
 Family history of cardiovascular disease
 Alcohol consumption
 Race (African American are most common)
5. Pathogenesis and symptomatology of HTN

RELATED RISK FACTORS Falling systemic blood pressure/volume

Baroreceptors in blood Hypothalamic

Reduce filtrate volume vessels osmoreceptors
content in renal tubes

Juxtaglomerular cell of Sympathetic nervous Posterior pituitary

kidney release renin system causing releases ADH
systemic arterioles
vasoconstriction
Angiotensin II formed
Collecting ducts of
in blood
kidneys causes water
Increased in peripheral reabsorption
resistance
Systemic arterioles
Adrenal cortex secretes
causes vasoconstriction
aldosterone in kidney
that result in increased
tubules
peripheral resistance

Increased Na+
reabsorption and water

Increased Blood S/Sx:

pressure  Severe headache
 Chest pain
 Fatigue
 Irregular heartbeat
 Dyspnea
 Change in vision
 6. Drug study for Hypertension

DRUG NAME MODE OF INDICATION CONTRAINDICATION SIDE/ADVERSE NURSING

ACTION EFFECTS RESPONSIBILITIES

Drug Name: Blocks  Hypertension  Gout  Dry mouth  Monitor for side
 Diuril reabsorption of  Edema  Known sensitivity to  Thirst effects
 Zaroxolyn sodium, chloride, associated sulfonamide derived  Weakness  Monitor for
and water in with heart medications  Drowsiness electrolytes
kidney failure,  Severely impaired  Lethargy imbalance
Generic Name: cirrhosis, kidney function  Muscle ache  Encourage intake of
 Cholothiazide renal disease  History of  Muscular fatigue potassium rich food
sodium hyponatremia  Tachycardia such as fruits
 Methyclothiazide  GI disturbance  Monitor blood
 Postural pressure to avoid
Classification: hypotension postural hypotension
Thiazide diuretic from significant
water depletion
Dosage:
Diuril 0.5-2 g
Zaroxolyn 2.5-5 mg

Route:
PO

Frequency:
Once a day
DRUG NAME MODE OF INDICATION CONTRAINDICATION SIDE/ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITIES

Drug Name: Blocks  Hypertension  Gout  Dry mouth  Monitor for side
 Lasix reabsorption  Edema  Known sensitivity to  Thirst effects
 Bumex of sodium, associated sulfonamide derived  Weakness  Monitor for
 Demadex chloride, and with heart medications  Drowsiness electrolytes
water in failure,  Severely impaired  Lethargy imbalance
Generic Name: kidney cirrhosis, kidney function  Muscle ache  Encourage intake of
 Furosemide renal disease  History of  Muscular fatigue potassium rich food
 Bumetanide hyponatremia  Tachycardia such as fruits
 Torsemide  GI disturbance  Monitor blood
 Postural pressure to avoid
Classification: hypotension postural hypotension
Loop Diuretics from significant
water depletion
Dosage:
Furosemide - 40 mg
Bumetanide – 0.5-1 mg
Torsemide – 5 mg

Route:
PO

Frequency:
Furosemide BID
Bumetanide q4
Torsemide OD
DRUG NAME MODE OF INDICATION CONTRAINDICATION SIDE/ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITIES

Drug Name: Blocks  Hypertension  Renal disease  Drowsiness  Monitor for side
 Midamor reabsorption of  Edema  Azotemia  Lethargy effects
 Dyrenium sodium, acts on associated  Severe hepatic  Headache  Monitor
distal tubule with heart disease  Hyperkalemia hyperkalemia if
Generic Name: independently of failure,  hyperkalemia  Diarrhea given with ACE
 Amiloride aldosterone cirrhosis,  inhibitors or
 Triamterene renal disease angiotensin receptor
blockers
Classification:  Administer
Potassium sparing medication after
diuretics meals
 Monitor BP before
Dosage: administration
Midamor - 5 mg
Dyrenium – 25 mg

Route:
PO

Frequency:
Midamor OD
Dyrenium OD
DRUG NAME MODE OF INDICATION CONTRAINDICATION SIDE/ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITIES

Drug Name: Competitively  History of  Hyperkalemia  Drowsiness  Monitor for side

 Inspra blocks the myocardial  Impaired renal  Lethargy effects
 Aldactone effects of infarction or function  Headache  Monitor for
aldosterone in symptomatic  Diabetes mellitus  Diarrhea hyperkalemia if
Generic Name: the renal ventricular  Gynecomastia given with ACE
 Eplerenone tubule, dysfunction inhibitor or
 Spironolactone causing loss angiotensin receptor
of sodium and blocker
Classification: water  Avoid use of
Aldosterone Receptor retention of potassium
Blockers potassium. supplements or salt
substitute
Dosage:  Teach patient,
Inspra – 5 mg families, and
Aldactone -50-100 mg caregivers signs and
symptoms of
Route: hyperkalemia
PO

Frequency:
Inspra OD
Aldactone OD
DRUG NAME MODE OF INDICATION CONTRAINDICATION SIDE/ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITIES
Drug Name: Inhibit  Hypertension  Impaired renal  Angioedema  Fluid replacement
 Lotensin, capoten, conversion of function  Hypotension  Monitor BP before
vasotec, vasotec IV, angiotensin 1  pregnant  Dizziness administration
monopril, prinivil, to angiotensin  Fatigue  Monitor for adverse
Zestril, univasc, II, lower total  Mouth sore effects of
aceon, accupril, peripheral  Sore throat medications
altace, mavik resistance
 Fever
 Chills
Generic Name:
 Irregular heart
 Benazepril, captopril,
beat
enalapril, enalaprilat,
 Chest pain
fosinopril, moexipril,
perindopril,  Swelling of face
quinapril, Ramipril,  Dyspnea
trandolapril

Classification:
ACE inhibitors

Route:
PO, IV

Frequency:
OD
DRUG NAME MODE OF INDICATION CONTRAINDICATION SIDE/ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITIES
Drug Name: Block the  Hypertension  Bronchial asthma  Insomnia  Monitor HR before
 Tenormin, kerlone, sympathetic  Stable angina  Allergic rhinitis  Lassitude administration
zebeta, Inderal, nervous pectoris  Right ventricular  Weakness  Monitor for
Inderal LA, system,  Silent failure  Fatigue occurrence of
Lopressor, Toprol especially the ischemia  Heart failure  Lightheadedness adverse effects
XL, corgard, sympathetic to  Depression  Nausea  Take BP in three
blocadren the heart,  positions and observe
Diabetes mellitus  Vomiting
producing a for hypotension
 Dyslipidemia  Epigastric
Generic Name: slower heart
 Heart block distress
 Atenolol, betaxolol, rate and
lowered blood  Peripheral vascular
bisoprolol,
pressure. disease
propranolol,
 Hypotension
metotrolol, nadolol,
timolol

Classification:
Beta-Blockers

Route:
PO, IV

Frequency:
OD
DRUG NAME MODE OF INDICATION CONTRAINDICATION SIDE/ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITIES
Drug Name: Decreases  Hypertension  Angina  Headache  Take BP and apical
 Apresoline peripheral  Pregnancy  Coronary disease  Flushing pulse before
resistance but induce  Heart failure  Hypotension administration
Generic Name: concurrently hypertension  Hypersensitivity  Sweating  Monitor intake and
 Hydralazine elevates  Dyspnea output
cardiac  Peripheral  Observe for local
Classification: output. Acts edema reactions at the
Vasodilators directly on injection site
 Dizziness
smooth
 Nausea
Route: muscle of
blood vessels  Palpitations
IV or IM
 Tachycardia
Dosage:
20-40 mg

Frequency:
qid
DRUG NAME MODE OF INDICATION CONTRAINDICATION SIDE/ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITIES
Drug Name: Suppress central  Hypertension  Severe coronary  Dry mouth  Monitor HR before
 Catapres nervous system artery disease  Drowsiness administration
outflow  Pregnancy  Sedation  Monitor for
Generic Name:  Occasional occurrence of
 Clonidine headache adverse effects
 Fatigue  Assess for safety
 Anorexia
Classification:  Malaise
Central Alpha 2  Vomiting
Agonist
 Constipation
 Impotence
Route:
PO, IV

Frequency:
OD
DRUG NAME MODE OF INDICATION CONTRAINDICATION SIDE/ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITIES
Drug Name: Inhibit calcium  Hypertension  Sinus or AV node  Headache  Report for adverse
 Calan ion influx,  Antiarrhythmic disease  Irregular effects
slows velocity  Severe heart failure heartbeat  Administer on empty
Generic Name: of conduction of  Severe hypotension  Dizziness stomach or before
 Varapamil cardiac impulse  Edema meal
 Hypotension  Do not discontinue
suddenly
Classification:  Monitor electrolytes
Calcium channel  Decrease dose for
blockers patient with liver or
renal failure.
Route:
PO

Dosage:
40-80 mg

Frequency:
tid
7. HTN known as “Silent Killer”
 Hypertension is sometimes called the “silent killer” because people who
have it are often symptom free until after it has done significant damage to
the heart and arteries.

8. Common complication of uncontrolled HTN

COMMON COMPLICATIONS
Cardiac Hypertrophy Results as the left ventricle attempts to keep up with
increased workload and oxygen demand
Heart Failure Develop when hypertrophy cannot maintain cardiac
output
Atherosclerosis This leads to angina and myocardial infarction
Kidney failure Due to weakened and narrowing of blood vessels
Stroke Due to atherosclerosis in the blood vessels causing it to
bursts that leads to hemorrhage
Aneurysm When high BP creates weak spots in arteries causing
balloon like formation which will lead to stroke

9. Assessment related to venous insufficiency disorder or arterial insufficiency

disorder.

Venous Insufficiency Disorder Arterial Insufficiency Disorder

 Lower leg edema
 Bronze-brown pigment
 Frequent pruritus
 Capillary refill >3 seconds
 Pain with exercise
 Thin, shiny, dry skin
 Absent pulses
 Cool to touch
 Pallor with elevation
 Thickened, brittle nails
10. 5 nursing Diagnoses and Prioritize

NURSING DIAGNOSIS
Decreased cardiac output
Acute pain
Risk for Activity Intolerance
Deficient knowledge
regarding conditions
Due to inadequate blood pumped by the heart to
meet the metabolic demands of the body. Also, in
patient with chronic hypertension, constant
contracting to meet the demand will develop
hypertrophy of the heart muscle which leads to
cardiomegaly (enlargement of the heart).
Due to ischemic attack or restriction in blood
supply to tissues - a shortage of oxygen that is
needed for to cellular metabolism.
Insufficient physiological energy because of acute
pain and decreased oxygen demand.
Lack of cognitive information related to disease
process on how to prevent the occurrence.

Risk for Imbalanced Inability to recognized importance of proper

nutrition more than body nutrition in preventing hypertension. Intake of
requirements nutrients that exceeds metabolic needs
 ASSESSMENT EXPLANATION OBJECTIVE NURSING RATIONALE EXALUATION
OF THE INTERVENTION
PROBLEM
Subjective: Decreased STO: Dx: Patient is able to
 “Nahihirapan ako cardiac output Within 6-8 hours,  Check for laboratory  To identify participate
huminga at due to impending patient will: data such as: cardiac contributing factors willingly in
masakit dibdib hypertension,  Participate in markers, CBC, necessary/desire
ko” patient heart activities that electrolytes, ABGs, d activities,
 “bumibigat po ata contractility reduce cardiac BUN and creatinine, proper diet and
ako” increased to meet workload an cardiac enzymes able to maintain
oxygen demand. stress such  Monitor BP and ECG  Data may serve as vital signs within
Objective: As as: Stress baseline data for manageable
 Capillary refill >3 consequences, management, progress of range.
seconds decreased in balanced interventions, as
 Cool to touch capillary refill, activities and well as it will help
 Lower leg edema cool to touch, rest plan determine extent of
noted pallor with  Demonstrate severity of
 Pallor with elevation, and dry understanding conditions
elevation skin. about diet  Determined pulses in  Determined the
 Bronze brown restriction and extremities extent of affected
pigment noted proper diet areas
 Thickened and
brittle nails  Observe skin color,  Determined for
LTO: moisture, temperature, peripheral
 Pruritus noted
After 2-3 days, and capillary refill vasoconstriction or
 Thin, shiny, dry
patient will be reflect cardiac
skin
able decompensation
 Absent pulses demonstrate and decreased
 BP 164/96 stable cardiac output
 HR 104 rhythm and rate
such as:  Evaluate evidence of  To assess for signs
Nursing Dx:  Pulse extreme fatigue, of poor ventricular
Decrease cardiac  Respirations intolerance for activity, function or
output r/t
 Blood weight gain, swelling impending cardiac
hypertension as
pressure of extremities, and failure
evidence by
within dyspnea
capillary refill >3
seconds, cool to acceptable
touch, pallor, range Therapeutic:
absent pulses, and  Demonstrate Independent:
lower leg edema changes in  Provide calm, restful  Helps lessen
lifestyle, and surroundings, sympathetic
activities minimize stimulation and
environmental activity promote relaxation
and noise. Limit the
number of visitors and
length of stay

 Maintain activity  To decrease oxygen

restrictions like consumption and
bedrest and chair rest demand

Dependent:
 Administer o2  Increase tissue
perfusion

 Administer  TO control blood

medication such as pressure and lessen
diuretics (Thiazide, cardiac workload
loop diuretics,
potassium sparing)
alpha, beta or
centrally acting
adrenergic
antagonist, calcium
channel, adrenergic
neuron blockers,
direct acting oral
vasodilators, direct
acting, ACE
inhibitors, angiotensin
II blockers.
 Implement dietary  Help manage fluid
sodium, fat, and retention and with
cholesterol restriction associated
hypertensive
response, and
decrease
myocardial workload