CVS DISORDERS Medical Surgical Nursing - I

Hypertension Defined as constant elevation of the systolic or diastolic pressure above 140/90 mm of Hg
Leads –heart work harder straining to blood vessels and even heart

SBP is imp- Depends on C.O

leading to

MI,

CVA,

RF,

Atherosclerosis

DBP is imp- it depends – Peripheral resistance -↑ in small arterioles - end organ damage

SBP

120-129 High normal

130-139 - Gr I Mild

140-159 - Gr II moderate

160-180 - Gr III

> 180 - Severe

DBP

85-90 --- Borderline

90-109 --- Gr I Mild

109-119 ---Gr II Moderate

120 and above ---Gr III

Etiology

1 RAVEESH KUMAR, ASSO PROF & HOD IN MSN, GOVT COLLEGE OF NURSING, KIMS, HUBBALLI
CVS DISORDERS Medical Surgical Nursing - I

Primary – essential/ idiopathic around 95 %

Secondary- definite causes

Primary Hypertension > 95 % cases

• Heredity - Genetic

• Increased Na Intake

• Obesity

• Excessive Alcohol intake

• Smoking

Other risk factors include

• Age

• Sex

• Excessive fat intake

• Sedentary life style

• DM

• Emotional stress

• Use of oral contraceptives

Secondary Hypertension < 5 % cases in adults person < 20 and > 50 yrs Hypertension is
suspected

• Renal diseases

• Endocrine causes- adrenal gland, Thyroid.

Others like

2 RAVEESH KUMAR, ASSO PROF & HOD IN MSN, GOVT COLLEGE OF NURSING, KIMS, HUBBALLI
CVS DISORDERS Medical Surgical Nursing - I

• Co-artcation or congenital narrowing of aorta

• Pregnancy

• Medication

• Neurological disorders

Pathophysiology

Pathophysiology
Excess Na Fewer Stress Genetic Obesity Endothelial
intake Nephrons factors

↓ ↓ ↓ ↓ ↓ ↓
↑Fvol Renal Fun ↑SNS Cell membrane alteration

ACE -
Aldesterone
Angiotension
1-2
Na reabsorb ↑ periphral resistance
-↑Fvol
↑pre load ↑ contrality ↑ after load load

↓ ↓ ↓
Cardiac out put ↑ - BP

Clinical manifestations

Silent killer because it usually occurs with out any symptoms (organ damage)

• PH is asymptomatic until complications develop

• S&S are non specfic – result from end organ damage

• fatigue

• - reduced activity tolerance

3 RAVEESH KUMAR, ASSO PROF & HOD IN MSN, GOVT COLLEGE OF NURSING, KIMS, HUBBALLI
CVS DISORDERS Medical Surgical Nursing - I

• - dizziness

• -palpitations

• -angina

• -dyspnoea

In advanced state

• headache

• blurred vision

• progressive decrease in cardiac and renal function

• Epitasis

• Stroke --- cerebral haemorrage

• depression

• altered consciousness

Investigations

• History – Family history, Personal History

• Elevated B.P Readings at least 2 separate occasions on both rt/lt arms

• Auscultation - Abdominal Bruit

• Blood – FBS, Urea, electrolytes, lipid profile, Serum Catecholocamines, Endocrine

disorders - Thyroid profile

• ECG - LV Hypertrophy

• Chest X Ray

• USG Kidney Size

• Urine – sugar / cortisone excretion

4 RAVEESH KUMAR, ASSO PROF & HOD IN MSN, GOVT COLLEGE OF NURSING, KIMS, HUBBALLI
CVS DISORDERS Medical Surgical Nursing - I

• Echo Cardiograph

Management

• Specific ---life style modification with support of drug therapy

– Dietary changes

– Limitations of alcohol

– Physical exercise- waking

– Stop tobacco

– Avoid strenuous exercise

• Drugs

1. Diuretics

2. Adrenergic inhibitors - Alfa blockers & Beta blockers

3. ACE inhibitors

4. Vasodilators

5. Ca Channel blockers

1. Diuretics

1. Thiazide ( act on ascending tubule-network of capillaries- Chlorothiazide/

hydrochlorothiazide) ,

2. Loop diuretics – lasix - Decreases the Na FV

2. Adrenergic inhibitors

Sympathetic and ↓ adrenaline level - ↓ the pulse & peripheral vascular resistance

1. Centrally acting Brain-hypothalamus Methyldopa

2. Alpha blocker- peripheral Vasodilatation (Prozosin, )

5 RAVEESH KUMAR, ASSO PROF & HOD IN MSN, GOVT COLLEGE OF NURSING, KIMS, HUBBALLI
CVS DISORDERS Medical Surgical Nursing - I

3. Beta blocker – Block SNS- ↓ HR and ↓B.P- Propranolol, Metaprolol, Atenolol

3. Vasodilaters – Nitroglycerine Na Nitropruside

4. ACE inhibitors – Angiotension converting enzyme - water & Na -ENVAS

5. Calcium Channel Blockers- ↓ cardiac contraction – Cardiac after load- decrease tone ( NOT
IN MI Patients)

– Eg, Amlodipine, Nifeidapen.

Step approach

Step 1: Low dose of any one :

• Thiazide diuretic

• Beta Blocker

• Ace inhibitor –limited

• Calcium channel blocker - limited

Step 2: increase dose or add another step

– one drug

Step 3: increase dose of step 2 or add third

– drug or choose different class from step one

Nursing Management

• Assessment

• Medication

• Diet medication

• Physical exercise

• Regular follow up

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CVS DISORDERS Medical Surgical Nursing - I

• Avoidance of rik factors

• Health education

• Lifestyle therapy

• Diet - reduction in sodium

• A low consumption of animal fat.

• Have - fruits, vegetables, whole grains

• can lower systolic blood pressure by 10–22 mm Hg.

• Lose Weight (BMI £ 25)

• Limit alcohol < 2 drinks/day

• Smoking cessation

• Stress control

• Exercise.

• 30 minutes of moderate exercise, such as brisk walking,— Exercise lower systolic

pressure by 4–9 mm Hg.

Hypotension - Hypotension is low blood pressure.

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CVS DISORDERS Medical Surgical Nursing - I

• Normal BP- in adults is 120/80 mmHg.

Hypotension is blood pressure that's lower than 90/60 mmHg.

Other names

• Low blood pressure

• Neural mediated hypotension

• Neurogenic orthostatic hypotension

• Orthostatic hypotension

• Postprandial hypotension

• Postural hypotension

• Shock

Etiology

• Reduced blood volume - hypovolemia,---

– hemorrhage, or blood loss;

– Excessive fluid losses -diarrhea or vomiting.

– Excessive use of diuretics.

– Insufficient fluid intake,-as in starvation

• Decreased cardiac output

– CHF, large MI or bradycardia, cardiogenic shock.

– Arrhythmias

– Meditation can - temporary hypotension - - nitrate preparations, calcium

channel blockers, ACE inhibitors, sedatives, hypnotics

• Excessive vasodilatation,

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CVS DISORDERS Medical Surgical Nursing - I

– injury to the brain / spinal cord

– also result from

• sepsis,

• acidosis,

• Anesthetic agents - spinal anesthesia and most inhalational agents

• Anemia .

• Severe infections.

• Endocrine conditions, such as thyroid disorders, Addison’s disease, low blood sugar, and
diabetes.

• Pulmonary embolism. Liver failure, Poisoning , A severe allergic reaction

Risk for Hypotension?

• Can affect people of all ages.

– Older adults

– People on medicines, such as antihypertensive medicines, CNS such as

Parkinson’s disease or some heart conditions

– Other risk factors - being immobile .

Types of hypotension

• Orthostatic Hypotension- may happen within a few seconds or minutes of standing up

after been sitting or lying down

– Dehydration , Fever, vomiting, and severe diarrhea .

• Postprandial hypotension - is a sudden drop in BP after a meal.

• Neurally Mediated Hypotension - parasympathetic nervous system. Almost all like OHT

– Clinical manifestations

9 RAVEESH KUMAR, ASSO PROF & HOD IN MSN, GOVT COLLEGE OF NURSING, KIMS, HUBBALLI
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In orthostatic hypotension

• Dizziness or feeling lightheaded

• Blurry vision

• Confusion

• Weakness

• Nausea

In shock

• The skin becomes cold and sweaty - blue or pale.

• Nail bud color returns to normal slowly

• A bluish network of lines appears under the skin.

• The pulse - weak and rapid/Tachynopea.

• Clinical manifestations

• Chest pain

• Shortness of breath/Irregular heartbeat

• Headache/ Stiff neck / upper back pain

• Profound fatigue

• Cough - or vomiting

• Dysphagia

• Dysuria - Foul-smelling urine

• Acute, life-threatening allergic reaction

• Seizures

• Temporary blurring or loss of vision

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CVS DISORDERS Medical Surgical Nursing - I

• Loss of consciousness

Investigations

• Physical condition with presence of CMs

• Blood Tests – anemia- low blood sugar

• ECG

• Echocardiography

• Valsalva Maneuver - heart rate and blood pressure will be checked during the test.

• CAG

Management - depends

• Drinking plenty of fluids, like water

• No alcohol

• Standing up slowly

• Not crossing legs while sitting

• Eating small, low-carbohydrate meals in case of postprandial hypotension

• If medicine cause - require change the medicine or adjust the dose

• Hypovolemia – Rx the cause – IVF/Blood transfusion.

• Nursing Management

• Volume Recuscitation

• Blood Pressure Support (with norepinephrine or equivalent)

• Ensure adequate tissue perfusion (maintain O2 saturation >70 with use of blood or
additional pressors)

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CVS DISORDERS Medical Surgical Nursing - I

• Blood sugar control (80-150)

• Early nutrition (PO or by tube NGT to prevent ileus)

• Address the underlying problem (i.e. antibiotic for infection, stent or CABG for
infarction, steroids for adrenal insufficiency, etc...)

12 RAVEESH KUMAR, ASSO PROF & HOD IN MSN, GOVT COLLEGE OF NURSING, KIMS, HUBBALLI