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Hypertension Nursing NCLEX Review

junio 4, 2018

[VidSitePro id=2 ]Hey everyone it’s sarah with registered nurse Orion comm and in this video I’m going to be going over an Inc Lex review for hypertension what I’m going to do for you in this video is I am going to highlight the causes the nursing management and the pharmacology aspects of hypertension then after this video I highly encourage you to visit my website registered nurse or en comm and take the free quiz that goes along with this lecture a card should be popping up so you can access that ok so let’s get started ok so what exactly is hypertension what’s the definition hypertension is a male of resistance of blood pumping through your body / arteries so what’s happening is that you’re having narrowing of those arteries and that’s increasing the blood pressure and how I like to think of it is the concept with a water hose if you’ve ever played with the water hose and you squeeze the water hose narrow it the water starts to jet out of the house and that’s like the same thing that’s happening with your blood vessels what’s happening those arteries are constricting and that blood is just jetting through and it’s going through to all those organs and over time that starts to wear those organs out which will go over here in a second what organs are affected by hypertension so this is a type of disease process that you really want to treat to prevent long term complications okay so what is an acceptable blood pressure range well according to the Joint National Committee I’m here are the ranges a normal blood pressure you have the systolic on top and the diastolic on the bottom you want a pressure of 120 over 80 or less and prehypertension is anywhere it’s 120 to 129 39 systolic or 80 over 89 diastolic and stage one is 140 to 159 systolic and 90 to 99 diastolic in stage 2 is anything greater than 160 systolic and anything greater than 100 diastolic so though that is a little guideline to help you as a nurse to figure out hey where’s my patient setting right now okay so let’s go over those organs that hypertension effect okay hypertension is known as the silent killer patients can have hypertension for years and not even know it because it just doesn’t present with symptoms whenever it usually starts presenting with symptoms is whenever it’s actually affected systems of the body and you start seeing blurred vision vision change the vision changes and things like that so how I like to remember what systems are affected is this little phrase can’t eat your cake and have it too and cake is the little mnemonic that will help us remember okay so see for cardiovascular your cardiac system is affected what happens high blood pressure over time causes congestive heart failure and this is due to the overworking of the heart muscle and what happens is that your ventricle enlarges and it doesn’t pump very well due to all that increased pressure ma for brain the am brain and you can have a stroke due to all that increased pressure going through the body it causes those arteries to weaken or rupture and whenever that happens you can have a stroke form mk4 kidneys and renal failure you can in the end get renal failure because all that blood going to the kidneys at such a fast hard rate and weakens arteries to the kidneys which decreases perfusion so the kidneys starting or working is good and then last efore eyes what happens is you have all that hard blood flow going to the eyes and it wears out the vessels to the retina which causes blurry visions patients can’t focus objects so all this increased blood flow and resistant on the arteries affects those major organ systems okay now you’ll really want to pay attention to this this is the causes of hypertension you have two types you have the primary slice essential hypertension and then you also have secondary hypertension typically on exams your nursing lecture exams especially they like to hit on give you a scenario and ask you which patient is most at risk for hypertension so try to remember these risk factors and to remember it remember the word risk factors in every word will correlate with the risk factor okay let’s get started are for right males who are black are definitely more at risk for hypertension I for increased intake of sodium or alcohol consuming that increases blood pressure s for smoking or stress K a low and level of potassium or vitamin D levels I’m studies are showing now that patients who suffer with low potassium levels because potassium helps balance out sodium so you have increased sodium which increases your blood pressure and bottom and D levels it actually shows that this affects the kidneys due to an enzyme that your kidneys release and low-bottom and D levels affects that enzyme so the kidneys will increase the blood pressure because it doesn’t have enough bottom in deep okay ever family history if mom or dad had a that increases your chances of developing it a for advanced age people who are older eventually over time almost everyone will have a blood pressure due to the stiffening of the arteries so advanced age definitely puts you more at risk for it see for an increased cholesterol level and a total cholesterol level you want it less than 200 so if you have high cholesterol you’re out risk for it T for too much M intake of caffeine caffeine constricts your vessels whenever you have vasoconstriction you have increased blood pressure o for obese and patients who have higher body mass index is BMI Zoar at risk for hypertension r for restricting activity just having a sedentary lifestyle not exercising not moving around and the last one s for sleep apnea if they snore at night they have that they’re definitely at risk for hypertension okay now let’s look at the secondary cause of hypertension now with the primary and essential they don’t really know the cause it’s idiopathic so you just look at the risk factors now with the secondary what’s causing it is a pre-existing condition so there’s something going on in the body why that patient is having it and typical ones that can cause it pregnancy Cushing syndrome chronic renal failure diabetes hypo or hyperthyroidism are just a couple of conditions that put a patient at risk for hypertension okay now let’s look at the meat and potatoes of this lecture things that you really want to pay attention to for in clicks and your nursing like sure exams ok nursing management and the pharmacology management ok for nursing management like I said usually these patients are going to be asymptomatic you’re going to take their blood pressure and it’s gonna be sky high and they’re gonna be like I don’t feel like my blood pressure’s high because it’s known as the silent killer and they’re not going to have symptoms until it’s actually affecting a system of the body which we don’t want it to get that far ok so if they do have symptoms typically what you’re going to see is blurred vision due to that increased pressure on those retina vessels headache and chest pain as a nurse that and whenever I’ve had patients with chronic hypertension that is usually three symptoms I have seen you can also see nosebleed dizziness ringing in the ears okay as a nurse it’s your job with these patients to assess evaluate and educate educate is a huge thing so really pay attention to the education part okay we’re going to be measuring the blood pressure it’s good to get a blood pressure in both arms to compare them five minutes apart make sure that patient’s resting they haven’t smoked before they because smoking causes vasoconstriction you want to get their family history ask brothers and sisters have it mom or dad you’re going to ask if they have any sensory changes and if they come in they have a really high blood pressure you’re going to ask them how everything’s working their eyes or ears things like that because maybe and it’s got so far that it’s hurt their sensory changes and calculate their BMI make sure that they’re not obese and report any high blood pressure readings to the physician to let them know and then the last thing look at their medications and ask them are you taking these regularly because a lot of reasons people who get hypertension they’re on medications but they’re not being compliant with their medicine so you always wanna make sure they’re being compliant with that okay education part and what you need to do if your patient has hypertension what you’ll normally be educating them on is limiting their sodium alcohol and caffeine intake because all those increase blood pressure if they smoke teach them about smoking cessation ask them if want to quit and collaborate with the doctor how you can get the patient ready to stop smoking because smoking affects your arteries makes them hard and stiff and increases blood pressure exercising goes a long way especially cardiovascular exercise so talk about exercising and show them how to measure their blood pressure at home how to get one of those monitors they can buy and keeping records of it and bringing it with them every time they come to the doctor so they can look at their blood pressure readings okay now let’s cover the pharmacological management of hypertension okay typically if a patient is newly diagnosed with hypertension non-pharmacological techniques will be used for about one to three months while monitoring the blood pressure before they’re starting on started on medications so you’ll be doing the limiting the sodium the alcohol increasing your exercise doing some diet modifications eating healthier and then if it’s still running high and they will be started on these medications slowly and add them on as you need it so typically what a patient started out on first is the thiazide diuretics and this includes hydrochlorothiazide HCTC a clora thiazide those drugs that end in I a Zi des the IDEs and while these work is that they remove water and sodium through the kidneys so the patient’s going to urinate more now the this medication is not for patients who have renal issues because it’s main action is working on the kidney so you don’t want to give it to patients with renal issues and you want if your patient is on lithium you want to make sure that you watch their lithium levels because lithium remember sodium and lithium go hand-in-hand and if you mess it up you can increase your toxicity of lithium so remember that and for your education pieces with thiazide you want to make sure that the patient consumes enough potassium because this drug is a diuretic causes them to urinate more they’re going to be wasting potassium so you want to make sure that they’re taking their supplements and also last but not least that they are aware that it causes photosensitivity meaning that whenever they go outside they need to wear sunscreen hats because it can cause their skin to burn okay next another took that and they maybe started on is called an ace inhibitor and these are your drugs that end in PRI L the prills like lisinopril and what these drugs do is that they prevent vasoconstriction by blocking those angiotensin one and two receptors so they help lower the blood pressure by blocking those now education pieces for the ACE inhibitors you want to let the patient know this is a huge thing I’ve seen this definitely in the clinical setting they can develop a dry cloth with this and sometimes patients can live with this they deal with the dry coffee it’s like a dry hacking cough 24/7 sometimes they can’t and so educate them about that also educate them about avoiding potassium substitutes by taking in too much potassium because this drug actually causes the body to retain potassium so if you’re already retaining potassium and you’re taking too much in you can increase your potassium level so watch that and compliance issues educate them never to just stop this drug all of a sudden because it can cause rebound hypertension which I’ve actually seen that happen as well and it’s really hard to get your blood pressure’s down whenever you have that and when you’re taking these ACE inhibitors especially captopril amok Supriya it’s good to take this medication one hour before meals because it increases absorption so remember with these drugs you like to give them one hour before meals next drug is ARBs these are your angiotensin receptor blockers these are the drugs that end in SA RTA n these are your sort ins like losartan and how they work on the body is a block aldosterone and your angiotensin receptors and this will help lower the blood pressure typically if a patient can’t tolerate the ACE inhibitor maybe they have that dry cough that is just really annoying they will be placed on an ARB with that these drugs typically have the same side effects as the ACE inhibitors except the dry cough next one calcium channel blockers these are your drugs like amoled Ola pine and the end indi IPIN II I’m also known as norvasc and you also have cartas IAM and rap emil and how calcium channel blockers work is that they lower the heart rate which decreases the workload on the heart and causes vasodilation and this helps lower the blood pressure but with these you have to watch because they affect the heart rate so you have to watch out for bradycardia any heart rate less than sixty and also watch using this drug on patients with congestive heart failure or patients who have any AVO ventricular heart blocks last but not least are your beta blockers and these are the drugs that engine oh LOL and they’re called like labetalol metoprolol a work is that they block epinephrine which blocks the sympathetic system of the heart so and what that causes the heart to do keep a nice slow heart rate because your sympathetic system is your fire flight response so you’ll keep a nice slow heart rate which will decrease the workload on the heart and cause vasodilation which decreases the blood pressure now certain patients who have a history of asthma or COPD should not take these drugs so you want to remember that that’s usually a typical NCLEX or nursing exam questions because you’re blocking those beta receptors and these beta receptors are found in your lungs as well as well as your heart so whenever you block those receptors and lungs you are blocking bronchodilation so you’re going to be causing bronchoconstriction which can send them into an asthma attack and affect their breathing so you don’t want to give these drugs to those type of patients next I would also remember this diabetics and diabetics who take beta blockers you need to educate them about watching their glucose levels regularly because beta blockers mask the symptoms of hypoglycemia like tachycardia because this medication isn’t going to let your heart rate increase so you want to let them be aware of that and also you want to watch patients and who have to slow the heart rate giving them them this medication because it’s going to slow it down even more and for those static hypotension okay so that is about hypertension now go to my website and take that free quiz and thank you so much for watching and check out my other in clicks review lectures and please consider subscribing to this YouTube channel

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