BY: Asmaa Manasrah

Outline

Definition
Types
Risk factors
Treatment
Nursing assessment and intervention

 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
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What is Blood Pressure

Systolic

Components of B/P
Pressure of blood
against the walls of
the arteries
The elasticity of the
artery walls
The volume and
thickness of the blood

Force while the heart

pumps
Pressure as the heart
pushes the blood out to the
body
Normal >130

Diastolic
Force between heart
pumps
Pressure as the heart
begins to fill with blood
Normal >85

Systolic over diastolic

120/80

What is Hypertension
Is the result of persistent
high arterial blood
pressure which may cause
damage to the vessels
and arteries of the

Heart
Brain
Kidneys
Eyes

B/P > 140/90

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

The patient should not have exercised, eaten or smoked for at

least half no hour prior to taking blood pressure.

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

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Bladder too large:

Underestimation of BP

Bladder too small:

Overestimation of BP

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).
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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.
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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).

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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.
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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
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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

Its a high value of systolic pressure, and a normal value of
diastolic pressure.
Its rare.

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 Headache
Bloody nose

Kidney

Brain

Blurred vision
Dizziness
Fatigue, activity intolerance
Palpitations
Blood spots in the eyes

Heart

Target
organ
diseases

Eyes

Facial flushing

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Complications
Hypertensive Heart Disease
Coronary Artery Disease
Hypertension is a major risk factor for CAD
Left Ventricular Hypertrophy (LVH)
Increased resistance in the arteries
Stiffness and narrowing of vessels
Left heart works harder pumping against
higher pressure
Increases myocardial work and 02
consumption

 Heart Failure
Heart can no longer pump enough blood to meet
the metabolic needs of the body
Contractility depressed
Stroke volume and cardiac output decreases
C/O
SOB on exertion, paroxysmal nocturnal dyspnea and
fatigue

Complications Cont
Cerebrovascular Disease (CVA)
Most common cause Atherosclerosis
Portions of plaque or a blood clot (forms on
plaque) breaks off
Thromboembolism
Travels to intracerebral vessels
Stops the flow of blood to parts of the brain
Aneurysms burst R/T increased pressure
Hemorrhage
Brain tissue damage

 Peripheral Vascular Disease (PVD)

Hypertension speeds up Atherosclerosis in the
peripheral blood vessels
Aortic aneurysm
Aortic dissection
PVD

C/O
Intermittent claudication

 Nephrosclerosis
End stage renal disease
Renal dysfunction
Ischemia
Narrowed intrarenal vessel
Atrophy of tubules
Destruction of glomeruli
Death of nephron

Earliest symptom
nocturia

 Retinal Damage
Red flag
Damage to retinal vessels may indicate vessel
damage in the heart, brain, and kidney

C/O
Blurred vision
Retinal hemorrhage
Loss of vision

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)

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Nursing Assessment Data

Subjective Data
Past medical
history/Family history
FHP 2 Nutrition
Alcohol use, salt and fat
intake, wt. gain/loss

FHP 3 Elimination
Nocturia

FHP 4 Activity/Exercise
Fatigue, Dyspnea on
exertion, palpitation,
angina, chest pain,
intermittent claudication,
muscle cramps, smoking
history, sedentary lifestyle

FHP 6
Cognitive/perception
Blurred vision
paresthesia
FHP 9 Sexual/Repro
Impotence
FHP 10 Coping/stress
Stressful life events
Noncompliance
knowledge deficit
financial

Objective Data
Cardiovascular
Persisted elevated B/P
Orthostatic change in B/P
or pulse
Retinal changes
Abnormal heart sounds
Diminished or absent
peripheral pulses
Carotid, renal, ischial or
femoral bruits
edema

Musculoskeletal
Truncal obesity
Abnormal waist-hip
ratio

Neurologic
Mental status
changes,
Localized edema

Abnormal Diagnostic Test

Lab

ECG

UA, BUN, serum

Creatinine
Renal involvement

Serum electrolytes
Potassium
Hyperaldosteronism

Blood Glucose
Serum cholesterol and
triglycerides
Uric acid

Left Ventricular
hypertrophy

EEG
Ischemic heart disease

Medications
Diuretics
Suppresses renal tubular re-absorption of
sodium
Diuril

Loop diuretics
Bumex, Lasix, Demadex

Potassium supplement
Potassium sparing diuretic
Aldactone

 Beta Blockers
Blocks sympathetic stimulation, decreases renin secretions,
decreases cardiac output.
Tenormin, Lopressor, Corgard, Inderal

Alpha Inhibitors
Decreases peripheral vascular resistance,
Vasodilator
Catapres

Central Inhibitors
Decreases cardiac output, peripheral resistance, and heart
rate
Aldomet, Tenex

 Peripheral Inhibitors
Relaxes smooth muscle, decreases peripheral
resistance, decreases heart rate, and B/P
Resperine

Vasodilators
Relaxation of arteriolar smooth muscle,
vasodilatation, decreases cardiac output,
decreases peripheral resistance
Nitroglycerin

 Calcium Channel
Blockers
Inhibits calcium into
smooth muscle cells,
vasodilatation,
decreases peripheral
resistance, increases
cardiac output
Amicor

AngiotensionConverting
Enzyme Inhibitors
Decreases
peripheral
vascular
resistance
Anapril 20 mg

Expected Outcomes
Patient will achieve and maintain desired B/P
Patient will understand, accept, and
implement the therapeutic plan for B/P
Patient will experience minimal or no side
effects from therapy
Patient will exhibit a confident ability to
manage and cope with hypertension.

MAIN GOALS:
Maintain

or

enhance

cardiovascular

functioning.
Prevent complications.
Provide information about disease process,
prognosis, and therapy.

Support active client control of condition.

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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

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Health
Promotion
Hypertensions pathology

Correct blood pressure measurement

Therapy
Adherence

Drug therapy
Inform about support groups and
Community support
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Explain

Health
Promotion

the

importance

about

therapy adherence.

Teaching

In case of Non-adherence:
Understand the patients reasons;
Adjust clinical treatment according
to the patients cultural beliefs and
individual attitudes

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Blood pressure measurements devices. V. 2.1. MHRA. (2013)

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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)

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