NRSG 3100 Unit 11 Latest Update Graded A+

NRSG 3100 Unit 11 Latest Update Graded A+ Hypertension Most common cardiovascular disease Affects 1 in 3 Americans Complex disease- genetic and environmental components Primary and Secondary 90% of Primary HTN cases are... idiopathic 10% of Secondary HTN cases.... have a specific cause that can be identified (Cushings, hyperthyroidism, chronic renal impairment, arteriosclerosis, pharmacotherapy) Complications of HTN Damage to blood vessels, atherosclerosis, kidney damage, retinal damage, worsens CAD, can lead to stroke, heart failure, MI Normal BP Less than 120/80 Elevated BP Systolic between 120-129 and diastolic less than 80 Stage 1 HTN Systolic between 130-139 or diastolic between 80-89 Stage 2 HTN Systolic at least 140 or diastolic at least 90 Hypertensive Crisis Systolic over 180 and/or diastolic over 120 with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage. Lifestyle Changes for HTN Limit intake of alcohol Restrict sodium consumption Increase aerobic physical activity Reduce intake of saturated fat and cholesterol, and increase consumption of fruits and vegetables Discontinue use of all tobacco products Explore measures for dealing with excessive stress Maintain optimum weight First line drugs for HTN Diuretics (hydrochlorothiazide) ACE inhibitors (lisinopril) ARBs (losartan) CCBs (verapamil, nifedipine) Second line drugs for HTN Alpha2-adrenergic agonists (clonidine) Alpha1-adrenergic blockers (prazosin) Beta-adrenergic blockers (olol's) Centrally acting alpha and beta blockers Direct-acting vasodilators (hydralazine) Direct renin inhibitors (tekturna) Peripherally acting adrenergic neuron blockers Hydralazine Classification Antihypertensive/direct vasodilator Hydralazine MOA Relaxes arterial smooth muscle, reduces afterload Hydralazine Indication Moderate to severe HTN, usually with other meds Hydralazine Adverse Effects HA, orthostatic hypotension, fluid retention, peripheral edema. Blood dyscrasias (rare). Lupus-like syndrome (rash, urticaria, myalgia fever, chills, fatigue) Hydralazine Contraindications Lupus Cerebrovascular disease or rheumatic heart disease. Caution with CAD - precipitate angina/MI Caution with renal impairment Hydralazine Nursing Considerations/Patient Education Discontinue gradually to avoid rebound HTN and anxiety. Monitor BP, HR Nitroprusside Sodium (Nitropress) Classification