Hypertension Case Study & Nursing Management

Hypertension, an intermittent or sustained elevation in diastolic or systolic blood pressure, occurs as two major types: essential (idiopathic) hypertension, the most common, and secondary hypertension which results from renal disease or another identifiable cause. Malignant hypertension is a severe, fulminant form of hypertension common to both types. Hypertension is a major cause of stroke, cardiac disease, and renal failure. The prognosis is good if this disorder is detected early and treatment begins before complications develop. Severely elevated blood pressure (hypertensive crisis) may be fatal.

Risk Factors and Causes

Hypertension affects 25% of the adults in the United States. If untreated, it carries a high mortality.

Risk factors for hypertension include:

• family history,
• race (most common in blacks),
• stress,
• obesity,
• a high diet in saturated fats or sodium,
• tobacco use,
• sedentary lifestyle, and
• aging.

Secondary hypertension may result from:

• renal vascular disease;
• pheochromocytoma;
• primary hyperaldestoronism;
• Cushing’s syndrome;
• thyroid, pituitary, or parathyroid dysfunction;
• coarctation of the aorta;
• pregnancy;
• neurologic disorders;
• and use of hormonal contraceptives or other drugs such as cocaine, epoetin alfa, and cyclosporine.

Complications

• Stroke
• Coronary artery disease
• Angina
• Myocardial Infarction
• Heart failure
• Arrhythmias
• Sudden death
• Cerebral infarction
• Hypertensive encephalopathy
• Hypertensive retinopathy
• Renal failure

Signs and Symptoms

Hypertension usually doesn’t show any clinical symptoms until vascular changers in the major organs occur. Severely elevated BP damages the intima of small vessels, resulting in fibrin accumulation in the vessels, development of local edema and, possibly intravascular clotting. Symptoms produced by this process depend on the location of the damaged vessels:

• brain – stroke
• retina – blindness
• heart – myocardial infarction
• kidneys – proteinuria, edema and, eventually, renal failure.
• HPN increases the heart’s workload, causing left ventricular hypertrophy and, later, left- and right-sided heart failure and pulmonary edema.

Diagnosis

Serial blood pressure measurements are obtained and compared to previous readings and trends to reveal an increase in diastolic and systolic pressures.

• Normal – < 120/80 mm Hg
• Pre-hypertension – 120/80 to 139/89 mm Hg
• Hypertension Stage I – 140/90 to 159/99 mm Hg
• Hypertension Stage II – Equal or more than 160/100 mm Hg

Laboratory tests might also be ordered to identify:

• Elevated cholesterol in the blood
• Echocardiogram or electrocardiogram to identify heart disease
• Basic metabolic panel and urinalysis or kidney ultrasound to identify kidney disease

Treatment

Lifestyle Modifications:

• Weight loss
• Moderation of alcohol intake
• Regular exercise
• Low fat and low salt diet
• Smoking cessation
• Stress reduction

Drug therapy:

• Thiazide diuretics
• Angiotensin-converting Enzyme (ACE) inhibitors
• Beta-adrenergic blocker
• Calcium channel blocker
• Angiotensin receptor blocker

Emergency drug therapy:

• Typically, hypertensive emergencies require parenteral administration of a vasodilator or an adrenergic inhibitor or oral administration of a selected drug, such as nifedipine, captopril, clonidinem or labetalol, to rapidly reduce blood pressure.
• Hypertension without accompanying symptoms or target-organ disease seldom requires emergency drug therapy.

Nursing Considerations

• Suggest to the patient to establish a daily routine of taking his/her medications.
• Encourage a change in dietary habits.
• Help patient examine and modify his lifestyle (reducing stress and exercising regularly)
• Ask the hospitalized client if he was taking any prescribed medications.
• When routine blood pressure screening reveals elevated BP, first make sure the cuff size is appropriate for the patient’s upper arm circumference. Take the pressure in both arms in lying, sitting, and standing positions. Ask the patient if he smoked, drank a beverage containing caffeine, or was emotionally upset before the test. Advise him to return for blood pressure testing at a frequent and regular intervals.

 References:

• Lippincott Williams and Wilkins’ Professional Guide to Diseases, Ninth Edition.
• PubMed Health

Found through:

hypertension case study, case study for hypertension, nursing case study hypertension, hypertension case study nursing, case study hypertension, nanda nsg diagnosis for metabolic encephalopathy, case study of hypertension stage 2