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Hypertension NCLEX Review
Introduction
Definition: The amount of resistance of blood pumping through the body/arteries.
Normal: <120/80 (looking at systolic & diastolic)
Prehypertension: 120-139/80-89
Stage 1 HTN: 140-159/90-99
Stage 2 HTN: >160/>100
*Per JNC7 guidelines (Joint National Committee)
Unfortunately, HTN is known as the SILENT KILLER. When a patient starts to have signs and
symptoms with hypertension, major organs have already been affected (a person can have it for
years without knowing it).
To remember organs in involved: “Can’t eat your CAKE and have it too.”
بيكلمك اي هي االعضاء اللي هيحصل فيها مشاكل لما الضغط يعلي وازاي االعضاء دي هتبدا تتاثر
Cardiac system: congestive heart failure (due to the overworking of the heart muscle which
makes it become enlarged)
brAin: stroke (increase pressure weakens blood vessels which can cause a clot to form or for
them to rupture)
Kidneys: renal failure (weakens and narrows the arteries to the kidneys and the kidneys don’t
receive proper perfusion)
Eyes: visual changes (damages blood vessels to the retina…blurred vision..can’t focus images)
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Primary/Essential Hypertension:
Unknown causes….look at the “risk factors”…know the risk factors for HTN (test questions come from this
section)
Race (black males)
Increased consumption of salt/alcohol
Smoking/stress
K+ level and vitamin d level low
Family health
Advanced aged
Cholesterol high
Too much caffeine intake
Obese
Restricting activity
Sleep apnea
Secondary Hypertension:
Caused by a pre-existing issue….there is something causing the person to have
high blood pressure:
Pregnancy, Cushing Syndrome,
Chronic Renal Failure
Diabetes
Hypo/hyperthyroidism
Pheochromocytoma (tumor on adrenal gland which cause
adrenaline/noradrenaline to be secreted increase BP)
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Coarctation of the aorta (congenital defect main artery of the body is super
narrow and this leads to high blood pressure)
Nursing Assessment of Hypertension
Remember silent killer…probably be without symptoms
Headache*
Blurry vision*
Chest Pain*
Nose bleeds
Ringing in the ears
Dizzy
*Most common symptoms
Nursing Interventions for Hypertension
Assess: measure blood pressure (obtain in both arms…make sure patient has been in a resting
position for 5 minutes, no smoking…causes vasoconstriction), ask about family history, and if
they have any sensory changes
Evaluate: blood pressure reading, dietary intake, body mass index (overweight)
Educate: limiting sodium, alcohol and caffeine in diet, quit smoking (vasoconstriction), start an
exercise program (cardiovascular) for weight loss, importance of medication compliance (some
patients think if their blood pressure reading are good they don’t need to take their
medication anymore), measuring blood pressure regularly and keeping a record of it and
bringing it to the doctor’s office.
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Pay attention to education part…asked on exams
Typically, non-pharmalogical techniques are implemented for about 1 to 3 months while
monitoring the patient’s blood pressure, and then if not controlled, medications are started.
Thiazide Diuretics: End in “iazide” HCTZ (hydrochlorothiazide), Diuril (Chlorothiazide)
Work by removing water and sodium through the kidneys WATCH BUN and CREATININE
Levels.
Not for patients in renal failure
Watch patients who are taking Lithium (increases chances of Lithium toxicity)
WASTE POTASSIUM…educate about potassium supplement compliance, and
photosensitivity
ACE Inhibitors (Angiotension -Converting Enzyme Inhibitors): End in “PRIL” Lisinopril
Prevent vasoconstriction by blocking Angiotension 1 and 2
Educate pt about a dry cough/taste changes
Avoid potassium substitutes or supplement…this drug causes potassium retention
Compliance very important due to rebound hypertension
Captopril (increased risk of bleeding) and Moexipril…take 1 hour BEFORE a meal
ARBS (Angiotension Receptor Blockers): drugs that end in “sartan” ex: Losartan (may
be prescribed in place of ACE inhibitors if patient can’t tolerate ACE Inhibitor)
Works by causing vasodilation by blocking aldosterone and Angiotension
Same side effects as ACEI (except dry cough)
Increase k+ level
CCB (Calcium Channel Blockers): end in “dipine” Amlodipine, and Cardizem, Verapamil
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Slow the heart rate to decrease the work load on the heart and cause vasodilation
which lowers blood pressure
Watch HR: bradycardia
Watch pts who have CHF or AV blocks
BB: Beta blockers: end in “olol” ex: Labetalol, Metoprolol
Affects epinephrine and norepinephrine which blocks the sympathetic nervous system
of the heart and this keeps the heart rate nice and low which helps dilates vessel which
lowers blood pressure
Not for patients with asthma and COPD because this medication blocks the receptors in
the lungs and causes bronchoconstriction
Monitor Glucose levels in diabetics because it conceals the signs of hypoglycemia
Monitor heart rate and for orthostatic hypotension
