Page 830 - Cardiac Nursing

LWBK340-c35_p799-822.qxd 29/06/2009 08:59 PM Page 806 Aptara

806 PA R T V / Health Promotion and Disease Prevention

DISPLAY 35-3 Important Aspects of the Patient’s History

Duration of the Hypertension Chest pain
Dyspnea
Last known normal blood pressure Edema
Course of the blood pressure
Claudication
Prior Treatment of the Hypertension
Presence of Other Risk Factors
Drugs: types, doses, side effects
Smoking
Intake of Agents That May Interfere Diabetes
Dyslipidemia
Nonsteroidal antiinflammatory drugs Physical inactivity
Oral contraceptives
Sympathomimetics Concomitant Diseases
Adrenal steroids Dietary History
Excessive sodium intake Weight change
Alcohol ( 2 drinks/day) Fresh versus processed foods
Herbal remedies
Sodium
Saturated fats
Family History
Hypertension Sexual Function
Premature cardiovascular disease or death Features of Sleep Apnea
Familial diseases: pheochromocytoma, renal disease, Early morning headaches
diabetes, gout Daytime somnolence
Loud snoring
Symptoms of Secondary Causes
Erratic sleep
Muscle weakness
Spells of tachycardia, sweating, tremor Ability to Modify Lifestyle and Maintain Therapy
Thinning of the skin Understanding the nature of hypertension and the need for
Flank pain regimen
Ability to perform physical activity
Symptoms of Target Organ Damage
Source of food preparation
Headaches Financial constraints
Transient weakness or blindness Ability to read instructions
Loss of visual acuity Need for care providers

From Kaplan, N. M. (2002). Kaplan’s clinical hypertension (8th ed.). Philadelphia. Lippincott Williams & Wilkins.

prevent the onset of HTN are as follows: weight loss, sodium re- Treatment Options
striction, reduction in alcohol intake, increased exercise, potassium
supplementation, and a diet high in fruits and vegetables. 74–80 Ef- The goal of therapy for patients with HTN is the prevention of
forts to begin the lifestyle habits that prevent the development of morbidity and mortality related to the elevated BP, specifically the
HTN should begin during childhood. 76 prevention of TOD and progression of atherosclerotic cardiovas-
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cular and renal disease. Factors to consider in making treatment
choices are any comorbid conditions, cost of treatment, patient
DISPLAY 35-4 Recommended and Optional Laboratory preference, and potential impacts on the individual’s quality of
Tests and Diagnostic Procedures
life. Figure 35-1 provides an algorithm for treatment of HTN in
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Recommended adults. Treatment options, which will be described in greater de-
tail below, include nonpharmacologic, or lifestyle modifications,
Urinalysis and pharmacologic options. Treatment to achieve a goal BP,
Hematocrit
Blood chemistries 140/90 or 130/80 mm Hg among those patients with dia-
Potassium, calcium, creatinine or estimated glomerular betes mellitus or renal disease, is associated with reductions in
filtration rate, fasting glucose, fasting lipid profile CVD morbidity and mortality.
12-lead electrocardiogram
Nonpharmacologic Management of HTN
Optional
Adoption of a healthy lifestyle is recommended for all persons for
Urinary albumin excretion or the prevention of HTN and is an indispensable part of the man-
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Albumin/creatinine ratio agement of those with HTN. Well-established lifestyle modifica-
tions that lower BP include weight loss, increased physical activity,
From Chobanian, A. V., Bakris, G. L., Black, H. R., et al. (2003). The Seventh Report and dietary modifications including sodium restriction, a diet
of the Joint National Committee on Prevention, Detection, Evaluation, and Treat-
ment of High Blood Pressure: The JNC 7 report. JAMA, 289(19), 2560–2572. high in fruits and vegetables and potassium and reduction in
(Erratum in JAMA, 2003, 290[2], 197.) alcohol intake. 79,80 A combined approach that aims to balance