ATI RN VATI & NCLEX Essentials – Hypertension

ATI RN VATI & NCLEX Essentials – Hypertension Pathophysiology & Classification • Hypertension = SBP ?130 or DBP ?80 on 2+ readings, 2 weeks apart. • Essential (Primary) Hypertension: Most common; no identifiable cause. • Secondary Hypertension: Due to underlying conditions (e.g., kidney disease, meds). • Can lead to organ damage: heart, brain, kidneys, eyes. Mechanisms Regulating BP • Arterial baroreceptors: Control BP via HR, vasoconstriction/dilation. • Body-fluid volume regulation: Kidneys retain/excrete fluid. • RAAS system: Angiotensin II ? vasoconstriction & aldosterone release. • Vascular autoregulation: Maintains consistent tissue perfusion. Risk Factors • Essential: Family hx, high Na intake, obesity, inactivity, alcohol, African American ethnicity, smoking, diabetes, age >60. • Secondary: Renal disease, Cushing’s, adrenal tumors, pregnancy, meds (estrogens, steroids). Expected Findings • Often asymptomatic. • Symptoms: Headache, dizziness, facial flushing, fainting, vision changes. Classification (AHA Guidelines) • Normal: <120/<80 • Elevated: 120–129/<80 • Stage 1: 130–139/80–89 • Stage 2: ?140/?90 • Hypertensive Crisis: >180/>120 Diagnostic & Lab Tests • No labs diagnose HTN, but labs detect causes/damage (BUN/Creatinine, cortisol, cholesterol, glucose). • ECG: Tall R waves = LVH. • CXR: Cardiomegaly. Nursing Care • Teach lifestyle modifications: DASH diet, weight loss, smoking cessation, stress reduction. • Monitor BP, teach home BP monitoring. • Encourage medication adherence even if asymptomatic. Medications • Diuretics (HCTZ, furosemide, spironolactone): Monitor K+ levels (?/? depending on type). • CCBs (amlodipine, verapamil): Avoid grapefruit juice, watch for hypotension, constipation. • ACE inhibitors (lisinopril): Watch for cough, angioedema, hyperkalemia. • ARBs (losartan): Use if ACE not tolerated. Watch for hyperkalemia, angioedema. • Beta blockers (metoprolol): Can mask hypoglycemia, cause bradycardia, sexual dysfunction. • Central alpha2 agonists (clonidine): Sedation, hypotension. • Alpha blockers (prazosin): Start low, give at night, watch for orthostatic hypotension. Client Education • Rise slowly to avoid orthostatic hypotension. • Avoid salt substitutes if on K+ sparing diuretics. • Monitor BP regularly. • Report side effects: cough (ACE), swelling (ARB), bradycardia (beta blocker). Nutrition & Lifestyle • DASH diet: High in fruits, vegetables, low-fat dairy. • Limit sodium <2.3 g/day, saturated fat, alcohol. • Increase potassium-rich foods unless contraindicated. • Exercise 3x/week. • Stress reduction: Yoga, massage, support. Complication – Hypertensive Crisis • S/S: SBP >180 or DBP >120, severe headache, blurred vision, epistaxis. • Actions: IV antihypertensives (labetalol, nicardipine), monitor BP q5–15 min, neuro/cardiac checks. • Goal: Lower BP by 20–25% in 1st hour, not below 140/90. NCLEX/VATI Tips • Spironolactone: Avoid K+ foods, salt substitutes. • ACE Inhibitor cough = report. • Take diuretics early in the day. • Monitor BP + HR before meds (esp. beta blockers). • DASH + meds = best combo for BP control. Hypotension – ATI RN VATI & NCLEX Essentials Definition & Types • Hypotension is defined as a systolic BP < 90 mm Hg or diastolic BP < 60 mm Hg. • Can result in inadequate perfusion of vital organs. • Orthostatic hypotension: Drop in SBP ? 20 mm Hg or DBP ? 10 mm Hg within 3 minutes of standing. • Shock states (cardiogenic, hypovolemic, septic) are associated with severe hypotension. Causes • Dehydration or blood loss (hypovolemia). • Medications (e.g., antihypertensives, diuretics, opioids). • Cardiac conditions (bradycardia, heart failure, MI). • Endocrine disorders (Addison's disease). • Prolonged bed rest or autonomic dysfunction. Risk Factors • Older adults (impaired baroreceptor response). • Diuretic or vasodilator use. • Recent surgery or prolonged immobility. • Dehydration or low fluid intake. • Acute illness, blood loss, or infection. Expected Findings • Dizziness or lightheadedness, especially on standing. • Blurred vision, fatigue. • Nausea, pallor, diaphoresis. • Syncope (fainting). • Cool, clammy skin (with shock). Nursing Interventions • Monitor BP lying, sitting, standing (orthostatic vitals). • Encourage slow position changes. • Ensure adequate fluid intake (unless contraindicated). • Apply compression stockings to promote venous return. • Educate on avoiding hot environments, large meals, alcohol (vasodilating). Patient Education • Rise slowly from lying or sitting positions. • Report dizziness or fainting spells to provider. • Increase fluid and salt intake if not contraindicated. • Use assistive devices if needed for safety. • Avoid driving or hazardous activities until symptoms are managed. Medication Management • Adjust antihypertensive dosage if contributing to hypotension. • Fludrocortisone may be prescribed to increase BP in chronic orthostatic hypotension. • Midodrine (vasopressor) may be used in neurogenic hypotension. Complications • Falls due to syncope or dizziness. • Inadequate perfusion to vital organs (brain, heart, kidneys). • Shock and organ failure if severe. NCLEX/VATI Tips • Assess BP in multiple positions when hypotension suspected. • Monitor for symptoms of decreased perfusion. • Educate on safety precautions related to dizziness and falls. • Reassess medication regimens contributing to hypotension. • Encourage wearing compression stockings if venous return is poor. SECTION 3 | Complications of Pregnancy Chapter 9: Medical Conditions Unexpected medical conditions can occur during pregnancy. Awareness, early detection, and interventions are crucial components to ensure fetal well-being and maternal health. Unexpected medical conditions include cervical insufficiency, hyperemesis gravidarum, anemia, gestational diabetes mellitus, and gestational hypertension. Cervical insufficiency (premature cervical dilatation) See detailed section above for full content. Hyperemesis gravidarum See detailed section above for full content. Iron-deficiency anemia See detailed section above for full content. Gestational diabetes mellitus See detailed section above for full content. Gestational hypertension See detailed section above for full content.