Nurse's Fast Facts: Your Quick Source for Core Clinical Content by Holloway FNP-BC DNSc Brenda Walters

Author:Holloway FNP-BC DNSc, Brenda Walters [Holloway FNP-BC DNSc, Brenda Walters]
Language: eng
Format: epub
Publisher: F.A. Davis Company
Published: 2004-04-11T16:00:00+00:00

HYPERTENSION (HTN)

Definition:

For adults:

120–139 systolic or 80–89 diastolic = Prehypertension

140–159 systolic or 90–99 diastolic = Stage 1 HΤN >160 systolic or > 100 diastolic = Stage 2 ΗΤN

For children:

95th percentile or greater adjusted for age, height., and gender.

See Normal Blood Pressure Readings chart in pediatric section.

Whichever reading is higher (systolic or diastolic) is used to classify blood pressure.

Pathophysiology and Etiology: Usually unknown (essential, primary, or idiopathic HTN). Excess renin may increase the production of angiotensin II, which raises blood pressure. HTN may be caused by insulin resistance, structural cardiac or vascular defects or disease, pregnancy, obesity, cocaine (most common cause of young adult HTN presentation to ER), sleep apnea, thyroid or parathyroid disease, kidney disease, pheochromocytoma, oral contraceptives, amphetamines, excess alcohol, steroids, erythropoietin, and other pathologies. The term secondary HTN is used when cause is known.

Manifestations: Initially, essential HTN is usually asymptomatic except for elevation of blood pressure. Occasionally headache. Late complications of uncontrolled HTN include manifestations of damage to eyes (retinopathy), kidneys, heart, or brain.

Med Tx: Lifestyle changes that include prevention or treatment of obesity and hyperlipidemia by increasing exercise and decreasing dietary calories, fat, and sodium (DASH diet). Smoking cessation and moderation of alcohol consumption. Antihypertensive reds—usually more than one med is needed.

Nsg Dx: Risk for decreased cardiac output (vasoconstriction), risk for sexual dysfunction (atherosclerosis or side effect of meds), pain (headache), knowledge deficit, impaired adjustment.

Nsg Care: Check B/P at every office visit or at least once per shift when hospitalized. Teach regarding healthy weight, exercise diet, smoking cessation, and alcohol moderation.

Prognosis: Excellent with B/P controlled below <140/90 or <130/80 for those with diabetes or kidney failure. Uncontrolled HTN may result in damage to eyes, kidneys, heart, or brain. These complications are called end-organ damage. Heart failure and death are possible.

HYDROCEPHALUS

Definition: Increased accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain.

Pathophysiology: Hydrocephalus results from obstructed flow of CSF (noncommunicating hydrocephalus) or an imbalance between production and reabsorption of CSF (communicating hydrocephalus). There is increased intracranial pressure, and head size increases abnormally if sutures and fontanels have not closed.

Etiology: Noncommunicating hydrocephalus (most common type) may result from development anomalies, tumors, abscesses, or trauma and occurs in about 80% of infants with myelomeningocele. Communicating hydrocephalus may result from tumors or infections such as meningitis.

Manifestations: Infant : abnormal increase in head circumference, bulging fontanel, enlargement of forehead, “setting sun sign” (sclera is visible above iris of the eye), pupils sluggish and/or unequal, high-pitched cry, irritability, and opisthotonos (head and body arch backward). Older child : Headache and nausea on awakening (lessened pain after vomiting), papilledema, strabismus, ataxia, and confusion.

Med Tx: Surgical removal of obstruction if possible or surgical placement of a shunt that drains CSF from the ventricles to the peritoneum or right atrium.

Nsg Dx: Potential for injury related to increased intracranial pressure, potential for infection related to mechanical drainage, knowledge deficit (parents).

Nsg Care: Measure head circumference, daily, of infants with myelomeningocele or meningitis. Monitor diagnosed infant for signs of increasing intracranial pressure (anorexia, vomiting, irritability, lethargy, seizures, or increased blood pressure).

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.