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NURS 287 (13)
Chapter 1

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NURS 287
Rick Nilson

Chapter 1:NURSING MANAGEMENT  The primary nursing responsibilities for long-term management of hypertension are to assist the patient in reducing BP and complying with the treatment plan. Nursing actions include patient and family teaching, detection and reporting of adverse treatment effects, compliance assessment and enhancement, and evaluation of therapeutic effectiveness.  Patient and family teaching includes the following: (1) nutritional therapy, (2) drug therapy, (3) physical activity, (4) home monitoring of BP (if appropriate), and (5) tobacco cessation (if applicable). o Home monitoring of BP should include daily BP readings when treatment is initiated or medications are adjusted and weekly once the BP has stabilized. A log of the BP measurements should be maintained by the patient. Devices that have memory or printouts of the readings are recommended to facilitate accurate reporting. o A major problem in the long-term management of the patient with hypertension is poor compliance with the prescribed treatment plan. The reasons include inadequate patient teaching, unpleasant side effects of drugs, return of BP to normal range while on medication, lack of motivation, high cost of drugs, lack of insurance, and lack of a trusting relationship between the patient and the health care provider. GERONTOLOGIC CONSIDERATIONS  The prevalence of hypertension increases with age. The lifetime risk of developing hypertension is approximately 90% for middle-aged (age 55 to 65) and older (age >65) normotensive men and women.  A number of age-related physical changes contribute to the pathophysiology of hypertension in the older adult.  In some older people, there is a wide gap between the first Korotkoff sound and subsequent beats (auscultatory gap). Failure to inflate the cuff high enough may result in underestimating the SBP.  Older adults are sensitive to BP changes. Reducing SBP to less than 120 mm Hg in a person with long-standing hypertension could lead to inadequate cerebral blood flow.  Older adults produce less renin and are more resistant to the effects of ACE inhibitors and angiotensin II receptor blockers.  Orthostatic hypotension occurs often in older adults because of impaired baroreceptor reflex mechanisms.  Orthostatic hypotension in older adults is often associated with volume depletion or chronic disease states, such as decreased renal and hepatic function or electrolyte imbalance.  To reduce the likelihood of orthostatic hypotension, antihypertensive drugs should be started at low doses and increased cautiously. HYPERTENSIVE CRISIS  Hypertensive crisis is a severe and abrupt elevation in BP, arbi
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