Chapter 38 Homework Complications Heart Coronary Artery Disease

Introduction to Medical-Surgical Nursing, 6th ed.

38

Lesson Plans for

Hypertension

CHAPTER LESSON PLANS & OBJECTIVES

Lesson 38.1:

2. Explain the physiology of blood pressure regulation.

4. Identify the nursing considerations when administering selected antihypertensive drugs.

5. List the data to be obtained in the nursing assessment of a person with known or suspected

7. Identify the nursing diagnoses, goals, and outcome criteria for the patient with hypertension.

CHAPTER TEACHING FOCUS

• In this chapter, the student is introduced to topics related to hypertension, including primary and

secondary hypertension and hypertensive emergencies.

• Furthermore, the chapter includes information on the anatomy and physiology of blood pressure

CONCEPTS

The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).

Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for

each concept have been tailored specifically to correspond to the Linton textbook.

THEME: Oxygenation and Hemostasis

• Concept: Perfusion

• Exemplar: Hypertension, p. 770

2 Chapter 38Hypertension____________________________________________________________________

Introduction to Medical-Surgical Nursing, 6th ed.

CHAPTER PRETEST

Have the students answer these questions prior to covering this chapter to understand where they stand

in relation to the content.

1) Which of the following blood pressure readings is considered to be normal for an adult?

a) 118/78

b) 128/84

c) 132/88

d) 144/90

2) The causes of secondary hypertension are __________.

a) lifestyle choices

b) genetics

c) underlying factors

d) unknown

3) Which of the following is a significant risk factor for developing primary hypertension?

a) Premenopausal female

b) Ten percent over ideal body weight

c) Cigarette smoking

d) Birth control pills

4) Which of the following is a symptom of hypertension?

a) Cold sweat

b) Insomnia

c) Nervousness

d) Nosebleed

5) Which of the following is a complication of hypertension?

a) Coronary artery disease

b) Kidney infection

c) Hoarseness

d) Diplopia (double vision)

6) Which of the following is a nonpharmacologic approach to treating hypertension?

a) ACE inhibitors

b) Diuretics

c) Beta blockers

d) Relaxation

7) Which of the following medications reduce blood pressure by promoting excretion of water and

sodium?

a) Beta blockers

b) Diuretics

c) ACE inhibitors

d) Calcium channel blockers

8) Older patients are at greater risk for adverse effects from medications for hypertension and should be

monitored for __________.

a) restlessness

b) nervousness

c) orthostatic hypotension

d) headaches

9) A patient is admitted to the medical-surgical unit with blurred vision, severe headache, nausea,

restlessness, confusion, and a blood pressure of 210/133 mm Hg. These are signs and symptoms of

__________.

a) hypertensive crisis

b) orthostatic hypotension

c) secondary hypertension

d) hyperlipidemia

10) Which of the following is a dietary modification that can assist with lowering blood pressure?

a) Decrease potassium in diet

b) Increase sodium in diet

c) Adequate calcium intake

d) Adequate fat intake

__________________________________________________________________ Chapter 38Hypertension 3

Introduction to Medical-Surgical Nursing, 6th ed.

Chapter Pretest Answers

CHAPTER BACKGROUND ASSESSMENT

Discuss these questions with your students prior to covering this chapter to understand where they stand

in relation to the content.

Question: What are the significant risk factors for primary hypertension?

Question: What are the two types of hypertension?

4 Chapter 38Hypertension____________________________________________________________________

Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 38.1

Instructor Preparation

Textbook Objectives Covered

1. Define hypertension.

3. Discuss the risk factors, signs and symptoms, diagnosis, treatment, and complications of

hypertension.

5. List the data to be obtained in the nursing assessment of a person with known or suspected

hypertension.

Lesson Preparation Checklist

• Prepare lecture from TEACH lecture slides available on Evolve.

• Student performance evaluation of all entry-level skills required for student comprehension of

principles underlying hypertension and its treatment, including:

• Understanding the anatomy and physiology of blood pressure regulation and the two main

types of hypertension

• Understanding the risk factors, signs and symptoms, complications, diagnostic tests and

Materials and Supplies

• computer and PowerPoint

projector

• flip charts

Key Terms

• dyslipidemia (p. 771)

• hypertrophy (p. 773)

• syncope (p. 781)

Assignments 2 hours

1

READ – Textbook (pp. 769-770)

REVIEW

ANSWER – Text

• Review Questions for the NCLEX Examination: 1, 3 (p. 784)

ANSWER – Study Guide

• Part IA: 4 (p. 239)

__________________________________________________________________ Chapter 38Hypertension 5

Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 38.1

2

READ – Textbook (pp. 770-771)

REVIEW

• Figure 38-1: Factors that increase blood pressure (BP) (p. 771)

ANSWER – Study Guide

• Part IIF: 7, 23, 24 (pp. 241-242)

• Part IIIH: 1 (p. 244)

3

READ – Textbook (pp. 771-773)

REVIEW

• Figure 38-2: How hypertension affects major target organs (p. 772)

• Table 38-2: Principles of Lifestyle Modification (p. 774)

ANSWER – Text

• Review Questions for the NCLEX Examination: 2, 4 (p. 784)

ANSWER – Study Guide

• Part IA: 2, 3, 4-7 (p. 239)

4

READ – Textbook (pp. 773-778)

REVIEW

• Table 38-3: Drug Therapy: Antihypertensives (pp. 775-776)

• Table 38-4: JNC 8 2014 Hypertension Management Guidelines (p. 776)

ANSWER – Text

ANSWER – Study Guide

• Part IA: 1 (p. 239)

• Part IIF: 9, 10, 12, 13, 14, 21 (pp. 241-242)

6 Chapter 38Hypertension____________________________________________________________________

Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 38.1

5

READ – Textbook (p. 778)

REVIEW

• Box 38-1: Nursing Assessment of the Patient with Known or Possible Hypertension (p. 779)

ANSWER – Study Guide

• Part IIF: 20 (p. 242)

Lecture Outline 20 minutes

Slide 1

Chapter 38

Hypertension

1

Slide 2

Definitions

• The Seventh Report of the Joint National Committee on Prevention, Detection,

Evaluation, and Treatment of High Blood Pressure

TALKING POINTS:

• What risks are included in each of the Risk Groups A, B, and C?

• Some people have only occasional elevations in blood pressure and normal readings at

other times; this is called isolated pressure elevations.

Slide 3

Types of Hypertension

• Primary hypertension

• 90% to 95% of all cases of hypertension

• Its cause is unknown

2

Anatomy and Physiology of Blood Pressure Regulation

• Cardiac output

__________________________________________________________________ Chapter 38Hypertension 7

Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 38.1

Slide 5

Anatomy and Physiology of Blood Pressure Regulation (cont.)

• Peripheral vascular resistance

• Force in the blood vessels that left ventricle must overcome to eject blood from the

heart

TALKING POINTS:

• Why does increased peripheral vascular resistance occur?

Anatomy and Physiology of Blood Pressure Regulation (cont.)

• Diameter of blood vessels regulated by the vasomotor center

Anatomy and Physiology of Blood Pressure Regulation (cont.)

• Norepinephrine and epinephrine (catecholamines) are vasoconstrictors: cause blood

vessels to constrict, making diameter smaller

Slide 8

Anatomy and Physiology of Blood Pressure Regulation (cont.)

• Vasoconstriction decreases blood flow to the kidneys, which then release renin

• Renin leads to the formation of angiotensin, another potent vasoconstrictor

• Angiotensin stimulates the adrenal cortex to secrete aldosterone, a hormone that

2

Age-Related Changes Affecting Blood Pressure

• Atherosclerotic changes reduce the elasticity of the arteries, causing decrease in cardiac

output and increase in peripheral vascular resistance

TALKING POINTS:

• After age 60 years, peripheral vascular resistance increases by approximately 1% per

year.

• Why does the systolic pressure rise in the older adult?

• Because research has shown that older people benefit from controlling hypertension, age

is no longer considered a barrier to aggressive treatment.

8 Chapter 38Hypertension____________________________________________________________________

Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 38.1

3

Slide 10

Risk Factors

• Dyslipidemia

• Atherosclerosis

• Diabetes mellitus

• Tobacco use

• Age >55 years for men or age >65 years for women

• Family history

• Father or brother with heart disease before age 55; mother or sister with heart

disease before age 65

• Sedentary lifestyle

• Obesity

TALKING POINTS:

Slide 11

Signs and Symptoms

• Occipital headaches that are more severe on arising

• Lightheadedness

• Epistaxis

• If hypertension has damaged blood vessels in the heart, kidneys, eyes, or brain, patient

may have symptoms of impaired function of those organs

Slide 12

Complications

• Heart

• Coronary artery disease develops in patients with hypertension two to three times

more frequently than in people with normal blood pressures

• Kidneys

• Narrowing of the renal arteries may decrease renal function and lead to chronic renal

failure

TALKING POINTS:

• Coronary artery disease reduces blood supply to the myocardium, which can result in

Complications (cont.)

• Brain

• Prolonged hypertension constricts and damages cerebral arteries, putting patient at

TALKING POINTS:

• What is a transient ischemic attack?

• People with hypertension have a sevenfold greater incidence of cerebrovascular

accidents than those with normal blood pressures.

__________________________________________________________________ Chapter 38Hypertension 9

LESSON 38.1

Slide 14

Diagnostic Tests and Procedures

• Confirmed by repeated findings of average pressures equal to or greater than 140/90

• Ambulatory blood pressure monitors

• Provider collects data about patient’s lifestyle, other cardiovascular risk factors, and other

TALKING POINTS:

• Why would providers feel there is no need to find the cause of a patient’s hypertension?

Slide 15

Medical Treatment

• Lifestyle modifications

• Weight reduction

• Smoking cessation

TALKING POINTS:

• Reduction of weight can reduce blood pressure by reducing the cardiac workload.

• Stopping smoking eliminates vasoconstriction caused by nicotine.

4

Slide 16

Medical Treatment (cont.)

• Pharmacologic therapy

• Specific antihypertensive drugs

• Diuretics

• Beta-adrenergic receptor blockers

• Calcium antagonists

TALKING POINTS:

• What is the goal of drug therapy?

10 Chapter 38Hypertension____________________________________________________________________

Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 38.1

Medical Treatment (cont.)

• Pharmacologic therapy

• Nursing implications

TALKING POINTS:

Slide 18

Question 1

• Secondary hypertension is most often caused by _______ disease.

A. cardiovascular

B. respiratory

C. renal

D. metabolic

TALKING POINTS:

Slide 19

Question 2

• The Seventh Report of the Joint National Committee on Prevention, Detection,

Evaluation, and Treatment of High Blood Pressure (JNC 7) defines normal blood pressure

as ________.

A. systolic pressure of less than 110 mm Hg and diastolic pressure of less than 60 mm

Hg

B. systolic pressure of less than 120 mm Hg and diastolic pressure of less than 80 mm

Hg

C. systolic pressure of less than 130 mm Hg and diastolic pressure of less than 70 mm

Hg

D. systolic pressure of less than 140 mm Hg and diastolic pressure of less than 90 mm

Hg

TALKING POINTS:

__________________________________________________________________ Chapter 38Hypertension 11

Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 38.1

Classroom Choose from below to make 30 minutes

Online

1

ASSESS BASELINE

• Have the class complete the Pretest. Collect

their work and use the results to guide how

you teach the class.

DISCUSS

• Discuss the definition of hypertension, as

well as the stages and risk groups.

• As a class, discuss and define the two types

of hypertension: primary and secondary. Ask

students to discuss the following questions:

Why is hypertension called the “silent killer”?

What distinguishes the risk groups for

hypertension? What distinguishes

prehypertension from hypertension?

PRACTICE

• Have the students classify the following

blood pressure readings:

• 119/98 mm Hg

• 125/85 mm Hg

• 165/97 mm Hg

ASSESS BASELINE

• Post the Pretest and the Background

Assessment online and have your class

complete them. Use the results to guide how

you teach the class.

POST & COMMENT

• Post the following discussion topic online

and have students comment. Distinguish

between stages 1 and 2 of hypertension.

Ask students to provide constructive

comments on each other’s postings

2

DISCUSS

• Discuss the factors that determine blood

pressure.

PRACTICE

• Divide the class in half. Have students apply

the correct term to the following definitions.

The half of the class with the most correct

answers wins the competition.

• Two factors that determine blood

POST & COMMENT

• Post the following discussion topic online

and have students comment. Ask students

to post a video depicting a nurse explaining

the physiology of blood pressure regulation.

Use of humor and music is encouraged. Ask

students to “vote” for the best video. Ask

students to provide constructive comments

on each other’s videos.

12 Chapter 38Hypertension____________________________________________________________________

LESSON 38.1

3

DISCUSS

• Discuss the age-related changes affecting

blood pressure. What are the implications for

assessment and treatment?

• Discuss the risk factors for primary

hypertension. How would you address these

in patient teaching?

• Discuss the long-term effects of prolonged

hypertension. Which organs are most

sensitive to damage from hypertension?

What are the implications for nursing care?

• Discuss nonpharmacologic treatment of

primary hypertension. How would you present

this in patient teaching?

PRACTICE

• As a class, discuss and identify the risk

factors, signs and symptoms, and

complications associated with hypertension.

Specifically, students should identify as

many risk factors as they can, rating the

significance of each; discuss the relative

lack of identifiable and distinguishing signs

and symptoms of hypertension; and discuss

the complications associated with the eyes,

heart, kidneys, and brain.

• Divide the class into three groups. Assign

each group one of the following. Have

students use flip charts to provide their

POST & COMMENT

• Post the following discussion topic online

and have students comment. Ask students

to select a “target organ” of the effects of

hypertension and to post comments on the

possible effects of a complication on that

organ. Ask students to comment on how this

complication would affect everyday

functioning. Ask students to provide

constructive comments on each other’s

postings.