__________________________________________________________________ Chapter 38Hypertension 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 38.1
4
DISCUSS
• Discuss common approaches to drug
therapy, including monotherapy and the
stepped-care approach. What are some of
the common antihypertensive drugs and
how do they affect the cardiovascular
system?
• Discuss the nursing implications of drug
therapy for hypertension. In what ways do
the elderly respond differently to drug
therapy?
PRACTICE
• Divide the class into small groups. Present
the following scenarios to each group and
have the group identify nursing interventions
for the side effect portrayed.
• A 25-year-old hypertensive patient
taking losartan is experiencing dizziness
on his job as a mailman.
• A 40-year-old cab driver is taking
propranolol for hypertension. She is
complaining of depression and
drowsiness.
POST & COMMENT
• Post the following discussion topic online
and have students comment. Ask students
to post a video of a nurse providing
patient/family education on a selected drug
category used to treat hypertension. Ask
students to provide constructive comments
on each other’s videos.
5
DISCUSS
• Discuss the assessment of a patient with
known or suspected hypertension.
PRACTICE
• Have student pairs take turns role-playing a
POST & COMMENT
• Post the following discussion topic online
and have students comment. Discuss
appropriate ways to ask a patient questions
regarding the patient’s risk factors. Ask
students to provide constructive comments
14 Chapter 38Hypertension____________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 38.1
Critical Thinking Question
How does aging affect blood pressure? Is advanced age considered a barrier to aggressive
antihypertensive treatment?
Discussion Guidelines: As people age, atherosclerotic changes reduce the elasticity of the
arteries, causing a decrease in cardiac output and an increase in peripheral vascular resistance.
Instructor Notes/Student Feedback
__________________________________________________________________ Chapter 38Hypertension 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 38.2
Textbook Objectives Covered
7. Identify the nursing diagnoses, goals, and outcome criteria for the patient with 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
Key Terms
• dyslipidemia (p. 771)
• epistaxis (p. 772)
• hypertension (p. 770)
• hypertrophy (p. 773)
• orthostatic hypotension
(p. 777)
• syncope (p. 781)
• thrombus (pl. thrombi)
(p. 773)
Student Preparation
Assignments 2 hours
READ – Textbook (pp. 779-783)
REVIEW
• Table 38–5: DASH Eating Plan (p. 780)
• Box 38-2: Action Items to Help Lower Blood Pressure (p. 781)
ANSWER – Text
ANSWER – Study Guide
• Part IIIH: 2, 10 (pp. 244-245)
READ – Textbook (pp. 779-783)
REVIEW
• Box 38–3: Emergency Antihypertensive Drugs (p. 783)
ANSWER – Study Guide
16 Chapter 38Hypertension____________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 38.2
Lecture Outline 20 minutes
Slide 20
Secondary Hypertension
• Has a specific known cause and is less common than primary hypertension
• Causes
• Renal disease
• Excess secretion of adrenal hormones
Slide 21
Interventions: Ineffective Self-Health Management
• Diet therapy goals
• Maintain ideal body weight; prevent fluid retention
• Exercise
TALKING POINTS:
• A diet low in saturated fats with no more than 2 g of sodium is often prescribed.
• What is the maximum daily intake of sodium recommended by the National Research
Council?
• If the patient is taking a potassium-wasting diuretic, dietary potassium intake may need to
be increased or potassium supplements may be recommended.
Slide 22
Interventions: Ineffective Self-Health Management (cont.)
• Stress management
• Help patients identify stressors in their lives and explore ways to reduce them
• Drug therapy
TALKING POINTS:
• Patients need to be well-informed about their medications.
• What adverse effects may be caused by suddenly stopping antihypertensive drugs?
__________________________________________________________________ Chapter 38Hypertension 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 38.2
Slide 23
Interventions
• Risk for injury
• Orthostatic hypotension
• Sudden drop in systolic blood pressure, usually 20 mm Hg, when going from lying
or sitting to a standing position
• Monitor for lightheadedness, dizziness, syncope
• Sedation
• Advise if drowsiness is likely so activities requiring alertness can be avoided
TALKING POINTS:
• How should patients who are prone to orthostatic hypotension be advised to prevent
falling?
Slide 24
Interventions (cont.)
• Ineffective coping
• If depression is a side effect of an antihypertensive, consult provider to substitute
another drug
• Sexual dysfunction
TALKING POINTS:
• What is the best way to introduce the subject of sexual dysfunction to a patient?
Slide 25
Older Patients
• Response to drug therapy more difficult to predict; side effects are more common
• Orthostatic hypotension and sedation problematic for the older person, who is prone
to fall and suffer serious injuries
• Depression also must be taken very seriously because it lowers motivation, impairs
quality of life, and can lead to suicide
TALKING POINTS:
• What effects can depression have on the older patient?
• The older patient should be treated just like a younger patient in the assessment and
management of distressing drug effects.
Hypertensive Emergencies
• A life-threatening medical emergency
TALKING POINTS:
• Malignant hypertension is a specific type of hypertensive emergency in which the diastolic
pressure exceeds 140 mm Hg.
• In what population is hypertensive crisis most commonly seen?
18 Chapter 38Hypertension____________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 38.2
Hypertensive Emergencies (cont.)
• Causes: malignant hypertension, hypertensive encephalopathy, eclampsia,
Slide 28
Medical Diagnosis
• Assessment in the ED reveals elevated blood pressure, pulse, and respiratory rate
• Retinal hemorrhage or papilledema, or both, observed in fundus (back, interior portion) of
eye
Slide 29
Medical Treatment
• The goal of drug therapy is to rapidly reduce the pressure to a non–life-threatening level
and then to bring it slowly within normal range
• Diuretics and potent vasodilators
• Fenoldopam
• Nitroglycerin
Medical Treatment (cont.)
• An intravenous line is usually established because many drugs are given by that route
Slide 31
Assessment
• Frequently check blood pressure, pulse, respiration, and level of consciousness
• Some drugs are given in intravenous fluids, requiring continuous monitoring and
Interventions
• Administer prescribed drugs
• Vital signs before and after each dose
__________________________________________________________________ Chapter 38Hypertension 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 38.2
Interventions (cont.)
• Take appropriate safety measures if the patient shows signs of seizure activity or a
decreasing level of consciousness
TALKING POINTS:
• What safety measures should be taken for signs of seizure activity or decreased
consciousness?
Activities
Classroom Choose from below to make 30 minutes
Online
6
DISCUSS
• Discuss the appropriate interventions to
address Risk for injury, Ineffective coping,
PRACTICE
• Divide the class into small groups. Have
each group refer to the nursing diagnoses,
goals, and outcome criteria for hypertension.
POST & COMMENT
• Post the following discussion topic online
and have students comment. List five
constructive comments on each other’s
posts.
20 Chapter 38Hypertension____________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 38.2
7
DISCUSS
• Discuss the nursing care of the patient with
hypertension. Why is patient education so
important to the effective management of
hypertension? What are some key
components of an effective patient teaching
plan?
• Discuss nursing care of the patient in
PRACTICE
• Present the following scenario to the class.
Ask students how they would respond to this
patient’s comments.
• A newly married, 25-year-old man has
been diagnosed with hypertension and
POST & COMMENT
• Post the following discussion topic online
and have students comment. Describe the
immediate care of a patient experiencing a
hypertensive emergency. Ask students to
provide constructive comments for each
other’s comments.
Critical Thinking Question
A 68-year-old man is diagnosed with essential hypertension. His wife is with him for a clinic
visit. The patient’s physician has asked the nurse to provide diet counseling for the patient
and his wife. The nurse asks the patient and his wife to write down a typical day’s diet. The
patient’s typical diet for a day included the following: breakfast—bacon or sausage, two
fried eggs, biscuits and gravy made from the bacon or sausage grease, and two cups of
caffeinated coffee; lunch—bologna sandwich or hot dog, chips and a coke; dinner—fried
chicken or fried pork chops, mashed potatoes and gravy, biscuits, and sweet tea. Snacks
include pie or cake daily with two cups of coffee. What is missing from the patient’s diet?
What type of modifications should be made to the patient’s diet?
Discussion Guidelines: Fruits, vegetables, and dairy products are missing from the patient’s diet.
The sodium content is high due to the bacon, sausage, bologna, hot dogs, and chips. Fried foods
__________________________________________________________________ Chapter 38Hypertension 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 38.2
Instructor Notes/Student Feedback
22 Chapter 38Hypertension____________________________________________________________________
38
Assessments for
Hypertension
CHAPTER OBJECTIVES
Lesson 38.1:
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 38.2:
6. Describe the nursing interventions for the patient with hypertension.
7. Identify the nursing diagnoses, goals, and outcome criteria for the patient with hypertension.
Assessments by Lesson & Objective
Lesson 38.1
Study Guide
• Part IA: 4 (p. 939)
• Part IIF: 1, 3-6, 8, 16, 17 (pp. 241-242)
Evolve Instructor Resources
Evolve Student Resources
• NCLEX Review: 5
Study Guide
• Part IIF: 7, 23, 24 (pp. 241-242)
• Part IIIH: 1 (p. 244)
Evolve Instructor Resources
• Test Bank: 29, 30
Evolve Student Resources
__________________________________________________________________ Chapter 38Hypertension 23
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
Study Guide
• Part IA: 2, 3, 4-7 (p. 239)
• Part IB: 1 (p. 239)
• Part IC: 1-17 (p. 240)
Evolve Instructor Resources
• Test Bank: 2-7, 16, 18, 19, 26-28
• Open Book Quiz: 2, 3, 4
Evolve Student Resources
• NCLEX Review: 6, 8, 9
Study Guide
Evolve Instructor Resources
• Test Bank: 9-14, 21
• Open Book Quiz: 5, 6
Evolve Student Resources
• NCLEX Review: 1, 4, 10
• Prioritization: 1, 2, 5
• Prioritization: 3, 4
Study Guide
• Part IIF: 20 (p. 242)
Evolve Instructor Resources
24 Chapter 38Hypertension____________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
Lesson 38.2
Study Guide
• Table 38–5: DASH Eating Plan (p. 780)
• Box 38-2: Action Items to Help Lower Blood Pressure (p. 781)
Evolve Instructor Resources
• Test Bank: 15, 17, 20
• Open Book Quiz: 8, 9
Study Guide
Evolve Instructor Resources
• Test Bank: 1, 22-25
• Open Book Quiz: 10
Instructor’s Notes/Student Feedback