48

Cardiovascular system

Understanding
risk factors for
hypertension is
important. After
all, some of these
risk factors can be
modified, eliminating
the need for drug
therapy.

Nitrates: isosorbide (Isordil), nitroglycerin

Vasodilator: nitroprusside (Nitropress)

INTERVENTIONS AND RATIONALES

Assess cardiovascular status, vital signs,
and hemodynamic variables to detect signs of
reduced cardiac output.
Assess respiratory status and oxygenation to detect increasing fluid in the lungs and
respiratory failure.
Keep the client in semi-Fowlers position
to increase chest expansion and improve
ventilation.
Administer medications, as prescribed, to
enhance cardiac performance and reduce excess
fluids.
Administer oxygen to enhance arterial oxygenation.
Measure and record intake and output.
Intake greater than output may indicate fluid
retention.
Monitor laboratory studies to detect electrolyte imbalances, renal failure, and impaired
cardiac circulation.
Provide suctioning, if necessary, and assist
with turning, coughing, and deep breathing to
prevent pulmonary complications.
Restrict oral fluids because excess fluids can
worsen heart failure.
Weigh the client daily. A weight gain of
1 to 2 lb (0.5 to 1 kg) per day indicates fluid
gain.
Measure and record the clients abdominal
girth. An increase in abdominal girth suggests
worsening fluid retention and right-sided heart
failure.
Maintain the clients prescribed diet (low
sodium) to reduce fluid accumulation.
Encourage the client to express feelings,
such as a fear of dying, to reduce anxiety.

Teaching topics
Explanation of the disorder and treatment
plan
Medications and possible adverse effects
Limiting sodium intake and supplementing
diet with foods high in potassium
Recognizing signs and symptoms of fluid
overload
Elevating legs when seated
Contacting the American Heart
Association

313419NCLEX-RN_Chap03.indd 48

Hypertension
Persistent elevation of systolic or diastolic
blood pressure (systolic pressure higher than
140 mm Hg, diastolic pressure higher than
90 mm Hg) indicates hypertension. Hypertension results from a narrowing of the arterioles, which increases peripheral resistance,
necessitating increased force to circulate
blood through the body.
There are two major types of hypertension.
Essential hypertension, the most common,
has no known cause, though many factors
play a role in its development. Secondary
hypertension is caused by renal disease or
other systemic diseases.

Mild to very severe

Hypertension is classified according to three
stages:
prehypertension: systolic 120 to
139 mm Hg or diastolic 80 to 89 mm Hg
stage 1: systolic 140 to 159 mm Hg or
diastolic 90 to 99 mm Hg
stage 2: systolic 160 mm Hg or higher or
diastolic 100 mm Hg or higher

CAUSES

Cushings disease
No known cause (essential hypertension)
Hormonal contraceptive use
Pheochromocytoma
Pregnancy
Primary hyperaldosteronism
Renovascular disease
Thyroid, pituitary, or parathyroid disease
Use of drugs, such as cocaine

CONTRIBUTING FACTORS (ESSENTIAL

HYPERTENSION)

Aging
Atherosclerosis
Diet (sodium and caffeine)
Family history
Obesity
Race (more common in blacks)
Sex (more common in males over age 40)
Smoking
Stress

4/8/2010 7:01:46 PM