Nursing 211

N211: Health Differences Across the Lifespan I

Diagnosis Diagnosis is made by serial blood pressure readings with a systolic greater than 140 and a diastolic greater than 90. Take two or more blood pressure readings rather than relying on one single abnormal reading. Nursing Diagnosis: • Deficient knowledge related to newly diagnosed hypertension • Risk for ineffective management of therapeutic regime related to side effects of medications and required lifestyle changes • Sexual dysfunction related to effects of antihypertensive medications Nursing Interventions Teaching plan to include information about disease process, risk factors, long term complications, lifestyle modifications, and relationship of treatment to prevent complications. Teach client how to take own BP, reasons for each medication, how and when to take each medication, necessity of consistency in medication regimen and need for ongoing assessment while taking antihypertensives. Need to monitor serum electrolytes every 90-120 days for duration of the treatment. Need to monitor renal functioning, BUN and creatinine, every 90-120 days and need to monitor BP and pulse rate. • Encourage client to implement stress reduction, weight loss, smoking cessation, and exercise. • Determine if client is experiencing side effects of medications such as insomnia and impotence. • Diet should be low salt, low fat and low cholesterol. • Primary cause of a stroke in a hypertensive client is noncompliance with medication regimen. Medical Management Medical management may include diuretics (Lasix, Diazide). Diuretics block sodium and therefore, water reabsorption in the renal tubule, producing a decreased blood volume. Vasodilators (Nipride, Apresoline, Hydralazi e) Act directly on the smoothmuscle to dilate arteries and arterioles. Typically used in combination with another antihypertensive as they cause increased sodium and fluid retention and can cause reflex tachycardia (particularly during first week of therapy). Instruct about orthostatic hypertension, avoid hot baths, steam, and to take medication with meals. Advise that nasal congestion may occur. Client must report peripheral edema or constipation to the physician. Alpha-Adrenergic Blockers (Minipress, Hytrin, Regitine, Cardura)

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