Polish up on client care

ASSESSMENT FINDINGS

Asymptomatic
Cerebral ischemia
Dizziness
Elevated blood pressure
Headache
Heart failure
Left ventricular hypertrophy
Papilledema
Renal failure
Vision disturbances, including blindness

49

Imbalanced nutrition: More than body

requirements

TREATMENT
Activity changes: regular exercise to
reduce weight, if appropriate (see Treating
hypertension: Step-by-step)
Dietary changes: establishing a lowsodium diet and limiting alcohol intake (see
Dash into dietary changes, page 50)

Drug therapy

DIAGNOSTIC TEST RESULTS

Blood chemistry tests show elevated
sodium, BUN, creatinine, and cholesterol
levels.
Blood pressure measurements result in
sustained readings higher than 140/90 mm Hg.
Chest X-ray reveals cardiomegaly.
ECG shows left ventricular hypertrophy.
Ophthalmoscopic examination shows
retinal changes, such as severe arteriolar narrowing, papilledema, and hemorrhage.
Urinalysis shows proteinuria, RBCs, and
WBCs.

ACE inhibitors: captopril (Capoten),

enalapril (Vasotec), lisinopril (Prinivil)
Antihypertensives: methyldopa, hydralazine,
prazosin (Minipress), doxazosin (Cardura)
Beta-adrenergic blockers: propranolol
(Inderal), metoprolol (Lopressor), carteolol
(Cartrol), penbutolol (Levatol)
Calcium channel blockers: nifedipine
(Procardia), verapamil (Calan), diltiazem
(Cardizem), nicardipine (Cardene)
Diuretics: furosemide (Lasix), spironolactone (Aldactone), hydrochlorothiazide
(Microzide), bumetanide (Bumex)
Vasodilator: nitroprusside (Nitropress)

NURSING DIAGNOSES
Excess fluid volume
Deficient knowledge (disease process and
treatment plan)

INTERVENTIONS AND RATIONALES

Assess cardiovascular status, including
vital signs to detect cardiac compromise.

Treating hypertension: Step-by-step

The National Institutes of Health recommend a stepped-care approach for treating primary hypertension.
STEP 1
The first step involves lifestyle modifications,
including weight reduction, moderation of
alcohol intake, reduction of sodium intake, and
smoking cessation.

STEP 3
If desired blood pressure still isnt achieved,
drug dosage is increased, another drug is substituted for the first drug, or a drug from a different
class is added.

STEP 2
If the client fails to achieve the desired blood
pressure, continue lifestyle modifications and
begin drug therapy. Preferred drugs include
thiazide-type diuretics, angiotensin-converting
enzyme (ACE) inhibitors, or beta-adrenergic
blockers. If these drugs arent effective or
acceptable, angiotensin receptor blockers or
calcium channel blockers may be used.

STEP 4
If the client fails to achieve the desired blood
pressure or make significant progress, add a
second or third agent or a diuretic (if one isnt
already prescribed). Second or third agents may
include vasodilators, alpha1-antagonists, peripherally acting adrenergic neuron antagonists,
ACE inhibitors, and calcium channel blockers.

313419NCLEX-RN_Chap03.indd 49

4/8/2010 7:01:47 PM