NCLEX - Hypertension Definitions & Etiologies
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Here are key facts for NCLEX from the Hypertension Overview tutorial, as well as points of interest at the end of this document that are not directly addressed in this tutorial but should help you prepare for the boards. See the tutorial notes for further details and relevant links.
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VITAL FOR NCLEX
1. Definition of Hypertension
- Hypertension is defined as sustained elevated blood pressure above 130/80 mmHg.
- It increases risk of stroke, heart failure, renal failure, and vision loss.
2. BP Categories (based on 2017 ACC/AHA Guidelines)
- Normal: <120/<80 mmHg
- Elevated: 120–129/<80 mmHg
- Stage 1: 130–139 or 80–89 mmHg
- Stage 2: ≥140 or ≥90 mmHg
3. Primary (Essential) Hypertension
- Most common type (90–95% of cases).
- No single cause, but risk factors include:
- Obesity
- High salt intake
- Sedentary lifestyle
- Family history
- Stress
- Smoking and alcohol use
4. Secondary Hypertension
- Caused by underlying medical conditions:
- Renal artery stenosis
- Primary aldosteronism
- Pheochromocytoma
- Cushing syndrome
- Sleep apnea
- Pregnancy (gestational HTN, pre-eclampsia)
- Medications: NSAIDs, oral contraceptives, decongestants
5. Clinical Signs and Symptoms
- Often asymptomatic (“silent killer”).
- When symptoms are present:
- Headaches
- Dizziness
- Visual disturbances
- Chest pain or shortness of breath
- Epistaxis (nosebleeds)
6. Complications of Untreated Hypertension
- Heart: left ventricular hypertrophy, heart failure, myocardial infarction
- Brain: stroke, encephalopathy
- Kidneys: nephropathy, renal failure
- Eyes: hypertensive retinopathy
7. Treatment Goals
- Lifestyle changes for all clients:
- Weight loss
- Low-sodium, heart-healthy diet (e.g., DASH)
- Regular physical activity
- Smoking cessation
- Limit alcohol and caffeine
- Medications: Based on patient-specific risk factors and comorbidities:
- Thiazide diuretics
- Calcium channel blockers
- ACE inhibitors / ARBs
8. Client Education: Essential Role of the Nurse
- Adherence to medications and appointments
- Home blood pressure monitoring
- Report signs of complications (e.g., sudden vision changes, chest pain, swelling, or severe headaches)
- Importance of lifestyle changes
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HIGH YIELD
9. "White Coat Hypertension"
- High BP in clinical settings only.
- Nurse role: Teach client about accurate BP measurement at home.
10. "Masked Hypertension"
- Normal in clinic, elevated at home.
- Ambulatory BP monitoring may be needed.
11. Pregnancy and Hypertension
- Monitor for gestational hypertension and pre-eclampsia:
- BP >140/90 after 20 weeks + proteinuria or end-organ signs
- Assess for edema, headaches, visual changes
- Safe meds: labetalol, nifedipine, methyldopa
12. Hypertensive Crisis
- Urgency: BP ≥180/120 with no organ damage.
- Emergency: Same BP with symptoms (e.g., chest pain, neuro deficits, renal failure).
- Immediate action required:
- Lower BP gradually
- Monitor for target organ damage
- Administer IV antihypertensives (as ordered)
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Beyond the Tutorial
13. Nursing Diagnoses for Hypertension
- Risk for decreased cardiac output
- Knowledge deficit related to disease process or medications
- Ineffective health maintenance
14. Key Nursing Interventions
- Monitor BP trends (lying, sitting, standing if orthostatic)
- Teach clients how to use BP cuff at home
- Check medication adherence and manage side effects (e.g., dizziness, fatigue)
- Encourage small, achievable lifestyle goals
15. Blood Pressure Measurement Best Practices
- Sit for 5 minutes before measurement
- Arm supported at heart level
- Avoid caffeine, exercise, or smoking for 30 minutes prior