Hypertension Easily Explained with NCLEX Review

Aug 24, 2023

Hypertension Easily Explained with NCLEX Review

Hypertension Easily Explained with NCLEX Review
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What is hypertension and how do I treat it?

High blood pressure (hypertension) is often diagnosed as a result of a routine medical exam or as a coincidental finding when patients are in with other concerns. This silent killer often comes without symptoms and can create damage to small vessels in the eyes, kidneys and brain, as well as trauma and damage to the larger vessels leading to further cardiovascular compromise.

The Hypertension Canada website provides guidelines for clinical practice that all nurses, nursing students, and healthcare providers should be aware of. While there are some minor differences across countries, one thing is clear, hypertension is not to be taken lightly. It is a serious illness that can cause serious consequences.

Learn about the types of Hypertension, the stages of disease progression and how to treat it.

Time Stamps
00:00 introduction
01:40 What is Normal Blood Pressure / What is Systolic v diastolic pressure
03:12 Diabetes and Hypertension Values
04:32 Hypertension.ca, Canada Blood Pressure Guide
06:26 American College of Cardiology Blood Pressure / Hypertension Guidelines
07:28 Causes of high blood pressure/ causes of hypertension
07:40 Essential Hypertension
08:01 Secondary Hypertension
08:12 Whitecoat Hypertension
08:36 the Silent Killer, signs and symptoms of hypertension
09:01 Factors for Developing High Blood Pressure / Hypertension
09:17 Nonmodifiable risk factors for High Blood Pressure
09:34 Modifiable risk factors for high blood pressure
10:16 Complications of High Blood Pressure / Hypertension
12:06 Steps to Hypertension Treatment /Management
15:19 Analogies to help with patient education on Hypertension
16:41 Hypertension NCLEX questions

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Content

0.65 -> Tell me if you've ever had an experience like this. You can share in the comments

6.18 -> below it's okay. You go to the pharmacy or at your physician's office and you

10.95 -> have your blood pressure taken, now we know in the pharmacy you've got those

13.98 -> non-manual ones where you put your arm in and it cuffs up and it gets really

17.52 -> really strong and tight feels like your arms about to fall off and at the

22.02 -> doctor's office they do the automatic blood pressure cuff as well they wrap

25.14 -> you up and we let it just run and it always seems to go too high and then you

31.529 -> get your reading back and you're like oh my god what just happened? Why is my

37.35 -> blood pressure so high and should I be worried? I mean I feel fine, there's

41.67 -> nothing wrong with me. So we're going to dive into high blood pressure today also

46.26 -> known as hypertension right after this,

56.239 -> Welcome back my name is Tammy and this is NurseMinder and on this channel we

60.809 -> do everything nursing so if you're new here consider subscribing below so that

65.309 -> you get the next video when it's released. In today's video we're going to

68.43 -> talk about a few different things. First of all we're going to define what high

72.09 -> blood pressure. We are going to look at the differences between Canada the States

77.009 -> and the European countries because if you're a nurse watching this video

80.31 -> you're gonna want to know these things and we're also going to look at some

85.229 -> of the signs and symptoms, the risk factors, and then the four steps to

89.49 -> managing hypertension. So we've got a lot to cover

91.619 -> now stick to write to stick through to the end because I also have an analogy

95.88 -> to help you explain blood pressure to your patients and an NCLEX question.

100.02 -> Now before we can talk about what a hypertensive reading is let's take a

104.88 -> quick step back and look at the normal values. So systolic is the value that we

110.52 -> use to describe the most pressure in your vessel so that's what the heart

114.75 -> contracts and diastolic is the term we use to describe the pressure in your

119.1 -> vessel when it is at rest. So 120 over 80 or less would be considered healthy and

126.329 -> normal, no concern, with one caveat obviously you can get to low and that's

130.47 -> hypotension completely different topic.

134.71 -> So generally speaking a normal blood pressure is less than 120 over 80

140.78 -> and not so low that it's causing you symptoms which would then be classified

144.8 -> as hypotension. I've often seen people sitting in the 90s to 120 as normal and

150.14 -> then the diastolic can be less than 80.

155.68 -> In Canada, and it's important that I talk about Canada versus the states and the

161.87 -> European countries, because there are some differences in Canada when you have

166.49 -> a reading that is over or actually greater than or equal to 135 over 80 and

177.38 -> we have multiple readings that average out to being more than 135 over 80, so

182.84 -> you can have two or three readings done at the same time or over subsequent

186.65 -> visits then we would classify this as hypertension. Now again there's a caveat

192.98 -> because if you do have some health history such as diabetes we're going to

197.87 -> back that down to 130 over 80 anything greater equal to 130 over 80 would be

203.959 -> diagnostic of hypertension. Now of course it can't just be this easy can it? No

208.94 -> because there are some different things we need to consider if you're using an

213.23 -> automated office based visit so you're doing the cuff at the doctor's office or

219.019 -> you're doing the cuff at the pharmacy we know that research shows us the blood

224.42 -> pressure cuff in places like pharmacies and public places tends to read higher.

229.43 -> So what is more important is that you're getting an average and you're

232.07 -> documenting all of those different readings and then when you bring that

235.34 -> information into your doctor's office they can do their own assessment. Now if

240.56 -> we're doing a manual cuff pressure so this is what we're actually pumping it

244.85 -> up and we're listening with our ears, those values will shift a little bit

248.48 -> higher depending on where you live but in general these are the numbers that

253.34 -> you'll need to know, 120 over 80 the range was up to 135 if you're in Canada

259.13 -> 130 if you have diabetes and you'll see here in a second I'm going to

262.91 -> show you the differences with the other countries at 130 over 80 is the standard

267.14 -> for a few other places that we need to be watching for. Now let's go to the

272.21 -> hypertension.ca website this is our Canadian guidelines and I want to show

276.92 -> the algorithm here. If you've done a blood pressure at home, in the pharmacy

282.38 -> or maybe you've had a blood pressure clinic at work and your reading is

286.04 -> greater than 130 over 80 we will want you to come in for a dedicated office visit. Now

293.39 -> when you come in if your blood pressure is greater than or equal to 180 systolic

297.53 -> over 110 diastolic that is a diagnosis of hypertension. If your reading is less

304.4 -> than that and you do not have a pre-existing condition of diabetes and

308.44 -> we are using an automated office blood pressure cuff we'll be looking for

313.79 -> readings to be less than 135 over 85. If you happen to have a reading that is

320.45 -> greater than 135 over 85 on this visit we will then look at implementing some

325.25 -> out of office measurements such as you will be completing tracking of your

330.14 -> blood pressure at home. If you're at home readings continue to be elevated over

335.54 -> 135 over 85 we would consider that to be hypertension. If they resume to levels

342.5 -> below that we would consider this to be a white coat hypertension. Now if you're

346.85 -> using a non automated cuff so this is the manual cuff and your readings are

351.83 -> greater than 140 over 90, we do give a little bit of a leeway there, then we're

356.36 -> going to continue on with the same out-of-office measurements. If with either

361.79 -> method your blood pressure remains less than that when you come in there's no

366.02 -> diagnosis of hypertension. Now here's the caveat we want to talk about is diabetes.

370.78 -> We like to have your blood pressure less than 130 over 80 regardless of which

376.34 -> method we are using. If when you come into the office your blood pressure is

380.15 -> elevated over 130 over 80 that would be a diagnosis of hypertension. Now let's

386.63 -> take a look at the American and European guidelines. This is coming from the

390.169 -> Journal of the American College of Cardiology this is from 2019 and I want

394.1 -> to highlight this table here. We'll see here that the office / Clinic

399 -> blood pressure in the American College of Cardiology they're looking for values

403.68 -> of greater than or equal to 130 over 80. The European Society has a little bit

409.62 -> more of a range there and they're looking for greater than 140 over 90.

413.81 -> Let's take a look next at staging blood pressure. Starting with normal blood

418.83 -> pressure we're looking for values of less than 120 over 80. Pre hypertension

422.94 -> or elevated blood pressure is 120 to 129 over less than 80. Stage 1 is 130 to 139

430.59 -> systolic over 80 to 89 diastolic and stage 2 hypertension is greater than or

436.65 -> equal to 140 over 90. There's two different names we use to describe

444.2 -> hypertension. So we have our staging then we also have a name to describe the

448.89 -> cause. So what can cause high blood pressure? T he first term you may hear is

453.75 -> that you have essential hypertension and essentially what that means is we don't

463.05 -> know what's causing it. It's of an unknown origin and you'll often have

468 -> this diagnosed after they've done some testing; 90% of high blood pressure is

473.7 -> considered essential according to the research.The second type is called

481.14 -> secondary which means you've already had a pre-existing condition illness disease

486.33 -> process that is resulting in high blood pressure. Now the third type of high

492 -> blood pressure you may have is known as white coat hypertension that essentially

497.07 -> means that when you come into the physician's office and you see the

499.65 -> doctor and you're sitting there waiting just the presence of the medical team

503.82 -> the white coat we call it will cause you to become tense and your blood pressure

509.13 -> will elevate.

516.33 -> Hypertension is known as the silent killer and that's because when we're

521.469 -> looking at signs and symptoms to help us define and diagnose an illness, high

527.59 -> blood pressure often comes without any signs or symptoms. So it's really

532.84 -> important then that we talk about the risk factors so that you know if you

536.32 -> need to be monitored more closely for the potential of high blood pressure. So

541.36 -> when we look at some of those risk factors that you may want to be aware of to

543.88 -> determine if you're at higher risk for hypertension, we have a soon as

548.58 -> non-modifiable those things we cannot control and then modifiable. We're going

553.93 -> to first talk about those that we cannot control, so our non-modifiable risk

557.98 -> factors include our age, look as much as we want to be younger, physiologically

564.67 -> biologically it's just not going to happen so your age is a factor, family

568.99 -> history and ethnicity. Now in terms of those things that we have some control

574.48 -> over that we can influence the trajectory of our cardiovascular health

578.86 -> the list is a little longer so diet so if we are eating unhealthy foods higher risk

585.1 -> change those over to healthy foods lower the risk, exercise, stress, weight, we're

592.3 -> looking at smoking and alcohol use, we are looking at our sleep patterns, other

596.14 -> things such as kidney disease where we have had an opportunity to prevent the

600.94 -> onset, those are known as modifiable risk factors and will definitely impact the

606.19 -> longevity and the health of your cardiovascular system, Next I want to

610.75 -> talk about what happens when you have hypertension what are the risks to you.

614.89 -> One of the things that happens when our pressure is high, I mean this is like

619.96 -> pushing a ton of fluid in a small straw kind of thing, is that the vessels become

626.47 -> damaged. They get so stretched and so worn that they get thin and the wall

631.78 -> starts to become, there are tears in the wall, so those tears set of a

636.67 -> response in the body to repair it and what ends up happening is we can end up

640.63 -> having plaque and development which in is what's known as atherosclerosis, so as

646.03 -> a result of having high blood pressure we now

648.82 -> build up inside the arteries. This will decrease the ability of those vessel

654.19 -> walls to stretch and recoil so we lose some of that flexibility which will

658.36 -> increase the peripheral vascular resistance. Now when you have to push

662.769 -> harder to get the fluid through the same hole what happens is in the heart size

667.36 -> has to increase because now the heart is working harder so we get hypertrophy

672.1 -> which is now leading into further cardiovascular concern. We now have

677.62 -> increased oxygen demand, our heart is getting larger it's working harder, we're

682.63 -> gonna get tired faster, and we potentially can rupture or remove - the

688.06 -> pressure might lift off that plaque and it gets dislodged - and it can settle in

692.529 -> the smaller vessels in the brain so a stroke, in the heart a cardiac arrest, and

697.63 -> we can also end up having damage to the smaller vessels as well. You may also

703.54 -> know somebody who has high blood pressure and they complain of vision troubles

707.079 -> that's because it's not just the bigger arteries that we're worried about it's

710.529 -> just smaller arteries that we also have to be worried about. They can get damaged

714.76 -> easily as well, the eyes, the kidneys, the brain all really important pieces of our

721.029 -> body that are at high risk of insult and injury if we're not taking care of our

726.73 -> blood pressure. So now you may be wondering okay so I've had high blood

730.569 -> pressure for a while and so was my neighbor but he seems to be fine with

734.589 -> diet and I have to take two different pills why is that? Well there are

739.12 -> there are four different stages to treating high blood pressure and we

742.389 -> often will start with lifestyle changes. Remember those modifiable things? Diet,

747.49 -> exercise, stres,s sleep. We'll look to see if we can correct those because the goal

752.889 -> of therapy is to restore our blood pressure down to baseline and normal

756.88 -> levels. If we can do that without adding on medications, we're gonna start with

762.069 -> that. So in treating high blood pressure there's four steps we call them and we

767.05 -> always want to start lowest and build our way up. Now in previous videos we've

771.13 -> talked about many different factors that affect our blood pressure which means

775.029 -> there's a lot of potential in treating it. We always start with lifestyle

779.8 -> changes. We want to see if we can modify and reduce your blood pressure back down

784.91 -> to normal levels without the need for additional medications. One of the

791.209 -> primary reasons that is are targeted treatment of choice is we know a lot of

795.889 -> patients struggle with the side effects of taking an antihypertensive drug

800.68 -> because previous to taking the medication they had no symptoms. Remember

806.63 -> this is the silent killer. Many people have zero symptoms and now

810.829 -> all of a sudden when they take a medication they're having side effects

814.339 -> and that makes compliance a little harder. So lifestyle is number one. If we

820.55 -> can't get any changes with, if we can't get sufficient changes with lifestyle

825.41 -> modifications we are going to add a drug. Notice I said add. We're not going to

831.529 -> abandon lifestyle changes, we're going to ramp up our approach so we're adding a

837.139 -> drug. This may be a diuretic so potentially you've heard of something

840.32 -> like lasix and there's other drugs that can be used drug classifications that

844.61 -> can be selected here. If after this period of time the lifestyle changes

851.42 -> plus the drug are not getting the results we want we have two options for

855.98 -> stage 3. We can either change our initial drug choice to another classification

863.18 -> and see how that works or we keep this drug and we add a second. Remember this

869.899 -> is an additive step process. Now I have lifestyle plus one drug plus a second

875.24 -> drug. Different classifications because they work differently and then as you

880.339 -> guessed at if stage 3 we're not getting success we're going to add another drug

884.209 -> in stage 4. So potentially you will have many patients with hypertension all

889.459 -> being treated across that spectrum with different different strategies one

896.18 -> patient may be salt restrictions with a diuretic another patient may be they

901.43 -> don't really focus on diet because that never worked with them but we're looking

904.279 -> at stress reduction we have a diuretic and we have an ACE inhibitor because we

910.85 -> need to attack that blood pressure process at many different points to

914.54 -> achieve our ultimate goal of lowering blood pressure to a safe level.

919.05 -> So now it's time for an analogy. How do I help my patient understand just what

924.24 -> hypertension is, especially when we can't see it and we can't feel it. Well I've

930.27 -> got a visual and a tactile example for you there's actually two, the first one

936.42 -> is the water in the tap. If you turn the water on gently they can see that

941.91 -> there's a regular stream of flow coming through the tap. If you turn it all the

948.48 -> way on and the volume and the noise increases that would represent the blood

953.97 -> pressure increasing in your stream. The second analogy is to use the example of

960.06 -> an air mattress and when you pump it up it gets harder and harder and harder but

966.84 -> there's a moment where it's comfortable and then it's uncomfortable. So when

970.92 -> you're pumping up your air mattress and you've reached that perfect place that's

974.67 -> where you want your blood pressure to be. If you put just a little bit more air in

978.57 -> it's a little firm but it's manageable that would be stage 1 hypertension and

984.18 -> if you pump it up too high it's really firm that kind of represents the vessels

990.93 -> not having any stretch and recoil left in them so our vessels are really wide

995.82 -> and they're at risk of getting damaged that would be stage 2. Now it's time for

1001.97 -> your NCLEX question. Okay so you've completed the blood pressure screening

1005.87 -> for an adult patient today and these are the results. How do you interpret this

1010.25 -> information? Go ahead and pause and come back when you're ready. Okay so you're

1014.18 -> back. If you identified pre hypertension you

1016.79 -> would be correct. Okay let's try one more. Your patient is

1020.72 -> at the office for follow-up. On his last visit a diuretic was added to his

1024.74 -> treatment plan for hypertension. Today his blood pressure is 148 over 92 what

1029.72 -> do you anticipate will be the next step in his treatment plan? You will select

1033.41 -> all that apply. Will it be a) add lifestyle changes such

1039.74 -> as diet and exercise B) increase the dose of his diuretic C) consider a change in

1048.53 -> the drug therapy so stop the diuretic and start an ACE inhibitor or D)

1052.73 -> add another drug to his treatment plan. Go ahead and pause here and come back

1056.27 -> when you're ready. Okay so did you answer add lifestyle changes such as diet and

1062.03 -> exercise? If you did that's one of the most commonly picked answers but it's

1065.9 -> not correct because remember this is an additive process and the lifestyle

1070.43 -> changes would have been put in in step one. So we're currently entering into

1073.79 -> step three so we will either increase the dose, change the drug, or add another

1078.62 -> drug to his treatment plan. Thanks for watching we're gonna be

1081.56 -> talking about the different medications to help treat hypertension in subsequent

1086.36 -> videos so be sure to subscribe and hit the bell so you get notified when those

1089.93 -> videos are released. In the comment section below

1092.81 -> share your own journey and the things that are working for you and are not

1095.78 -> working for you I think when we do sure that people can see that 1) they're not

1099.41 -> alone 2) it's not always easy and 3) that there's multiple ways to help

1103.64 -> patients navigate their blood pressure. Thanks for watching and until next time

1108.86 -> make it a great day :)

Source: https://www.youtube.com/watch?v=p0kHBAfQ8uM