Question

Disease teaching

TOPIC:           Hypertension

Write the following summary of the disease, making sure to include all of the points below. Your lesson should include:

• Pathophysiology of the disease: In your own words, write the pathophysiology of the disorder and relate the clinical manifestations of each back to the pathophysiology based on the information you taught your peer.

• Clinical manifestations of the disease (at least two assessment findings)

• Two nursing diagnoses: Discuss 2 nursing diagnoses common to patients and the interventions you chose for each diagnosis.

• Treatment plan (at least two interventions: intraprofesional and nursing care) and the rationale for interventions

• Four patient teaching points for this disease: Include the disease, the treatment plan, and the evaluation of the effectiveness of your teaching.

Answer 1

pathophysiology:-

The pathogenesis of essential hypertension is multifactorial and highly complex. The kidney is both the contributing and the target organ of the hypertensive processes, ^[1] and the disease involves the interaction of multiple organ systems and numerous mechanisms of independent or interdependent pathways. Factors that play an important role in the pathogenesis of hypertension include genetics, activation of neurohormonal systems such as the sympathetic nervous system and renin-angiotensin-aldosterone system, obesity, and increased dietary salt intake.

Arterial hypertension is the condition of persistent elevation of systemic blood pressure (BP). BP is the product of cardiac output and total peripheral vascular resistance. Multiple factors are involved in short-term and long-term regulation of BP for adequate tissue perfusion; these include the following:

• Cardiac output and circulatory blood volume

• Vascular caliber, elasticity, and reactivity

• Humoral mediators

• Neural stimulation

Over the course of its natural history, essential hypertension progresses from occasional to established hypertension. After a long, invariable, asymptomatic period, persistent hypertension develops into complicated hypertension, in which target organ damage to the aorta and small arteries, heart, kidneys, retina, and central nervous system is evident.

The progression of essential hypertension begins with prehypertension in persons aged 10-30 years (by increased cardiac output); then advances to early hypertension in persons aged 20-40 years (in which increased peripheral resistance is prominent); then progresses to established hypertension in persons aged 30-50 years; and finally advances to complicated hypertension in persons aged 40-60 years.

CLINICAL MANIFESTATIONS:-

Following the documentation of hypertension, which is confirmed after an elevated blood pressure (BP) on at least 3 separate occasions (based on the average of 2 or more readings taken at each of ≥2 follow-up visits after initial screening), a detailed history should extract the following information:

• Extent of end-organ damage (eg, heart, brain, kidneys, eyes)

• Assessment of patients’ cardiovascular risk status

• Exclusion of secondary causes of hypertension

Patients may have undiagnosed hypertension for years without having had their BP checked. Therefore, a careful history of end-organ damage should be obtained. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) identifies the following as targets of end-organ damage

• Heart: left ventricular hypertrophy, angina/previous myocardial infarction, previous coronary revascularization, and heart failure

• Brain: stroke or transient ischemic attack, dementia

• Chronic kidney disease

• Peripheral arterial disease

• Retinopathy