Teaching Plan For Hypertension

TEACHING PLAN FOR HYPERTENSION DESCRIPTION OF THE LEARNER: The learner is a 59 years old client. She is living in Pangasinan with 2 children. She is a high school graduate and can understand Pangalatoc, Ilokano, Tagalog and English. She is currently a housewife with a BMI of 33.19 kg/m2. There are no cultural or spiritual concerns in terms of hypertension. LEARNING NEED: To define hypertension, problems in hypertension and preventive measures to be taken. LEARNING DIAGNOSIS: Inability to make decisions with respect to taking appropriate health actions due to: 1. Failure to comprehend the nature/magnitude of the problem. 2. Lack of adequate knowledge as to alternative courses of action open to them. GOAL: AFTER OF VARIED LECTURE-TEACHING, THE FAMILY WILL BE ABLE TO ACQUIRE BASIC KNOWLEDGE, DEVELOP SKILLS AND POSITIVE ATTITUDE IN THE CONCEPT OF HYPERTENSION. BEHAVIORAL LEARNING OBJECTIVES After 15 to 20 minutes of health teaching, the client will be able to: 

Define hypertension

LEARNING CONTENT

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TEACHING STRATEGY, METHODS AND ACTIVITIES

TIME ALLOTMENT

Hypertension, also One-on-one discussion; 1 minute referred to as high use of visual aids/ blood pressure, handouts HTN or HPN, is a medical condition in which the blood pressure is chronically elevated. Hypertension is defined as a

METHOD OF EVALUATION

Instant oral feedback: The patient was able to share her realization, understanding, and their appreciation regarding the definition of hypertension.





Enumerate the 2 classifications of hypertension

sustained elevation in the mean arterial pressure. It is often an asymptomatic disorder characterized by persistent elevation of blood pressure 1 minutes associated with One-on-one discussion; the thickening and use of visual aids/ loss of elasticity in handouts the arterial walls.

Hypertension can be classified either primary or secondary. Primary hypertension indicates that no specific medical cause can be found to explain a patient's condition. It is also called essential hypertension or idiopathic hypertension. About 90 % of all hypertensive have Discussion, visual aids primary hypertension. Identify the Secondary hypertension classification of BP

1 minutes

Instant oral feedback The patient was able to share her realization, understanding, and their appreciation regarding the hypertension and was able to enumerate 2 classification of hypertension

Instant oral feedback The patient was able to share her realization, understanding, and their appreciation regarding the hypertension and was able to

and categories of hypertension for adults 18 and older

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indicates that the high blood pressure is a result of (i.e., secondary to) another condition, such as kidney disease or tumours.

Normal is classified with 5 minutes a blood pressure of <120 mmHg systolic One-on-one discussion; and <80 mmHg use of visual aids/ diastolic. Pre- handouts hypertension is Enumerate 5 classified with a blood pressure of 102-139 Contributing mmHg systolic and 80factors of factors 89 mmHg diastolic. Stage 1 hypertension is classified with a blood pressure of 140-159 mmHg systolic and 9099mmHg diastolic. The risk of hypertension is 5 times higher in the obese as compared to those of normal weight and up to two-thirds of cases can be attributed to excess weight. More than 85% of cases occur in those with a BMI>25.

identify classification of hypertension

Instant oral feedback The patient was able to share her realization, understanding, and their appreciation regarding the hypertension and was able to enumerate 5 contributory factors of hypertension

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Sodium sensitivity Sodium is an environmental factor that has received the greatest attention. Approximately one third of the essential hypertensive population is responsive to sodium intake. This is due to the fact that increasing amounts of salt in a person's bloodstream causes cells to release water (due to osmotic pressure) to equilibrate concentration gradient of salt between the cells and the bloodstream; increasing the pressure on the blood vessel walls.  Role of renin Renin is an enzyme secreted by the juxtaglomerular apparatus of the kidney and linked with aldosterone in a negative feedback loop. The range of renin activity observed in hypertensive subjects

tends to be broader than in normotensive individuals. In consequence, some hypertensive patients h ave been defined as having low-renin and others as having essential hypertension. Low-renin hypertension is more common in African Americans than white Americans, and may explain why African Americans tend to respond better to diuretic therapy than drugs that interfere with the renin-angiotensin system. High Renin levels predispose to Hypertension: Increased Renin → Increased Angiotensin II → Increased Vasoconstriction, Thirst/ADH and Aldosterone → Increased Sodium Resorption in the Kidneys (DCT and CD) → Increased Blood Pressure. Some authorities claim

that potassium might both prevent and treat hypertension.  Insulin resistance Insulin is a polypeptide hormone secreted by cells in the islets of langerhans, which are contained throughout the pancreas. Its main purpose is to regulate the levels of glucose in the body antagonistically with glucagon through negative feedback loops. Insulin also exhibits vasodilatory properties. In normotensive individuals, insulin may stimulate sympathetic activity without elevating mean arterial pressure. However, in more extreme conditions such as that of the metabolic syndrome, the increased sympathetic neural activity may over-ride the vasodilatory effects

of insulin. Insulin resistance and/or hyperinsulinemia have been suggested as being responsible for the increased arterial pressure in some patients with hypertension. This feature is now widely recognized as part of syndrome X, or the metabolic syndrome.  Genetics Hypertension is one of the most 2 minutes common complex disorders, with genetic heritability averaging 30. Data supporting this One-on-one discussion; view emerge from use animal studies as well of visual aids/ handouts as in population studies in humans. Most of these studies support the concept that the inheritance is probably multifactorial or that a number of different genetic defects each have an elevated blood pressure as one of their phenotypic expressions.

Instant oral feedback The patient was able to share her realization, understanding, and their appreciation regarding the hypertension and was able to 3 signs and symptoms of hypertension

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

Age

Over time, the number of collagen fibers in artery and arteriole walls increases, making blood vessels stiffer. With the reduced Identify the 3 out elasticity comes a of 5 signs and smaller cross-sectional symptoms of area in systole, and so a hypertension raised mean arterial blood pressure.  Liquorice Consumption of liquorice (which can be of potent strength in liquorice candy) can lead to a surge in blood pressure. People with 2 minutes hypertension or history of cardio-vascular disease should avoid liquorice raising their blood pressure to risky One-on-one discussion; levels. Frequently, if use of visual aids/ liquorice is the cause of handouts the high blood pressure, a low blood level of potassium will also be present. 

Hypertension is usually found

Instant oral feedback The patient was able to share her realization, understanding, and their appreciation regarding the hypertension and was able to enumerate



incidentally by healthcare professionals measuring blood pressure during a routine checkup. In isolation, it usually produces no symptoms although some people report headaches, fatigue, dizziness, blurred vision, facial flushing, transient insomnia or difficulty Enumerate the 2 sleeping due to ways on how feeling hot or hypertension can flushed, and be diagnosed tinnitus during beginning onset or before hypertension diagnosis. Hypertension is often confused with mental tension, stress and anxiety. While chronic anxiety and/or irritability is associated with poor outcomes in people with

hypertension, it alone does not cause it. Accelerated hypertension is associated with somnolence, confusion, visual disturbances, and nausea and vomiting (hypertensive encephalopathy). 

Diagnosis in adults as made when an average of two or more One-on-one discussion; diastolic readings use of visual aids/ on at least two handouts subsequent visits is between 80-90 mmHg or when the average on multiple systolic BP on two or more subsequent visits is between 120139 mmHg. Tests are undertaken to identify possible causes of secondary hypertension, and seek evidence for end-organ

4 minutes

Instant oral feedback The patient was able to share her realization, understanding, and their appreciation regarding the hypertension and was able to enumerate 2 non-pharmacological management of hypertension.



damage to the heart itself or the eyes (retina) and kidneys. Diabetes and raised cholesterol levels being additional risk factors for the development of cardiovascular disease are also tested for as they will also require management. List the non- Blood tests commonly performed include: pharmacological and non Creatinine (renal pharmacological function) to management for identify both hypertension underlying renal disease as a cause of hypertension and conversely hypertension causing onset of kidney damage. Also a baseline for later monitoring the possible sideeffects of certain antihypertensive drugs.  Electrolytes

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

(sodium, potassium) Glucose to identify diabetes mellitus Cholesterol

Lifestyle modification (nonpharmacologic treatment)  Weight reduction and regular aerobic exercise (e.g., jogging) are recommended as the first steps in treating mild to moderate hypertension. Regular mild exercise improves blood flow and helps to reduce resting heart rate and blood pressure. These steps are highly effective in reducing blood pressure, although drug therapy is still necessary for many patients with moderate or severe

 



hypertension to bring their blood pressure down to a safe level. Reducing dietary sug ar intake Reducing sodium (salt) in the diet is proven very effective: it decreases blood pressure in about 60 percent of people (see above). Many people choose to use a salt substitute to reduce their salt intake. Additional dietary changes beneficial to reducing blood pressure includes the DASH diet (dietaryapproaches to stop hypertension) , which is rich in fruits and vegetables and low fat or fat-free dairy foods. This diet is shown effective based on research sponsored by the US National Institutes of



Health.[citation needed] In addition, an increase in daily calcium intake has the benefit of increasing dietary potassium, which theoretically can offset the effect of sodium and act on the kidney to decrease blood pressure. This has also been shown to be highly effective in reducing blood pressure. Discontinuing tobacco use and alcohol consumption has been shown to lower blood pressure. The exact mechanisms are not fully understood, but blood pressure (especially systolic) always transiently increases following alcohol and/or nicotine consumption. Besides, abstention



from cigarette smoking is important for people with hypertension because it reduces the risk of many dangerous outcomes of hypertension, such as stroke and heart attack. Note that coffee drinking (caffeine ingestion) also increases blood pressure transiently, but does not produce chronic hypertension. Reducing stress, for example with relaxation therapy, such as meditation and other mindbody relaxation techniques, by reducing environmental stress such as high sound levels and overillumination can be an additional method of ameliorating hypertension. Jacobson's

Progressive Muscle Relaxation and biofeedback are also used, particularly, device-guided paced breathing, although meta-analysis suggests it is not effective unless combined with other relaxation techniques.

LEARNING CONTENT DEFINITIONS: 

Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the blood pressure is chronically elevated. Hypertension is defined as a sustained elevation in the mean arterial pressure. It is often an asymptomatic disorder characterized by persistent elevation of blood pressure associated with the thickening and loss of elasticity in the arterial walls.

CLASSIFICATION: Hypertension can be classified either primary or secondary. Primary hypertension indicates that no specific medical cause can be found to explain a patient's condition. It is also called essential hypertension or idiopathic hypertension. About 90 % of all hypertensive have primary hypertension. Secondary hypertension indicates that the high blood pressure is a result of ( i.e., secondary to) another condition, such as kidney disease or tumours.Normal is classified with a blood pressure of <120 mmHg systolic and <80 mmHg diastolic. Pre-hypertension is classified with a blood pressure of 102-139 mmHg systolic and 80-89 mmHg diastolic. Stage 1 hypertension is classified with a blood pressure of 140-159 mmHg systolic and 90-99mmHg diastolic. CONTRIBUTERY FACTORS: The risk of hypertension is 5 times higher in the obese as compared to those of normal weight and up to two-thirds of cases can be attributed to excess weight. More than 85% of cases occur in those with a BMI>25. 

Sodium sensitivity

Sodium is an environmental factor that has received the greatest attention. Approximately one third of the essential hypertensive population is responsive to sodium intake. This is due to the fact that increasing amounts of salt in a person's bloodstream causes cells to release water (due to osmotic pressure) to equilibrate concentration gradient of salt between the cells and the bloodstream; increasing the pressure on the blood vessel walls. 

Role of renin

Renin is an enzyme secreted by the juxtaglomerular apparatus of the kidney and linked with aldosterone in a negative feedback loop. The range of renin activity observed in hypertensive subjects tends to be broader than in normotensive individuals. In consequence, some hypertensive patients have been defined as having low-renin and others as having essential hypertension. Low-renin hypertension is more common in African Americans than white Americans, and may explain why African Americans tend to respond better to diuretic therapy than drugs that interfere with the renin-angiotensin system. High Renin levels predispose to Hypertension: Increased Renin → Increased Angiotensin II → Increased Vasoconstriction, Thirst/ADH and Aldosterone → Increased Sodium Resorption in the Kidneys (DCT and CD) → Increased Blood Pressure. Some authorities claim that potassium might both prevent and treat hypertension.  Insulin resistance Insulin is a polypeptide hormone secreted by cells in the islets of langerhans, which are contained throughout the pancreas. Its main purpose is to regulate the levels of glucose in the body antagonistically with glucagon through negative feedback loops. Insulin also exhibits vasodilatory properties. In normotensive individuals, insulin may stimulate sympathetic activity without elevating mean arterial pressure. However, in more extreme conditions such as that of the metabolic syndrome, the increased sympathetic neural activity may over-ride the vasodilatory effects of insulin. Insulin resistance and/or hyperinsulinemia have been suggested as being responsible for the increased arterial pressure in some patients with hypertension. This feature is now widely recognized as part of syndrome X, or the metabolic syndrome. 

Genetics

Hypertension is one of the most common complex disorders, with genetic heritability averaging 30. Data supporting this view emerge from animal studies as well as in population studies in humans. Most of these studies support the concept that the inheritance is probably multifactorial or that a number of different genetic defects each have an elevated blood pressure as one of their phenotypic expressions. 

Age

Over time, the number of collagen fibers in artery and arteriole walls increases, making blood vessels stiffer. With the reduced elasticity comes a smaller cross-sectional area in systole, and so a raised mean arterial blood pressure. 

Liquorice

Consumption of liquorice (which can be of potent strength in liquorice candy) can lead to a surge in blood pressure. People with hypertension or history of cardio-vascular disease should avoid liquorice raising their blood pressure to risky levels. Frequently, if liquorice is the cause of the high blood pressure, a low blood level of potassium will also be present. SIGNS AND SYMPTOMS



Hypertension is usually found incidentally by healthcare professionals measuring blood pressure during a routine checkup. In isolation, it usually produces no symptoms although some people report headaches, fatigue, dizziness, blurred vision, facial flushing, transient insomnia or difficulty sleeping due to feeling hot or flushed, and tinnitus during beginning onset or before hypertension diagnosis.

Hypertension is often confused with mental tension, stress and anxiety. While chronic anxiety and/or irritability is associated with poor outcomes in people with hypertension, it alone does not cause it. Accelerated hypertension is associated with somnolence, confusion, visual disturbances, and nausea and vomiting (hypertensive encephalopathy). WAYS TO DIAGNOSE: 

Diagnosis in adults as made when an average of two or more diastolic readings on at least two subsequent visits is between 80-90 mmHg or when the average on multiple systolic BP on two or more subsequent visits is between 120-139 mmHg. Tests are undertaken to identify possible causes of secondary hypertension, and seek evidence for end-organ damage to the heart itself or the eyes (retina) and kidneys. Diabetes and raised cholesterol levels being additional risk factors for the development of cardiovascular disease are also tested for as they will also require management. Blood tests commonly performed include:    

Creatinine (renal function) - to identify both underlying renal disease as a cause of hypertension and conversely hypertension causing onset of kidney damage. Also a baseline for later monitoring the possible side-effects of certain antihypertensive drugs. Electrolytes (sodium, potassium) Glucose - to identify diabetes mellitus Cholesterol

NON- PHARMACOLOGICAL MANAGEMENT: Lifestyle modification (nonpharmacologic treatment) 

 

Weight reduction and regular aerobic exercise (e.g., jogging) are recommended as the first steps in treating mild to moderate hypertension. Regular mild exercise improves blood flow and helps to reduce resting heart rate and blood pressure. These steps are highly effective in reducing blood pressure, although drug therapy is still necessary for many patients with moderate or severe hypertension to bring their blood pressure down to a safe level. Reducing dietary sugar intake Reducing sodium (salt) in the diet is proven very effective: it decreases blood pressure in about 60 percent of people (see above). Many people choose to use a salt substitute to reduce their salt intake.







Additional dietary changes beneficial to reducing blood pressure includes the DASH diet (dietaryapproaches to stop hypertension), which is rich in fruits and vegetables and low fat or fat-free dairy foods. This diet is shown effective based on research sponsored by the US National Institutes of Health.[citation needed] In addition, an increase in daily calcium intake has the benefit of increasing dietary potassium, which theoretically can offset the effect of sodium and act on the kidney to decrease blood pressure. This has also been shown to be highly effective in reducing blood pressure. Discontinuing tobacco use and alcohol consumption has been shown to lower blood pressure. The exact mechanisms are not fully understood, but blood pressure (especially systolic) always transiently increases following alcohol and/or nicotine consumption. Besides, abstention from cigarette smoking is important for people with hypertension because it reduces the risk of many dangerous outcomes of hypertension, such as stroke and heart attack. Note that coffee drinking (caffeine ingestion) also increases blood pressure transiently, but does not produce chronic hypertension. Reducing stress, for example with relaxation therapy, such as meditation and other mindbody relaxation techniques, by reducing environmental stress such as high sound levels and over-illumination can be an additional method of ameliorating hypertension. Jacobson's Progressive Muscle Relaxation and biofeedback are also used, particularly, device-guided paced breathing, although meta-analysis suggests it is not effective unless combined with other relaxation techniques.

Saint Louis University School of Nursing Bonifacio Street, Baguio City Teaching Plan for Hypertension Presented to the Faculty of the School of Nursing In partial fulfilment For the Requirements for the Related Learning Experience for 1st semester 2014 Submitted to Prof. Ejercito Balay-odao Clincial Instructor

Tupac, Rushnol Jade P. BSN IV-F4

September 12, 2014 Friday