Care of Clients with Problems in Oxygenation, Fluid and Electrolyte,

Infectious, Inflammatory and Immunologic Response,

Cellular Aberrations, Acute and Chronic

Module #8 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Lesson Title: PATIENTS WITH OXYGEN PERFUSION RELATED Materials:

DISORDERS – HYPERTENSION
Learning Targets: Pen, paper, index card, book, and class List
At the end of the module, students will be able to:
1. Discuss the pathophysiologic responses to alterations/problems
in oxygenation specifically with patients with oxygen perfusion References:
related disorders-specifically hypertension;
2. Assess the at-risk and sick adult client’s one’s health Hinkle, J. L., Cheever, K. H., & Hinkle, J.
status/competence; L. (2018). Brunner & Suddarth's
3. Formulate with the client a plan of care to address needs Textbook of Medical-Surgical Nursing.
/problems and based on priority; Wolters Kluwer.
4. Implement safe and quality nursing interventions with client to
address needs/ problems; Grinslade, S., Singel, L. J., & Keys, P. L.
5. Institute appropriate corrective actions to prevent or minimize (2005). Study Guide for Black & Amp; Hawks
harm arising from adverse effects; and, Medical Surgical Nursing: Clinical
6. Compare patients with hypertension with regard to cause, Management for Positive Outcomes. Elsevier
incidence, clinical manifestations, management, and the Saunders.
significance of preventive health care.
Anef, C. D. R. D., & Faan, R. P. L. W. M.
(2012). Medical-Surgical Nursing: Patient-
Centered Collaborative Care, Single Volume
(Ignatavicius, Medical-Surgical Nursing,
Single Vol) (7th ed.). Saunders.

A. LESSON PREVIEW/REVIEW

Instruction: Enumerate the three crises in sickle cell anemia. Explain each briefly.
1. ___________________, _________________________________________________________________________
2. ___________________, _________________________________________________________________________
3. ___________________, _________________________________________________________________________

B. MAIN LESSON

Hypertension, or high blood pressure (BP), is an important medical and public health problem. There is a direct
relationship between hypertension and cardiovascular disease (CVD). As BP increases, so does the risk of myocardial
infarction (MI), heart failure, stroke, and renal disease

Hypertension is sometimes called the “silent killer” because people who have it are often symptom free. Hypertension by
definition is known as a systolic blood pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg
based on the average of two or more accurate blood pressure measurements taken during two or more contacts with a
health care provider

How the Cardiovascular System Works

⎯ The cardiovascular system is responsible for delivery of blood, which carries oxygen and other nutrients, to the tissues
of the body.
⎯ The heart pumps the blood to the body where it delivers nutrients and oxygen, picks up waste products, and then
returns to the heart.

Normal Regulation of Blood Pressure

⎯ Blood pressure (BP) is the force exerted by the blood against the walls of the blood vessel. It must be adequate to
maintain tissue perfusion during activity and rest.

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 1

 Care of Clients with Problems in Oxygenation, Fluid and Electrolyte,
Infectious, Inflammatory and Immunologic Response,
Cellular Aberrations, Acute and Chronic

Module #8 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

⎯ The maintenance of normal BP and tissue perfusion requires the integration of both systemic factors and local
peripheral vascular effects.
⎯ BP is primarily a function of cardiac output (CO) is the total blood flow through the systemic or pulmonary circulation
per minute; and systemic vascular resistance which is the force opposing the movement of blood within the blood
vessels.

⎯ Stabilizing mechanisms exist in the body to exert an overall regulation of systemic arterial pressure and to prevent
circulatory collapse.

Four Control Systems that Maintain Blood Pressure:

1. The Arterial Baroreceptor System – monitors the level of arterial pressure and counteracts a rise in arterial pressure
through vagally mediated cardiac slowing and vasodilation with decreased sympathetic tone.
2. Regulation of Body Fluid Volume. If the kidneys are functioning adequately, a rise in systemic arterial pressure
produces diuresis (excessive voiding) and a fall in pressure.
3. The Renin-Angiotensin-Aldosterone System
4. Vascular Autoregulation keeps perfusion of tissues in the body relatively constant

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 2

 Care of Clients with Problems in Oxygenation, Fluid and Electrolyte,
Infectious, Inflammatory and Immunologic Response,
Cellular Aberrations, Acute and Chronic

Module #8 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Classification:
⎯ Primary (Essential or Idiopathic) Hypertension is elevated BP without an identified cause, and it accounts for 90%
to 95% of all cases of hypertension.
⎯ Secondary Hypertension is elevated BP with a specific cause that often can be identified and corrected.

These are the Further Classifications of Hypertension:

a. Normal <120 mmHg Systolic / <80 mmHg Diastolic
b. Prehypertension: 120–139 mmHg Systolic / 80–89 mmHg Diastolic
c. Stage 1 Hypertension: 140–159 mmHg Systolic / 90–99 mmHg Diastolic
d. Stage 2 Hypertension: 160 mmHg / Systolic 100 mmHg Diastolic
e. In Diabetic Patients: Hypertension is defined as 130/80 or higher

Hallmark Signs and Symptoms

✓ Asymptomatic until it becomes severe and target organ disease occurs
✓ Secondary symptoms include:
⎯ fatigue
⎯ dizziness
⎯ palpitations
⎯ angina
⎯ dyspnea

Interpreting Test Results

✓ Blood pressure readings higher than 140/90 mmHg on at least three occasions.
✓ Ventricular hypertrophy depicted on EKG or chest x-ray.
✓ Blood test to look for associated cardiovascular risks.
✓ High cholesterol—often associated with hypertension.
✓ Check electrolytes for imbalance—sodium, potassium, chloride, CO2.
✓ Monitor BUN and creatinine for renal function, a sign of impaired organ damage.
✓ Chemistry to check for diabetes mellitus.

Pathophysiology

The pathogenesis of essential hypertension is multifactorial and highly complex. The pathophysiology of hypertension

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 3

 Care of Clients with Problems in Oxygenation, Fluid and Electrolyte,
Infectious, Inflammatory and Immunologic Response,
Cellular Aberrations, Acute and Chronic

Module #8 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

involves the impairment of renal pressure natriuresis, the feedback system in which high blood pressure induces an
increase in sodium and water excretion by the kidney that leads to a reduction of the blood pressure. Pressure natriuresis
can result from impaired renal function, inappropriate activation of hormones that regulate salt and water excretion by the
kidney (such as those in the renin-angiotensin-aldosterone system), or excessive activation of the sympathetic nervous
system.

Hypertensive emergencies and urgencies may occur in patients whose hypertension has been poorly controlled, whose
hypertension has been undiagnosed, or in those who have abruptly discontinued their medication.
✓ Hypertensive Emergency is a situation in which blood pressure is extremely elevated (more than 180/120 mm Hg)
and must be lowered immediately (not necessarily to less than 140/90 mm Hg) to halt or prevent damage to the target
organs. Conditions associated with a hypertensive emergency include hypertension of pregnancy, acute myocardial
infarction, dissecting aortic aneurysm, and intracranial hemorrhage.
✓ Hypertensive Urgency describes a situation in which blood pressure is very elevated but there is no evidence of
impending or progressive target organ damage. Elevated blood pressures associated with severe headaches,
nosebleeds, or anxieties are classified as urgencies. In these situations, oral agents can be administered with the goal
of normalizing blood pressure within 24 to 48 hours

Medical Management
⎯ The goal of hypertension treatment is to prevent complications and death by achieving and maintaining the arterial
blood pressure at 140/90 mm Hg or lower.
⎯ The optimal management plan is one that is inexpensive, simple, and causes the least possible disruption in the
patient’s life.

Lifestyle Modifications are directed toward reducing the patient’s BP and overall cardiovascular risk. Modifications
include
1. Weight Reduction
✓ A weight loss of 22 lb. (10 kg) may decrease SBP by approximately 5 to 20 mm Hg.
2. Dietary Approaches to Stop Hypertension (DASH) Eating Plan
✓ Emphasizes fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds,
and nuts.
3. Dietary Sodium Reduction,
✓ Healthy adults should restrict sodium intake to less than or equal to 2300 mg/day.
4. Moderation of Alcohol Consumption,
✓ Men should limit their intake of alcohol to no more than two drinks per day and women and lighter weight men to
no more than one drink per day. One drink is defined as 12 oz of regular beer, 5 oz of wine (12% alcohol), or 1.5
oz of 80-proof distilled spirits.
5. Regular Physical Activity,
✓ Adults perform moderate-intensity aerobic physical activity for at least 30 minutes most days (i.e., more than 5
days per week) or vigorous intensity aerobic activity for at least 20 minutes 3 days a week.
6. Avoidance of Tobacco Use
✓ Smoking and chewing
7. Management of Psychosocial Risk Factors
✓ By their impact on lifestyle behaviors and choices

The drugs currently available for treating hypertension have two main actions:
1. They decrease the volume of circulating blood
2. They reduce SVR.

The drugs used in the treatment of hypertension include diuretics, adrenergic (SNS) inhibitors, direct vasodilators,
angiotensin and renin inhibitors, and calcium channel blockers

Nursing Diagnosis
⎯ Deficient knowledge related to disease process and treatment regimen

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 4

 Care of Clients with Problems in Oxygenation, Fluid and Electrolyte,
Infectious, Inflammatory and Immunologic Response,
Cellular Aberrations, Acute and Chronic

Module #8 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

⎯ Ineffective self-health management related to lack of knowledge of pathology, complications, and management of
hypertension
⎯ Noncompliance with therapeutic regimen related to side effects of prescribed therapy
⎯ Anxiety related to complexity of management regimen
⎯ Sexual dysfunction related to side effects of antihypertensive medication
⎯ Risk for decreased cardiac tissue perfusion
⎯ Risk for ineffective cerebral tissue perfusion
⎯ Risk for ineffective renal perfusion

Nursing Management
⎯ The objective of nursing care for patients with hypertension focuses on lowering and controlling the blood pressure
without adverse effects and without undue cost
⎯ Carefully monitoring the blood pressure at frequent intervals and then at routinely scheduled intervals.
⎯ A complete history is obtained to assess for signs and symptoms that indicate target organ damage (ie, whether
specific tissues are damaged by the elevated blood pressure).
⎯ The nurse must support and teach the patient to adhere to the treatment regimen by implementing necessary lifestyle
changes, taking medications as prescribed, and scheduling regular follow-up appointments with the health care
provider to monitor progress or identify and treat any complications of disease or therapy.
⎯ The nurse needs to emphasize the concept of controlling hypertension rather than curing it. The nurse can encourage
the patient to consult a dietitian to help develop a plan for improving nutrient intake or for weight loss
⎯ The nurse assists the patient to develop and adhere to an appropriate exercise regimen, because regular activity is a
significant factor in weight reduction and a blood pressure–reducing intervention in the absence of any loss in weight
⎯ Providing written information about the expected effects and side effects of medications is important. When side
effects occur, patients need to understand the importance of reporting them and to whom they should be reported.
Patients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly
stopped. Thus, patients should be advised to have an adequate supply of medication.
⎯ The nurse can encourage and teach patients to measure their blood pressure at home. This practice involves patients
in their own care and emphasizes that failing to take medications may result in an identifiable rise in blood pressure

CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed
Case Study: Read and examine the case thoroughly.

Patient Profile: K.J. is a 73-year-old African American woman with no history of hypertension. She came to the doctor’s
office for a flu shot.

Subjective Data
✓ Says she has gained 20 lbs. over the past year since her husband died
✓ Has never smoked and uses no alcohol
✓ Only medication is one multivitamin per day
✓ Eats a lot of canned food
✓ Does not exercise

Objective Data
✓ Height: 5 ft, 4 in (162.6 cm)
✓ Weight: 170 lbs. (77.1 kg)
✓ BP: 170/82
✓ Physical examination shows no abnormalities
✓ Serum potassium: 3.3 mEq/L (3.3 mmol/L)

The health care provider diagnosed isolated systolic hypertension (ISH) and prescribed lifestyle modifications.

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 5

 Care of Clients with Problems in Oxygenation, Fluid and Electrolyte,
Infectious, Inflammatory and Immunologic Response,
Cellular Aberrations, Acute and Chronic

Module #8 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Discussion Questions
1. What contributing factors to the development of ISH are present in K.J.?
Answer:__________________________________________________________________________________________
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2. What additional risk factors are present?

Answer:__________________________________________________________________________________________
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3. What specific dietary changes would the nurse recommend for K.J.?
Answer:__________________________________________________________________________________________
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4. If drug therapy became necessary to treat K.J.’s hypertension, what diuretic would be indicated based on her laboratory
results?
Answer:__________________________________________________________________________________________
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.

5. Priority Decision: What other priority teaching measures should be instituted by the nurse?
Answer:__________________________________________________________________________________________
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6. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses?
Answer:__________________________________________________________________________________________
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Multiple Choice

1. What are non-modifiable risk factors for primary hypertension (select all that apply)?
a. Age
b. Obesity
c. Gender
d. Ethnicity

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 6

 Care of Clients with Problems in Oxygenation, Fluid and Electrolyte,
Infectious, Inflammatory and Immunologic Response,
Cellular Aberrations, Acute and Chronic

Module #8 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

e. Genetic link
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

2. How is secondary hypertension differentiated from primary hypertension?

a. Has a more gradual onset than primary hypertension
b. Does not cause the target organ damage that occurs with primary hypertension
c. Has a specific cause, such as renal disease, that often can be treated by medicine or surgery
d. Is caused by age-related changes in BP regulatory mechanisms in people over 65 years of age
Answer: ________
Rationale:________________________________________________________________________________________
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_________________________________________________________________________________________________

3. What is the patient with primary hypertension likely to report?

a. No symptoms
b. Cardiac palpitations
c. Dyspnea on exertion
d. Dizziness and vertigo
Answer: ________
Rationale:________________________________________________________________________________________
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_________________________________________________________________________________________________

4. Priority Decision: A patient with stage 2 hypertension who is taking hydrochlorothiazide (Hydrodiuril) and lisinopril
(Prinivil) has prazosin (Minipress) added to the medication regimen. What is most important for the nurse to teach the
patient to do?
a. Weigh every morning to monitor for fluid retention
b. Change position slowly and avoid prolonged standing
c. Use sugarless gum or candy to help relieve dry mouth
d. Take the pulse daily to note any slowing of the heart rate
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

5. A 38-year-old man is treated for hypertension with triamterene and hydrochlorothiazide (Maxzide) and metoprolol
(Lopressor). Four months after his last clinic visit, his BP returns to pretreatment levels and he admits he has not been
taking his medication regularly. What is the nurse’s best response to this patient?
a. “Try always to take your medication when you carry out another daily routine so you do not forget to take it.”
b. “You probably would not need to take medications for hypertension if you would exercise more and stop smoking.”
c. “The drugs you are taking cause sexual dysfunction in many patients. Are you experiencing any problems in this area?
d. “You need to remember that hypertension can be only controlled with medication, not cured, and you must always take
your medication.”
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

6. A 78-year-old patient is admitted with a BP of 180/98 mm Hg. Which age-related physical changes may contribute to
this patient’s hypertension (select all that apply)?

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 7

 Care of Clients with Problems in Oxygenation, Fluid and Electrolyte,
Infectious, Inflammatory and Immunologic Response,
Cellular Aberrations, Acute and Chronic

Module #8 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

a. Decreased renal function d. Increased adrenergic receptor sensitivity

b. Increased baroreceptor reflexes e. Increased collagen and stiffness of the myocardium
c. Increased peripheral vascular resistance f. Loss of elasticity in large arteries from arteriosclerosis
Answer: ________
Rationale:________________________________________________________________________________________
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7. What should the nurse emphasize when teaching a patient who is newly prescribed clonidine (Catapres)?
a. The drug should never be stopped abruptly.
b. The drug should be taken early in the day to prevent nocturia.
c. The first dose should be taken when the patient is in bed for the night.
d. Because aspirin will decrease the drug’s effectiveness, Tylenol should be used instead.
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

8. What is included in the correct technique for BP measurements?

a. Always take the BP in both arms.
b. Position the patient supine for all readings.
c. Place the cuff loosely around the upper arm.
d. Take readings at least two times at least 1 minute apart.
Answer: ________
Rationale:________________________________________________________________________________________
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_________________________________________________________________________________________________

9. Which manifestation is an indication that a patient is having a hypertensive emergency?

a. Symptoms of a stroke with an elevated BP
b. A systolic BP >200 mm Hg and a diastolic BP >120 mm Hg
c. A sudden rise in BP accompanied by neurologic impairment
d. A severe elevation of BP that occurs over several days or weeks
Answer: ________
Rationale:________________________________________________________________________________________
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10. During treatment of a patient with a BP of 222/148 mm Hg and confusion, nausea, and vomiting, the nurse initially
titrates the medications to achieve which goal?
a. Decrease the mean arterial pressure (MAP) to 129 mm Hg
b. Lower the BP to the patient’s normal within the second to third hour
c. Decrease the SBP to 160 mm Hg and the DBP to between 100- and 110-mm Hg as quickly as possible
d. Reduce the systolic BP (SBP) to 158 mm Hg and the diastolic BP (DBP) to 111 mm Hg within the first 2 hours
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 8

 Care of Clients with Problems in Oxygenation, Fluid and Electrolyte,
Infectious, Inflammatory and Immunologic Response,
Cellular Aberrations, Acute and Chronic

Module #8 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

C. LESSON WRAP-UP

AL Activity: Formative Assessment

This strategy focuses on the assessment of your learnings after a lesson. You must answer the following questions, as
honest as possible, based on your own understanding.

1. What specific part of the Main Lesson for this session do you find the most confusing?
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2. What makes your answer in #1 confusing? What is the question in your mind?
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3. Since that is your most confusing lesson, what are the interventions that you must do to understand the topic?
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THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 9