Role of Nursing in Hypertension - Assignment Example

Running Head: Hypertension Role of Nursing in Hypertension of Introduction Hypertension is one of the most prevalent causes of morbidity and mortality in the world. With the development of medical knowledge, many hidden aspects of this condition have started to emerge. For a health professional, it is important to know the different aspects of hypertension and hypertensive care, as he or she is most likely to come across such cases. Hypertension is also a concern for the number of complications that it can lead to. The paper overlooks at the outlines of the disease, its pathology the etiological and epidemiological factors that contribute to it. The paper identifies the importance of screening programs in this case and the role of the government and the different health care sectors in the provision of screening and health care facilities related to hypertension. In doing so, it highlights the importance of nursing in the identification of the condition and the contribution nurses can make in addressing the various aspects of hypertensive care. Hypertension has now become one of the most prevalent diseases in humans. This condition is very significant as it is one of the leading causes of cardiovascular disease development. Up to 50% of hypertension cases lead to CVD cases, followed by high blood cholesterol levels, sedentary lifestyle, tobacco and smoking, and low amount of fruit and vegetable intakes. (World Health Report, 2002) Flack (2003) describes hypertension as a "nutritional hygienic disease" based on the risk factors that contribute to it. (Flack, 2003) The commonly known definition of hypertension is the increase in the blood pressure. If the systolic blood pressure of an individual is above 140 mm/Hg and the diastolic blood pressure is above 90 recorded on multiple occasions, the person is termed as hypertensive. (Wikipedia, 2006) Patients may show both systolic and diastolic increased values, or show one of these in isolation. A person who is "prehypertensive" is likely to develop the condition at some point of life. Prehypertension refers to a systolic blood pressure ranging from 120 to 139 and diastolic blood pressure of 80 to 89 on multiple readings. Hypertension can be classified as either essential or primary hypertension, or secondary hypertension. Essential hypertension denotes hypertension resulting from unknown causes. Secondary hypertension is usually the result of another condition, such as kidney diseases or disorders and tumors. Primary hypertension accounts for approximately 90% of the cases. Secondary hypertension accounts for 10%. (Wikipedia, 2006) Hypertension is an important condition not only for the increased prevalence in the different populations around the world, but also for the complications that this condition can lead up to. The problem with this condition is that there are no overt symptoms of hypertension, and those that do arise are everyday symptoms like headaches. However, patients are advised to visit a doctor if they feel certain symptoms occurring more than usual. It is for this reason that hypertension has been referred to as the "silent killer". (Williams, 2001) The pathological processes of primary hypertension are less understood as opposed to secondary hypertension. However, some mechanisms have helped in clarifying the picture. It is mostly thought that discrepancies occur in the blood pressure controlling systems of the body, which leads to the elevation of the blood pressures. Blood vessels dilate and contract themselves in order to maintain the blood pressure of the body. If these vessels fail to do so, the pressure in the vessels begins to increase, or causes hypertension. It is known now that at the initial stage the heart responds to the changes by increasing the cardiac output. (Wikipedia, 2006) In the later stages, the situation reverses when the heart starts giving out the normal cardiac output, but the total peripheral resistance, which was normal in the initial stages, starts to increase. Why these changes take place can occur due to one of the three possible reasons. The kidneys may not be able to excrete sodium from the body, a mechanism which reduces the amount of blood volume in the body. The renin/ angiotensin mechanism may become increasingly functional, leading to vasoconstriction of the blood vessels as well as the retention of sodium and water. The third reason can be the over activity of the sympathetic system. (Wikipedia, 2006) Of the many causes of hypertension, some of the most common etiology of it is increased "salt intake, obesity, occupation, alcohol intake, family size, excessive noise exposure, and crowding". (Wikipedia, 2006) The role of renin, the enzyme secreted by the kidney, is also considered in the contribution of hypertension, and depending upon the quantity, patients can be classified as high renin and low renin cases. (Wikipedia, 2006) The role of insulin has also been suggested in the development of hypertension. Hyperinsulinemia is now an established component of the syndrome X or metabolic syndrome. Sleep apnea can also lead to hypertension, although it is easily cured with weight loss and application of positive airway pressure to the nose while sleeping. With recent advances in geniology, it is a widely known fact that hypertension is acquired through heredity. Up to 50 genes have been positively implicated in the production of hypertension, with more research underway. (Wikipedia, 2006) The prevalence of hypertension is seen in all parts of the world. However, hypertension has been found to be more prevalent in Afro-Caribbean and in people of African descent. This group is also at an increased risk to develop complications stroke, renal failure etc. with increased incidences of mortality. In South Asians, hypertension mostly leads to the complications of coronary heart disease. (Lane & Lip, 2001) This prevalence, however, has been under controversy due to the many mixed reports detailing different incidences. In the UK, one of the reasons for this is the selection of the "first generation" of the ethnic population, as well as the selecting different populations. Hypertension is seen in increased prevalence with the advancement of age. In the UK, this prevalence amounts to 3.6 % in people less than 40 years of age, but up to 50% in patients aged 80 years of above, showing an upward trend in hypertension. (Lane & Lip, 2001) Only 50% of the cases are diagnosed of hypertension, of which half are well controlled cases. Usually hypertension is diagnosed in routine medical appointments carried out for a different purpose. The ethnic prevalence and risk issue does not end here. Many of the drugs prescribed for hypertension give good response in one racial or ethnic group, while at the same time none in another group. For example, it is usually wise to treat a Black patient with a multiple therapy regime comprising of alpha-antagonists, calcium channel blockers and diuretics. (Lane & Lip, 2001) These patients also show better responses to equal amounts of drug doses when compared to their white counterparts. (Lane & Lip, 2001) Many factors contribute to hypertension. A mostly sedentary lifestyle in the modern living combined with the intake of excess amounts of calories is the main cause of gradual rise in the BP. The controlling factor in such case would be alteration of the life style of the individuals by more exercise and a more cautious approach to eating habits. (Flack, 2003) Sodium is perhaps one of the most contributing factors in the formation of hypertension. The daily intake of sodium exceeds the limit of 10mmol that is normally required by the kidneys. (Stier, 2000) The Caucasians are seen to use lesser amounts of sodium in their daily intake when compared to the African American public. Sodium reversibly disrupts the normal autoregulation mechanism of the GFR, which can expose it to high blood pressures leading to hemodynamic injury in the kidney. Sodium worsens proteinurea and increases left ventricular mass, and acts as a direct vascular toxin. Sodium augments the production and release of TGF- , the vascular injury mediators as well as stimulates aldosterone which leads to fibrosis and scarring of the target organs. (Stier, 2000) Obesity is another one of the major factors leading not only to hypertension, but also to diabetes mellitus, salt sensitivity, glucose intolerance, dislipidemia, left ventricular mass, and high urinary protein excretion rates. (Brands, 1999) The effects on kidney are very damaging and include excessive renal sodium absorption, mesangial cell hypertrophy, matrix production, and glomerullar hyperfiltration. (Adelman, 2002) Recent researches have established the facts that hypertension and obesity are closely related to each other, and demonstrate a linear relationship between mean BMI and blood pressures. Undernutrition a common finding in the asian and the African races, adds to the list of hypertension, and extreme variations of BMI are also associated with the development of hypertension. (Tesfaye, 2006) The effects of hypertension on the general health of a person are evident. If not controlled properly, hypertension can lead to reduced functional capacity of a person with increased demand on the body and its organs. The main organs in concern are evidently the heart, the brain and the kidneys. Hypertension is one of the leading causes of CVDs in the world. Other complications that can arise are cerebrovascular accident, myocardial infarction, hypertensive cardiomyopathy or heart failure, retinopathy and nephropathy. (Wikipedia, 2006) Hypertension can also result during pregnancy. These cases are rare, however, if complications arise, they can cause pre-eclampsia, HELLP syndrome, and eclampsia. Other complications include kidney disease and its failure, accounting for the second most common cause of its failure after diabetes. It can also lead to artery symptoms, angina and heart attack, left ventricular hypertrophy, heart failure, left side heart failure, stroke, cerebrovascular disease, cerebral hemorrhage, and impaired vision. (Complications of Hypertension, 2006) The most common treatment advised for patients with hypertension is modification of their lifestyle. In many of the cases, this application alone is effective in preventing any complications. However, in cases that do require a medicine regime, there are varieties of drugs available that are prescribed depending upon the status of the condition. The most common drugs prescribed in the treatment for hypertension include "ACE inhibitors, angiotensin II receptor antagonists, alpha blockers, beta blockers, calcium channel blockers, diuretics and combination products". (http://www.clinicaltrials.gov/ct/show/NCT00208221) Lifestyle modifications include exercising, which improves the cardiovascular system and reduces the risk of heart disease. The intake of calcium is shown to lower blood pressure levels. The use of adequate magnesium and potassium has also shown a positive effect on the blood pressure. Replacing saturated fats in the diet with polyunsaturated fats and relaxation techniques are also advised to patients with high blood pressures. (Lane and Lip, 2001) With more and more cases reported each year, recommendations have been made to conduct screening tests for early detection and possible avoidance of complications of hypertension. However, screening for hypertension is not one of the easiest tasks to be carried out by the health departments. There are many factors that influence this decision and merit consideration. For example, from the patient's point of view, although the application of screening procedures may be a good initiative, it can lead to extreme anxiety in cases which come out positive for hypertension. This reaction may not be of concern in an institute carrying out researches on related topics, but for an ordinary person in an ordinary setting, this news may be quite alarming. The psychological effect may in fact lead to aggravation of the situation. Also, the compliance among the patients with known hypertension is poor, and therefore, the focus in the new policies is more on preventing the disease and improving the resources for the treatment of hypertension. (UK National Screening Committee, 2002) The National Screening Committee has two purposes. The first is to identify the potential of screening programs in the overall improvement of the health of the masses and applying it accordingly. The second is to ensure the quality of these screening programs. Other areas that it overlooks are to minimize the possibilities of errors, and if done so, quick identification and handling of it accordingly, improve the quality of the working professionals, and conduct regular reviews. (UK National Screening Committee, 2002) The committee is currently evaluating the effect of screening programs in different age groups regarding diagnosis of hypertension. So far, it does not allow children to be screened for hypertension, and is working on establishing proper methods of screening in diagnosing hypertension in different areas of health care. The detection of hypertension has also been advised in the emergency departments. Studies have demonstrated that this technique is feasible and helpful in detection of hypertension in the EDs, and about 5% of the cases seen in the ED show same BPs at follow ups. However, care must be taken in correctly diagnosing the condition and tactfully telling the patient about his or her condition. (Fleming, 2004) It has been demonstrated by Bengston (2003) that the participation of a nurse in the care of hypertensive patients leads to significant improvements in the condition of the patients. This was demonstrated in the decrease in the weight, lesser sodium dietary intake, cessation of smoking, increased physical activity, taking timely medications, which reduced the overall costs and visits to the practitioners. The study clearly demonstrated that if programs are introduced keeping in mind the nursing approach to patients and knowledge, hypertension can be controlled more quickly and more positive results can be obtained. (Anne Bengtson, 2003) Nurses come across hypertensive patients every day in the primary care setting. It is therefore important that nurses be trained properly to handle, manage, teach and guide patients, and in the event of an emergency, be able to handle these patients. The most important areas that nurses need to know are measuring of blood pressures, risk stratification according to risk factors and locating any target organ damage, special investigations and general management issues, drug therapy issues, and referral criteria. (Greeff, 2001) By application of nursing knowledge and compassion in the care, it is expected that more treatment and medication compliance can be achieved from the patients, which remains the crux of the issue. Most of the cases of hypertension involve an adult old age group, of which majority may be in nursing care in one form or the other. The nurses are most frequently exposed health care professionals to these patients and in this way may be able to better assess and monitor the conditions of the patients on a day to day basis. By doing so, the nurses will be able to identify early signs and symptoms of worsening of the condition and prevent and treat complications. Nursing in simple words can contribute highly in the health of hypertensive patients. In conclusion, it can be stated that the role of nurses in improvement of care of hypertensive patients has been contributory, and more effort should be placed in utilizing this asset to better address the global issue of hypertension. Hypertension can not be simply prevented by screening alone, but if it is done so with proper medical care and follow up, and with good education and awareness, the results can be very benefiting. References Adelman RD: Obesity and renal disease. Curr Opin Nephrol Hypertens 11: 331-335, 2002 Anne Bengtson, The Nurse's Role and Skills in Hypertension Care. 2003. Site last accessed on December 29th, 2006. http://www.medscape.com/veiwarticle/463185 Complications of hypertension, 2006. Site last accessed on December 29th, 2006 www.wrongdiagnosis.com John M. Flack, Rosalind Peters, Tariq Shafi, Hisham Alrefai, Samar A. Nasser and Errol Crook, 2003. Prevention of Hypertension and its Complications: Theoretical Basis and Guidelines for Treatment. Journal of American Society of Nephrology, 14:S92-S98, 2003. J Fleming, C Meredith and J Henry. 2004 Detection of hypertension in the emergency department Emergency Medicine Journal 2005;22:636-640; doi:10.1136/emj.2004.015040 Douw G S Greeff,2001. Hypertension. Professional Nursing Today. Site last accessed on December 29th, 2006. http://www.medpharm.co.za/pnt/2001/first/hypertension1.html Hall JE, Brands MW, Henegar JR: Mechanisms of hypertension and kidney disease in obesity. Ann N Y Acad Sci 18: 91-107, 1999 D.A.Lane and G.Y.H. Lip, 2001. Ethnic Differences in Hypertension and Blood Pressure Control in the UK. QJM: An International Journal of Medicine. Volume 94, Number 7 Pg 391-396. Rocha R, Stier CT Jr, Kifor I, Ochoa-Maya MR, Rennke HG, Williams GH, Adler GK: Aldosterone: a mediator of myocardial necrosis and renal arteriopathy. Endocrinology 141: 3871-3878, 2000 F Tesfaye, N GNawi, HVan Minh, PByass, YBerhane,RBonita and SWall. Association between body mass index and blood pressure across three populations in Africa and Asia. Journal of Human Hypertension (2007) 21, 28-37. doi:10.1038/sj.jhh.1002104; published online 26 October 2006 UK National Screening Committee, 2002.Programme Director's Report, 2000-2002. Site last accessed on December 29th, 2006. http://www.library.nhs.uk/SpecialistLibrarySearch/Download.aspxresID=60282. Hypertension - Wikipedia, the free encyclopedia. Site last accessed on December 29th, 2006. http://en.wikipedia.org/wiki/Hypertension Bryan Williams, 2001. Treatment of Hypertension in UK: Simple as ABCD Site last accessed on December 29th, 2006. http://www.pubmedcentral.nih.gov/articlerender.fcgiartid=539621 World Health Report. Reducing risks, promoting healthy life. 2002 http://www.who.int/whr/en Clinical Trial: Higher Dose of Ramipril Versus Addition of Telmisartan-Ramipril in Hypertension and Diabetes. Site last accessed on December 29th, 2006. http://www.clinicaltrials.gov/ct/show/NCT00208221 Read More