Hypertension

Stages of Hypertension

Hypertension, or high blood pressure, is a major risk factor for cardiovascular disease. It is classified into stages based on systolic and diastolic blood pressure readings.

• Normal: Systolic < 120 mmHg and Diastolic < 80 mmHg

• Elevated: Systolic 120–129 mmHg and Diastolic < 80 mmHg

• Stage 1 Hypertension: Systolic 130–139 mmHg or Diastolic 80–89 mmHg

• Stage 2 Hypertension: Systolic ≥ 140 mmHg or Diastolic ≥ 90 mmHg

White coat hypertension refers to elevated blood pressure readings in a clinical setting but not in other settings, often due to anxiety.

Secondary Hypertension

Secondary hypertension is high blood pressure caused by another medical condition, such as kidney disease or endocrine disorders.

• Diagnosis: Requires investigation of underlying causes.

• Treatment: Focuses on managing the primary condition.

Medication and Discharge Teaching

• Medication teaching: Patients should understand the purpose, dosage, and side effects of antihypertensive medications (e.g., ACE inhibitors, beta-blockers, diuretics).

• Discharge teaching: Emphasize medication adherence, lifestyle modifications (diet, exercise), and regular blood pressure monitoring.

Coronary Artery Disease (CAD)

Risk Factors

CAD is the narrowing or blockage of coronary arteries due to atherosclerosis.

• Modifiable risk factors: Smoking, hypertension, high cholesterol, obesity, physical inactivity, poor diet, diabetes.

• Non-modifiable risk factors: Age, gender, family history, genetic predisposition.

Lifestyle Changes and Health Promotion

• Adopt a heart-healthy diet (low in saturated fat, high in fruits and vegetables).

• Engage in regular physical activity (at least 150 minutes of moderate exercise per week).

• Manage stress and avoid tobacco and excessive alcohol use.

Angina

• Stable chronic angina: Predictable chest pain with exertion, relieved by rest or nitroglycerin.

• Prinzmetal’s (variant) angina: Chest pain at rest due to coronary artery spasm; treated with calcium channel blockers and nitrates.

Nitrate Use

• Short-acting nitrates: Used for acute relief of angina (e.g., sublingual nitroglycerin).

• Long-acting nitrates: Used for prevention of angina episodes (e.g., nitroglycerin patch).

• Contraindications: Nitrates should not be used with sildenafil (Viagra) due to risk of severe hypotension.

Medications in Cardiovascular and Respiratory Health

Common Medications

• Isoniazid (INH), Rifampin (Rifadin), Pyrazinamide (PZA), Ethambutol: Used in tuberculosis treatment.

• Ciprofloxacin (Cipro): Antibiotic for bacterial infections.

• Albuterol (Ventolin): Short-acting beta2-agonist for asthma/COPD.

• Methylprednisolone (Solu-Medrol), Prednisone, Triamcinolone (Azmacort): Corticosteroids for inflammation.

• Salmeterol (Serevent): Long-acting beta2-agonist for long-term asthma/COPD control (not for acute attacks).

• Beta-blockers (e.g., Propranolol): Lower blood pressure and heart rate.

• ACE inhibitors (e.g., Captopril): Lower blood pressure by inhibiting angiotensin-converting enzyme.

• Diltiazem (Cardizem): Calcium channel blocker for hypertension and angina.

• Furosemide (Lasix): Diuretic for fluid overload.

• Warfarin (Coumadin): Anticoagulant to prevent blood clots.

Prednisone side effects: Weight gain, hyperglycemia, osteoporosis, increased infection risk.

Pneumonia

Types and Manifestations

• Community-acquired pneumonia (CAP): Acquired outside healthcare settings.

• Hospital-acquired pneumonia (HAP): Develops 48 hours or more after hospital admission.

• Manifestations: Cough, fever, chills, dyspnea, chest pain, sputum production.

Diagnosis and Management

• Diagnosis: Chest X-ray, sputum culture, blood culture.

• Positioning: Upright or semi-Fowler’s position to facilitate breathing.

• Ineffective airway clearance: Teach coughing, deep breathing, and use of incentive spirometry.

• Nursing process and ABCs: Prioritize Airway, Breathing, Circulation.

Tuberculosis (TB)

Diagnosis and Isolation

• Bacteriological testing: Sputum smear and culture for Mycobacterium tuberculosis.

• Discontinuing isolation: When three consecutive negative sputum smears are obtained.

Drug Therapy and Compliance

• First-line drugs: Isoniazid, Rifampin, Pyrazinamide, Ethambutol.

• Side effects: Hepatotoxicity, neuropathy, orange discoloration of body fluids (rifampin).

• Importance of compliance: Prevents drug resistance and treatment failure.

Personal Protective Equipment

• HEPA mask: Provides higher filtration efficiency than standard surgical masks; required for healthcare workers caring for TB patients.

Chronic Obstructive Pulmonary Disease (COPD)

Diagnosis and Management

• Diagnosis: Spirometry (reduced FEV1/FVC ratio), clinical history.

• Nutrition: High-calorie, high-protein diet to prevent weight loss.

• Oxygen therapy: Titrate to maintain SpO2 88–92% (avoid suppressing respiratory drive).

• Bronchodilator use: Administer before chest physiotherapy to open airways.

• Increasing activity tolerance: Gradual exercise, energy conservation techniques.

• Discharge teaching: Smoking cessation, medication adherence, recognizing exacerbation signs.

• Home oxygen therapy: Improves quality of life and survival in severe COPD.

• Positioning: Tripod position or sitting upright to ease breathing.

• Pursed lip breathing: Inhale through nose, exhale slowly through pursed lips to improve oxygenation.

• Chronic bronchitis manifestation: Chronic productive cough, cyanosis, wheezing.

Asthma

Diagnosis and Management

• Diagnosis: History, physical exam, spirometry (reversible airway obstruction).

• Nursing management: Monitor respiratory status, administer bronchodilators and corticosteroids, educate on trigger avoidance.

• Medications: Short-acting beta2-agonists (albuterol) for acute relief; inhaled corticosteroids and long-acting beta2-agonists for control.

• Discharge teaching: Inhaler technique, action plan for exacerbations, medication adherence.

Vascular Disorders

Peripheral Arterial Disease (PAD)

• Definition: Narrowing of peripheral arteries, usually in the legs, due to atherosclerosis.

• Diagnosis: Ankle-brachial index (ABI), Doppler ultrasound.

• Nursing management: Promote circulation, foot care, encourage walking to point of pain.

• Medications: Antiplatelets, statins, vasodilators.

• Teaching: Smoking cessation, foot inspection, exercise.

Deep Vein Thrombosis (DVT)

• Definition: Formation of a blood clot in a deep vein, usually in the legs.

• Nursing management: Monitor for signs of pulmonary embolism, encourage mobility, use compression devices.

• Medications: Anticoagulants (warfarin, heparin).

• Discharge teaching: Medication adherence, signs of bleeding, avoid prolonged immobility.

Buerger’s Disease

• Definition: Inflammatory disease of small and medium arteries and veins, strongly associated with tobacco use.

• Nursing management: Smoking cessation, pain management, protect extremities from injury.

• Medications: Vasodilators, antiplatelet agents.

• Discharge teaching: Importance of quitting smoking, foot care.

Raynaud’s Phenomenon

• Definition: Vasospastic disorder causing color changes (white, blue, red) in fingers and toes in response to cold or stress.

• Nursing management: Keep extremities warm, avoid triggers.

• Medications: Calcium channel blockers (e.g., diltiazem).

• Discharge teaching: Avoid cold exposure, stress management.

Table: Comparison of Vascular Disorders

Additional info: Academic context and definitions have been expanded for clarity and completeness. Medication details and disease management strategies are included for comprehensive exam preparation.