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HYPERTENSION
Alfrina Hany
Topics
Definition
Etiology
Classification
Clinical Manifestation
Diagnostic Tests
Complication
Hypertension
Hyper excessive / high
Tension Pressure
Hypertension High blood pressure
Williams & Hopper, 2007
The most common primary diagnosis in the United States, 50 million American
affected.
Only 70% are aware they have HTN, only 50% are being treated.
Only 25% of all hypertensive patients have their BP under control
Cardiovascular risk increases two-fold for each 20mm/Hg rise in systolic pressure or
each 10mm/Hg rise in diastolic pressure
Indonesia best 3, 7% mortality
11/04/2013
Hypertension Defined
Hipertensi
keadaan bertahan dari kenaikan TD arterial
Hypertension (HTN)
is defined as
sustained abnormal
elevation of the
arterial blood
pressure (Brashers,
2006, p.1).
Cardiac output
Factors Controlling BP
4.9 L/min
70 mls
70 bpm
Etiology
tidak dapat dihindari (heriditer, etnik, jenis kelamin, usia)
dapat dihindari (gaya hidup, diet, alkohol, obesitas)
Systolic
Diastolic
Normal
<120
and
<80
Pre-hypertension
120-139
or
85-89
Stage 1
hypertension
140-159
or
90-99
Stage 2
hypertension
>160
or
>100
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140159 /9099
160179 /100109
180 /110
Secondary Hypertension
Secondary-Resulting from a
specific
cause such as renal
or endocrine
disorders;
Medications
5% of cases
Manifestasi Klinis
Silent killer symptoms free mild hypertension
Kelelahan, konfusi, nausea, vomit, ansietas, keringat
berlebihan, tremor, nyeri dada, epiktaksis,
pandangan kabur, nokturia, azotemia severe
hypertension
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Diagnostic Tests
Diagnostic Tests
Laboratorium:
Penunjang Lain:
Web of Causation
Genetik,
gerontologi,
obesitas
DM
Pelepasan renin
Merokok
Asetil kolin ke PD
Nikotin
PD Otak
Beban jtg
Angiotensin I
Hipertropi ventrikel
Mediator nyeri
Angiotensin II
Perubahan
struktur & Fgs PD
Norepineprin
Elastisitas PD
epineprin
Katekolamin
CO
Penurunan CO
Iskemi
Kelelahan
Aldosteron
Retensi Na & K
Pompa jantung
Vasokonstriksi PD
Tekanan sistemik
HypertensionComplication
Over long time, high bp damages arterial walls
Sclerosis, decreased lumen
Wall may dilate, tear
Aneurysm
Nyeri kepala
Nyeri akut/kronis
Filtrasi ginjal
Kelebihan Vol.Cairan
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The Heart
High Blood Pressure is a major risk factor for
heart attack.
Is the number one risk factor for Congestive
Heart Failure.
The Kidneys
Kidneys act as filters to rid the body of wastes.
High blood pressure can narrow and thicken the
blood vessels.
Waste builds up in the blood, can result in kidney
damage.
Angiotensin I
ACE
vasoconstriction
Angiotensin II
Inc. PVR
The Eyes
Can eventually cause blood vessels to break
and bleed in the eye.
Can result in blurred vision or even blindness.
The Arteries
Causes arteries to harden.
This in turn causes the kidneys and heart to work
harder.
Contributes to a number of problems.
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Be Physically Active
Helps lower blood pressure and lose/
maintain weight.
30 minutes of moderate level activity on
most days of week. Can even break it
up into 10 minute sessions.
Use stairs instead of elevator, get off
bus 2 stops early, Park your car at the
far end of the lot and walk!
11/04/2013
Quit Smoking
Injures blood vessel walls
Speeds up process of hardening of the
arteries.
Current or quit within past 6 months
Stimulate E & NE => raise HR +
pheriperal vasoconstriction
Farmakologi
Vasodilator
Mengembangkan PD
arteri, kurangi
tahanan perifer
Diazoxide, Minoxidil,
Prozasin
Farmakologi
ACE Inhibitor
Diuretik
Hambat renin,
Turunkan volume
angiotensin,
plasma, retensi
vasodilatasi, turunkan
perifer
vol.darah
Furosemid, Thiazide
Captopril, Elanapril,
Ramipril
=ASKEP=Pengkajian
Tn.K, Usia 55 thn
Sangat pusing sekali
Usaha harus tutup
3 bulan ini pusing,
jarang OR, sering
makan malam hari
TB 170cm, BB 93kg
(BBI 63 kg, BMI 39,8)
Pengusaha rumahmakan
Nadi 60x/mnt regular
TD190/110mmHg,T36,7
Tangan dan kaki pucat
terut.saat elevasi, kulit
dingin dan lembab
CRT ekstremitas 3 dtk
Kolesterol total 245
Kalsium Antagonis
Hambat masukan ion
kalsium ke dalam sel
dan turunkan
afterload
Diltiazem, Nifedipin
Farmakologi
Beta Bloker
Kurangi impuls ke
jantung dan PD
Nervous system
inhibitors
slow nerve impulses
to the heart.
Askep=Analisa Data
Usia 55 tahun
Pengusaha RM
Sering makan di
malam hari
TB 170cm, BB 93 kg
BBI 63 kg, BMI
Total serum kolesterol
245 mg/dL.
Ketidakseimbangan
Nutrisi lebih dari
kebutuhan tubuh
intake makanan
berlebihan akibat
kebutuhan metabolik
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Askep=Analisa Data
Sering makan di
malam hari
Jarang berolahraga
Sebelumnya merasa
penyakit belum parah
sehingga tidak perlu
periksa
Inefective health
maintenance koping
individu yang tidak
efektif dengan gaya
hidup yang tidak sehat
Askep=Analisa Data
Sangat sibuk dengan Kurang Pengetahuan
usahanya
kurangnya paparan
informasi
Kadang pusing 3
bulan ini tapi tidak
pernah periksa
Klien suka makanan
berlemak dan merasa
hal tersebut biasa
dalam keluarganya
Ketidakefektifan perfusi
jaringan perifer
hipertensi
Kurang pengetahuan
kurang informasi tentang
pengobatan
Risiko penurunan perfusi
jaringan jantung
Ketidaknyamanan
proses penyakit (HT)
Askep=Analisa Data
Mengatakan sakit kepala
Nadi 60x/mnt regular, TD
(duduk): 190/110 mmHg
Tangan dan kaki pucat
terutama saat elevasi,
CRT ekstremitas 3 detik
Kulit teraba dingin dan
lembab
Ketidakefektifan perfusi
jaringan perifer
proses penyakit
(hipertensi)
Askep=Analisa Data
Kepala sangat pusing
sekali
Ketidaknyamanan
proses penyakit
Diagnosa 1 Nutrisi
Dalam 4 minggu,
kelebihan nutrisi klien
dapat mencapai
indikator 3 pada
NOC : nutritional
status
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Diagnosa 1 intervensi
Domain: Nutrition
1.1 Identifikasi pilihan
support
makan klien
Nutrition management 1.2 anjurkan intake
kalori yang sesuai
2.1 yakinkan perlunya
diet DASH
2.2 kolaborasi diet
DASH diet HT
sesuai klien
Conclusion
Cardiovascular disease is the number one killer.
Hypertension is a very controllable disease, with
drastic consequences if left uncontrolled.
It is highly preventable and controllable with diet
and exercise.
Good resource: www.americanheart.org ;
www.nhlbi.nih.gov
Thanks
Good Luck and see you around