LESSON PLAN ON HYPERTENSION

SUBMITTED TO Asst.prof. Geetha.C. H.O.D. Child health nursing Smt.Nagarathnamma college of nursing Bangalore SUBMITTED BY Mrs.Radhika Ist.year M.Sc. nursing Smt.Nagarathnamma college of nursing Bangalore

Programme Course Topic Group No of students Venue Date Duration Method of teaching Av aids

: Bsc(N) : Medical Surgical Nursing : HYPERTENSION : Bsc(N) -II : 50 : Lecture hall- 5 :12/09/2009 : 1 hrs : Lecture cum discussion : black board, O.H.P, Chart. year

Name of the student teacher : Radhika.A.B.

Central objectives: At the end of the class the students will be able to gain in-depth knowledge on hypertension & develop desirable skill & attitude while taking care of hypertensive patients. Contributory objectives: At the end of the class the students will be define hypertension discuss the incidence of blood pressure regulation list down the types of hypertension enumerate the risk factors of hypertension describe the pathophysiology of hypertension explain the clinical manifestation of hypertension Identify the diagnostic investigation of hypertension appreciate the effect of hypertension elaborate the collaborative management of hypertension

SL TIME NO

SPECIFIC OBJECTIVE

CONTENTS

TEACHERS ACTIVITY

LEARNERS ACTIVITY

AV AIDS

EVALUATION

2min

INTRODUCTION The hypertension is probably the most the topic important public health problem in developed countries. It is common, asymptomatic readily hypertension detectable, usually easily treatable and often to the students. leads to lethal complications if left untreated. As a result of extensive educational programs in the late 1960s and 1970s by both private and government agencies, the number of undiagnosed or untreated patients was reduced significantly by the late 1980s to a level of 25% with a concomitant decline in cardio vascular mortality. - introduce DEFENITION OF HYPERTENSION Hypertension is a systolic blood pressure greater than 140mm hg and a diastolic pressure greater than 90mm hg over a sustained period, based on the average of two or more blood pressure measurements taken in two or more contacts. (Joint national committee 1997) INCIDENCE It is estimated that nearly one billion

Writes the topic on the black board. & Introduces the topic by narration.

Listens

Black board What is

hypertension?

3min

Define the term Hypertension, and its incidence.

Defines the term hypertension and explained about its incidence.

Listening & Notes taking

OHP

Define hypertension, And its incidence?

people are affected by hypertension worldwide, and this figure is predicted to increase to 1.5 billion by 2025
5min

CLASSIFICATION A. Based on pressure detail about the Stage-I(mild) Stage-II(moderate) classification of Stage-III(severe) hypertension Stage- IV(Very severe) explain in B.Based on etiology Primary hypertension Secondary hypertension ETIOLOGY A.Primary hypertension causes Family history Aging High salt intake Obesity Occupation oral Contraceptives Excessive alcohol consumption B. Secondary hypertension causes Renal artery stenosis Renal parenchymal diseases Pheochromacytoma Cushing syndrome Brain tumor

Described the classification of hypertension,

Listening and taking notes.

Blackboard.

What are the classifications of hypertension?

5min

-To explain in detail Regarding the Cause and risk factor of hypertension.

Explains the cause and risk factors of hypertension.

Listens and discusses

OHP

Explains the etiology of hypertension?

Head injury

PATHOPHYSIOLOGY
5min

-To describe in detail about pathophysiolo gy of hypertension.

Three theories have been proposed to explain this:

Explains the pathophysiology

Listens and takes notes.

Chart

Inability of the kidneys to excrete sodium, of hypertension. resulting in natriuretic factors such as Atrial Natriuretic Factor being secreted to promote salt excretion with the side effect of raising total peripheral resistance. An overactive Renin-angiotensin system leads to vasoconstriction and retention of sodium and water. The increase in blood volume leads to hypertension. An overactive sympathetic nervous system, leading to increased stress responses.

Explain in detail about the pathophysiology of hypertension?

3min

-To explain in detail about signs and symptoms of

hypertension.

CLINICAL MANIFESTATION Symptoms of hypertension where through to include: - headache - epistaxis - dizziness - vertigo - tinnitus - diminished vision or syncope.

Explain in detail About clinical manifestations of hypertension.

Listens and discusses

Black board What are the

clinical manifestations of hypertension?

- nausea and vomiting - palpitation - convulsion However unless blood pressure is very high or low this symptoms are not more frequent in people with hypertension than in general population. DIAGNOSTIC INVESTIGATION History Ambulatory blood pressure monitor Blood analysis Urine analysis ECG & Echo MANAGEMENT OF HYPERTENSION Prevention The process of managing hypertension according the guidelines of the British Hypertension Society suggest that nonpharmacological options should be explored in all patients who are hypertensive or prehypertensive. These measures include;

2min

enumerate In detail about Diagnosis of

hypertension.

Explains the diagnostic procedures.

Listens and Notes taking.

chart

What are the diagnostic procedures for

hypertension?

10min

discuss in detail about the management and treatment modalities of

hypertension.

Explains the management of hypertension.

Listens and discuss.

black board

Explain about the management of

hypertensive patient.

Weight reduction and regular aerobic exercise (e.g., walking) are recommended as the first steps in treating mild to moderate hypertension. Reducing dietary sugar intake.

Reducing sodium (salt) in the diet may be effective: It decreases blood pressure in about 33% of people. Additional dietary changes beneficial to reducing blood pressure include the DASH diet (dietary approaches to stop hypertension) which is rich in fruits and vegetables and low-fat or fat-free dairy foods. This diet has been shown to be effective based on research sponsored by the National Heart, Lung, and Blood Institute. Discontinuing tobacco use and alcohol consumption has been shown to lower blood pressure. 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

Pharmacological Therapy Commonly used drugs include the typical groups of:

ACE inhibitors such as captopril, enalapril, fosinopril (Monopril), Angiotensin II receptor antagonists may be used where ACE inhibitors are not tolerated: eg, irbesartan (Avapro),

losartan (Cozaar), Calcium channel blockers such as nifedipine amlodipine (Norvasc), diltiazem, verapamil Diuretics: eg, bendroflumethiazide, chlorthalidone, hydrochlorothiazide

5min

NURSING MANAGEMENT OF Assessment nursing Focused assessment of the client with hypertension includes: management of - Health history: patient with - Physical examination - Diagnostic tests hypertension Discuss the Nursing Diagnosis Impaired tissue perfusion related to increased peripheral vascular resistance secondary to hypertension. Ineffective health maintenance related to lack of knowledge of pathology, complications& management of hypertension. Fatigue related to decreased cardiac output & inadequate tissue perfusion Anxiety related to complexity of management regimen & lifestyle changes

Discuss about nursing management of

Listens and discuss.

Black board.

Hypertension.

Explain in detail about the nursing management of patient with hypertension.

5min

SUMMARY The hypertension is probably the most

important public health problem in developed countries. It is common, asymptomatic readily detectable, usually easily treatable and often leads to lethal complications if left untreated. Hypertension is a systolic blood pressure greater than 140mm hg and a diastolic pressure greater than 90mm hg over a sustained period, based on the average of two or more blood pressure measurements taken in two or more contacts. It is estimated that nearly one billion people are affected by hypertension worldwide, and this figure is predicted to increase to 1.5 billion by 2025.
5min

CONCLUSION At the end of the class the student have gain knowledge about hypertension and its types, risk factors,clinical manifestations, diagnosis, and its management.

5min

EVALUATION Short answer question 5 x 3 = 15. 1) Hypertension. 2) Management of patient with Hypertension. 3) Treatment and nursing management of Hypertension.

5min

ASSIGNMENT Write an assignment on DASH diet BIBLIOGRAPHY 1. Students bibliography Brunner and suddarths, TEXT BOOK OF MEDICAL SURGICAL NURSING, 10TH edition, Lippincott Williams and Wilkins. Lippincott, MANNUAL OF NURSING PRACTICE, 8th edition, Lippincott Williams and Willkins.

2. Teachers bibliography Brunner and suddarths, TEXT BOOK OF MEDICAL SURGICAL NURSING, 10TH edition, Lippincott Williams and Wilkins. Lippincott, MANNUAL OF NURSING PRACTICE, 8th edition, Lippincott Williams and Willkins. Long & Phipps -Medical Surgical Nursing Luckman &Sorenson -Medical Surgical Nursing