Nursing can be a lot to take into sometimes. You have to study hundreds of diseases and pick out the most appropriate nursing actions to address them. But how do you do that when you have so much to learn? For cases such as hypertension, for example. Here’s a mnemonic trick that would help you remember the interventions needed and things to consider for hypertension.
When hypertensive, remember: DIURETIC
D -daily weight
If the patient is hypertensive or even suspected to be, then his/her weight must be monitored. He/she must be weighed daily. Indicators for risk of hypertension include obesity, abdominal obesity and weight gain.Weight gain was associated with increased risk of developing hypertension.On the other hand, weight-loss can lead to a significant drop in blood pressure.
I-Intake and Output
Intake and output of the patient must also be kept closely monitored. Sodium balance is precisely regulated by intake and output.High salt intake increases extracellular volume (ECV), blood volume, and cardiac output resulting in elevation of blood pressure. Normal blood pressure are attained by increased glomerular filtration and decreased sodium reabsorption. In some individuals, the kidneys have difficulty in excreting sodium, so the equilibrium is achieved at the expense of elevated blood pressure. At times, the sodium balance must be achieved via dialysis and ultrafiltration.
U-Urine Output
When BP is low, renal blood flow drops. This stimulates renin and angiotensin production by the kidney. Angiotensin is converted to angiotensin II in the lung. This is controlled by angiotensin-converting enzyme. Angiotensin II is a vasoconstrictor – which will increase SVR. Angiotensin II also stimulates the adrenal cortex to produce aldosterone. Aldosterone causes sodium and water to be retained by the kidney. This will increase the extra cellular fluid (ECF) volume and therefore the circulating blood volume. This is also supported by antidiuretic hormone (vasopressin) which is produced by the hypothalamus and released by the posterior pituitary in response to angiotensin II. Angiotensin II also stimulates thirst, leading to increased fluid intake.
R-Response of B/P
A person’s blood pressure is not fixed as it rises and falls throughout the day in response to what that person is doing and what is happening around him/her. It’s important that the BP be monitored so as to know whether it is responding appropriately to your interventions, or to modify the treatment regimen.
E-Electrolytes
Dietary choices, even the amount of electrolytes you consume, can influence the blood pressure. These electrolytes such as sodium and potassium play a major role in regulating a person’s blood pressure.One of the functions of electrolytes is the balance of fluid in and around your cells. Electrolytes partially break down in water to form an ion. When this occurs, they influence where the fluids inside your body go. Sodium boosts water retention, leading to excess fluid in blood vessels and higher blood pressure.
TI-Transient Ischemic Episodes (TIA)
A transient ischemic attack (TIA) occurs when blood flow to a part of the brain stops for a brief time.High blood pressure is the main risk for TIAs and stroke.
C-Complications: 4 Cs (CAD, CRF, CHF, CVA)
You also have to remember that if left untreated, hypertension can cause certain complications. Over time this extra pressure can increase your risk of a heart attack, stroke and kidney disease.High blood pressure can cause many different diseases of the heart and blood vessels (medically known as cardiovascular diseases) and can also damage the small blood vessels in your kidneys and stop them from working properly.
Sources:
- http://www.obesityaction.org/educational-resources/resource-articles-2/obesity-related-diseases/hypertension-and-obesity-how-weight-loss-affects-hypertension
- http://www.patient.co.uk/education/hypertension
- http://www.ncbi.nlm.nih.gov/pubmed/19090863
- http://www.livestrong.com/article/434371-do-electrolytes-cause-high-blood-pressure/
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