kuliah hipertensi 2013

7/26/2019 Kuliah Hipertensi 2013

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HYPERTENSION

Alfrina Hany

Do You Know?

The most common primary diagnosis in the United States, 50 million Americanaffected.

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 oreach 10mm/Hg rise in diastolic pressure

Indonesiabest 3, 7% mortality

Topics

Definition

Etiology

Classification

Clinical Manifestation

Diagnostic Tests

Complication

What is Blood Pressure?

The force of blood against the wall of the

arteries.

Systolic- as the heart beats

Diastolic - as the heart relaxes

Written as systolic over diastolic in mm Hg

Williams & Hoppers, 2007

Hypertension

Hyperexcessive / highTensionPressure

HypertensionHigh blood pressure

Williams & Hopper, 2007

Why is High Blood Pressure Important?

Makes the Heart work too hard.Makes the walls of arteries hard.

Increases risk for heart disease and

stroke.

Can cause heart failure, kidney

disease, and blindness. Heart

disease and stroke are the 1stand 3rd

leading causes of death in the U.S.


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Hypertension (HTN)

is defined assustained abnormal

elevation of the

arterial blood

pressure (Brashers,

2006, p.1).

Hypertension Defined Hipertensi

keadaan bertahan dari kenaikan TD arterial

sistemik, ditandai dengan kenaikan curah

jantung /c.o dan tahanan periferal

vaskular/svrmelibatkan multifaktorial

Brunner & Suddarth, 2009

70 bpm 70 mls

4.9 L/min

Cardiac outputFactors Controlling BP

Etiology

tidak dapat dihindari (heriditer, etnik, jenis kelamin, usia)

dapat dihindari (gaya hidup, diet, alkohol, obesitas)

penyakit penyebab (DM; CKD)

Klasifikasi JNC VII (2003)

(Brashers, 2006, p.1)

Category Systol ic Diastol ic

Normal 100


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Klasifikasi berdasarkan tahapan

High Blood Pressure

Stage 1 140159 /9099

Stage 2 160179 /100109

Stage 3 180 /110

Klasifikasi berdasarkan penyebab (1)

Primary HypertensionIs usually of gradual onset

Usually develops between the ages of30 and 50

Tends to remain asymptomatic for 10to 20 years

Essential or Primary-Underlyingpathophysiologic alteration of unknowncause

95% of cases of HTN

Contributing factors for Primary HTN:

Psychological stress, high-sodium intake,and alcohol intake over 1 ounce per day

Increased activity of: sympathetic nervous system (SNS) Renin-angiotensin-aldosterone system (RAA)

Defects in natriuretic hormone function

Inflammation

Obesity

Endothelial dysfunction

Insulin resistance

Klasifikasi berdasarkan penyebab (2)

Secondary Hypertension

Secondary-Resulting from a

specific cause such as renal

or endocrine disorders;

Medications

5% of cases

Klasifikasi berdasarkan kegawatan

Hipertensi emergensi

TD diastolik>120 mmHg, kerusakan organ

target, keterlambatankematian

Hipertensi urgensi

TD Diastolik > 120 mmHg, tanpa kerusakan

organ, harus diturunkan 24 jam

Manifestasi Klinis

Silent killersymptoms freemild hypertension

Kelelahan, konfusi, nausea, vomit, ansietas, keringat

berlebihan, tremor, nyeri dada, epiktaksis,

pandangan kabur, nokturia, azotemiasevere

hypertension


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Diagnostic Tests

Laboratorium:

HBnilai viskositas dan indikator faktor risiko (anemia, hiperkoagulability)Leukosit infeksi/kegagalan sumsum tulang

BUN/Kreatininperfusi/faal ginjal

Glukosahiperglikemi

Kolesterolpredisposisi terbentuknya plak

Serum aldosteronaldosteronisme primer

Asam uratfaktor risiko

Elektrolitkalium, natrium, kalsium

Urineanalisa darah, protein, glukosa, identifikasi fungsi renal

Diagnostic Tests

Penunjang Lain:

CT Scanemboli pada otakRontgen dadaedema paru, kardiomegali

EKGkardiomegali, gangguan konduksi jantung

Phaechromecytoma kolesterol dalam darah dan urin

Echocardiogram: shows a graphic outline of the hearts movement

Web of CausationGenetik,

gerontologi,

obesitas

Perubahan

struktur & Fgs PD

Elastisitas PD

Pompa jantung

Aliran darah perifer

Nikotin

Merokok

Asetil kolin ke PD

Stress, cemas, takut

Norepineprin

Vasokonstriksi PD

Tekanan sistemik

epineprin

Katekolamin

DM

Pelepasan renin

Angiotensin I

Angiotensin II

Aldosteron

Retensi Na & K

Mediator nyeri

PD Otak

Hipertropi ventrikel

Tekanan darah sistemik

CO

Beban jtg

BUN & Cr

Iskemi

Nyeri kepala

Vol.intravaskuler

Ggn Perfusi Jar

Filtrasi ginjal Kelebihan Vol.Cairan

Penurunan CO

Kelelahan

Intoleransi

aktivitas

Nyeri akut/kronis

HypertensionComplication

Over long time, high bp damages arterial walls Sclerosis, decreased lumen

Wall may dilate, tear Aneurysm

Areas most frequently damaged: Kidneys, brain, retina

End result of poorly controlled hypertension: Chronic kidney disease

Stroke

Loss of vision

CHF

How Does It Effect the Body?

The Brain

High blood pressure is the most important riskfactor for stroke.

Can cause a break in a weakened blood vessel

which then bleeds in the brain.


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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 theblood vessels.

Waste builds up in the blood, can result in kidney

damage.

The Role of the Kidney

Renin is made by the juxtaglomerular cells of the kidney

Renin transforms plasma angiotensinogen toangiotensin I which is converted to angiotensin II by

ACE

Angiotensin II alters BP by increasing both PVR andblood volume by causing vasoconstriction and bystimulating the secretion of aldosterone which increasesthe reabsorption of sodium

The Kidney cont.

Angiotensinogen

Renin

Angiotensin I

ACE vasoconstriction

Angiotensin II Inc. PVR

aldosterone (inc. reabsorp of Na)

Inc. blood volume

The Eyes

Can eventually cause blood vessels to breakand 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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Life Style Changes

Following a healthy eating pattern.

Maintaining a healthy weight.

Being Physically Active.

Limiting Alcohol.

Quitting Smoking.

Penatalaksanaan non Farmakologi

Tips for Reducing Sodium

Buy fresh, plain frozen or canned no added salt

veggies.

Use fresh poultry, lean meat, and fish.

Use herbs, spices, and salt-free seasonings at

the table and while cooking.

Choose convenience foods low in salt.

Rinse canned foods to reduce sodium.

Maintain Healthy Weight

Blood pressure rises as weight rises.

Obesity is also a risk factor for heartdisease.

Even a 10# weight loss can reduceblood pressure.

35-55% higher risk compared tothose maintaining ideal weight

BMI > 30 kg / m2 or waist girth > 100cm (39.4 inches)

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!

Limit Alcohol Intake

Alcohol raises blood pressure and canharm liver, brain, and heart

What counts as a drink?

12 oz beer

5 oz of wine

1.5 oz of 80 proof whiskey


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Quit Smoking

Injures blood vessel walls

Speeds up process of hardening of thearteries.

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

Kalsium Antagonis

Hambat masukan ion

kalsium ke dalam sel

dan turunkan

afterload

Diltiazem, Nifedipin

Farmakologi

ACE Inhibitor

Hambat renin,

angiotensin,

vasodilatasi, turunkan

vol.darah

Captopril, Elanapril,

Ramipril

Diuretik

Turunkan volume

plasma, retensi

perifer

Furosemid, Thiazide

Farmakologi

Beta Bloker

Kurangi impuls ke

jantung dan PD

Nervous system

inhibitors

slow nerve impulses

to the heart.

=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

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.

KetidakseimbanganNutrisi 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

maintenancekopingindividu yang tidak

efektif dengan gaya

hidup yang tidak sehat

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 periferproses penyakit

(hipertensi)

Askep=Analisa Data

Sangat sibuk dengan

usahanya

Kadang pusing 3

bulan ini tapi tidak

pernah periksa

Klien suka makanan

berlemak dan merasahal tersebut biasa

dalam keluarganya

Kurang Pengetahuan

kurangnya paparan

informasi

Askep=Analisa Data

Kepala sangat pusing

sekali

Ketidaknyamanan

proses penyakit

DAFTAR DIAGNOSA KEP

KetidakseimbanganNutrisi lebih dari

kebutuhan tubuh

intake makanan

berlebihan

Inefective health

maintenance

(ketidakefektifan

pemeliharaan

kesehatan)gaya

hidup tidak sehat

Ketidakefektifan perfusijaringan perifer

hipertensi

Kurang pengetahuan

kurang informasi tentang

pengobatan

Risiko penurunan perfusi

jaringan jantung

Ketidaknyamanan

proses penyakit (HT)

Diagnosa 1 Nutrisi

Dalam 4 minggu,kelebihan nutrisi klien

dapat mencapai

indikator 3 pada

NOC : nutritional

status

Intake nutrient : diet seimbang : KH, Prot,Lemak, Mineralindikator 3

Food intake : DASH bertahap mulai diet

HT 1indikator 3

Energy : olahraga 30 menit sehari

indikator 3

Weight/height ratio : BBI dan BMI

menurun bertahapindikator 3


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Diagnosa 1 intervensi

Domain: Nutrition

support

Nutrition management

1.1 Identifikasi pilihan

makan klien

1.2 anjurkan intake

kalori yang sesuai

2.1 yakinkan perlunya

diet DASH

2.2 kolaborasi diet

DASHdiet HT

sesuai klien

Conclusion

Cardiovascular disease is the number one killer.Hypertension is a very controllable disease, withdrastic consequences if left uncontrolled.

It is highly preventable and controllable with dietand exercise.

Good resource: www.americanheart.org;www.nhlbi.nih.gov

Thanks

Good Luck and see you around
http://www.americanheart.org/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.americanheart.org/

kuliah hipertensi 2013

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