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Hypertension: Risks (Nursing)

by Rhonda Lawes

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    00:00 Now here's the part where you're like, "Yeah, yeah, yeah. I know about these things." But I want you to understand these are three factors that you can't do anything about: Age.

    00:11 As you age until about age 64, hypertension is more common in men, but women are more likely to develop hypertension after 65.

    00:21 So keep that in mind.

    00:23 Generally, as a patient ages, we expect their blood pressure to go up a little bit.

    00:27 That's why we have to be on guard for monitoring it, and dealing with the risk factors we can modify.

    00:34 Now, race is the second non-modifiable.

    00:37 Means like it's the card you're dealt.

    00:39 You don't change that.

    00:40 Patients with African heritage often develop at an earlier age.

    00:44 So they're going to get hypertension development at an earlier age.

    00:48 Now, serious complications such as stroke, and heart attack, and kidney failure are also more common in patients of African heritage.

    00:56 So that means as a patient, I know if I have these non-modifiable risk factors, I've really need to be taking significant steps to monitor my health and take control of my diet and lifestyle.

    01:11 Now, if you have a family history doesn't matter what your race or age is, you also had an increased risk to develop high blood pressure, because high blood pressure tends to run in families.

    01:22 All right, before we move on, I want you to have solid in your mind, what are three non-modifiable risk factors? Age, race, and family history.

    01:32 Why are we spending so much time on this? Because excellent nurses know the risk factors for their patients.

    01:38 And students who are taking exams also need to recognize who's most at risk to develop hypertension.

    01:45 because that's a very common exam format question.

    01:49 You'll see four patients with different factors and they'll ask you, rank them in order from most to least at risk for diabetes, hypertension, whatever.

    01:58 So it behooves you to invest some time in recognizing and remembering these risk factors.

    02:05 Now let's get personal.

    02:06 Let's talk about the things that you can modify.

    02:10 Now being overweight or obese is a risk factor for hypertension.

    02:14 You knew that before you started nursing school.

    02:17 But I want you to be able to explain it to the patient in a non-judgmental way.

    02:22 People who are overweight, know they're overweight.

    02:25 You're not telling them something they don't know.

    02:28 But sit down and have a rational conversation about these modifiable risk factors without appearing judgmental.

    02:37 help them to understand, the reason being overweight is a challenge for your body in developing hypertension is: the more you weigh, the more blood you need to supply oxygen and nutrients to your tissues.

    02:49 So as that volume of blood increases and it's circulating through your blood vessels, the pressure on your artery walls also increases.

    02:57 That's why overweight kind of goes along with hypertension.

    03:01 So we can help the patient make healthier choices and move toward a healthier weight, they'll have less blood volume, and they'll see a usually a pretty significant drop in their blood pressure.

    03:13 I also understand that very thin people who are super active can also be hypertensive.

    03:17 But this is a pretty common occurrence that someone's carrying some extra weight.

    03:21 This is why their blood pressure tends to be a little higher.

    03:25 Now along with that is not being physically active.

    03:28 Here's the reason: Can everybody knows being overweight and not exercising are not healthy habits.

    03:35 But talk to your patients for a way that will make sense to them.

    03:39 When you're not active, when you're inactive, your heart rate is relatively higher.

    03:44 that just goes with it.

    03:45 Most people will get that straight up.

    03:47 We explain, when you exercise you're going to be able to lower your heart rate.

    03:51 Here's why this will benefit you.

    03:53 Because the higher your heart rate, the harder your heart has to work with each contraction and the stronger the force it needs to pump that through the rest of your body.

    04:03 and that means there's more force on your arteries.

    04:06 So lack of physical activity also increases your risk of being overweight.

    04:11 So these two are people's least two favorites to talk about.

    04:15 But if you can come at it from a little bit different angle, you can help them understand how just small changes and small steps toward improvement in their health will make a big overall difference.

    04:27 Now, the third one.

    04:28 People can get pretty self-righteous if they don't smoke, right? Like I know I'm overweight, but I don't smoke.

    04:34 It doesn't matter.

    04:36 All of us have something that's harder for us to say no to.

    04:41 But smoking and chewing tobacco does some things to your cardiovascular system, they're a little unique.

    04:46 Because smoking or chewing tobacco immediately raise your blood pressure temporarily.

    04:51 But it's the chemicals in the tobacco that can damage the lining of your artery walls.

    04:56 Yeah, yeah, I'm not talking about your lungs.

    04:58 You know that that's hard on your lungs.

    05:00 But there's chemicals in tobacco that actually damage the lining of your arteries.

    05:05 Well, that puts you at risk for atherosclerosis.

    05:09 So you have damaged, in fact, that's how atherosclerosis starts.

    05:12 There's a damage to the artery, then the body responds with these fatty issues, and then they have the inflammatory markers that gets trapped in the wall, and hangs out there long enough that the wall gets bigger.

    05:24 You've got really thick, fibrous plaque.

    05:28 Now, this leads to arteries that are narrow and increases your risk of heart disease.

    05:34 So, dealing with people who are using tobacco, you have to approach them with respect.

    05:40 Same way you're dealing with an obese patient, talking about their food.

    05:43 Same thing with tobacco, it's a tough habit to quit.

    05:47 You don't have to convince them.

    05:49 I've never usually met a smoker who hasn't thought about quitting.

    05:54 Most people do want to quit. It's just really tough.

    05:58 So this is one way you can help them understand why it might be worth them taking that step.

    06:04 I cannot emphasize enough and we're going to talk about motivational interviewing.

    06:08 But how you approach these conversations is really, really important.

    06:13 None of us are perfect.

    06:14 None of us do everything right.

    06:16 So this is just one other behavior, not worse or better than any other habit.

    06:22 There's too much salt in your diet.

    06:24 Wow, man, we're really meddling here, right.

    06:26 The more salt you have in your diet, the more water you hang on to because wherever salt goes, water follows.

    06:32 So when that happens, you have volume on board, it's hard on your body, your blood pressure is up, your hearts got to work harder, all those things.

    06:40 But it's not just salt that we watch.

    06:42 Too little potassium in your diet can be a problem.

    06:45 Now before we go on, there's a relationship between salt and potassium.

    06:50 The more salt I have on board, the less potassium I'll have.

    06:54 Because as you hang on to salt you get rid of potassium.

    06:57 And you need potassium it helps you keep balance.

    07:00 so the sodium in your cells.

    07:02 So if you don't get enough potassium in your diet or retain enough potassium, you may accumulate extra sodium even more.

    07:09 So it's really important that you get the healthy amount of potassium in your diet.

    07:16 Now we've talked about overweight, smoking, exercise.

    07:20 Now we're going to hit the last one in alcohol.

    07:23 This really feels like meddling in people's lives.

    07:26 But over time, heavy drinking can damage your heart.

    07:29 It's not just your liver that takes a hit, but your heart can also have a problem.

    07:34 So having more than one drink a day for women and more than two drinks a day for men may affect their blood pressure.

    07:40 So what you can recommend to your patients is if you drink alcohol, if you can ask them to consider doing it in moderation.

    07:46 So for healthy adults, that means up to one drink a day for women and up to two drinks a day for men.

    07:51 One drink equals about 12 ounces of beer, or five ounces of wine, or one and a half ounces of left of 80 proof liquor.

    08:01 So those are just some guidelines.

    08:03 I know you're probably breaking out in a sweat, just thinking about having these conversations.

    08:07 But it really doesn't have to be that way.

    08:09 I'm going to teach you how to approach patients in a way.

    08:13 so you clearly communicate to them.

    08:15 You recognize how difficult it is what you're asking them to do.

    08:20 And you're going to try to give them some small steps that can help them be successful.

    08:25 Now stress.

    08:25 Everyone kind of at least in America wears that like as a badge of honor, right? Oh, I'm so busy.

    08:30 I'm so important.

    08:31 I'm so stressed.

    08:32 But high levels of stress really can lead to a temporary increase in blood pressure.

    08:37 And then if the patient tries to relax by like eating more, or using tobacco, or drinking alcohol, now we're really making things problematic.

    08:45 So stress should be something that we all recognize that we can control.

    08:50 It's how we respond to situations.

    08:53 So we have more control over the stress we allow in our life, then we realize.

    09:00 Then lastly, I love when we wrap up something with these kind of certain chronic conditions.

    09:04 I know. Real helpful, right? And you're welcome.

    09:07 But we'll talk about those.

    09:09 There are certain chronic conditions that it can increase your risk of high blood pressure, like kidney disease, diabetes, and sleep apnea.

    09:18 Okay, let's pause for just a minute and I want to give you time to write those in.

    09:22 Kidney disease, diabetes, and sleep apnea.

    09:27 Now, we're listing these under modifiable risk.

    09:31 Yeah, cuz we can do things to help protect your kidneys.

    09:33 We can help you prevent type two diabetes, and sleep apnea, we can treat with a CPAP mask at night.

    09:41 So there's things we can do to try to modify those particular risk factors.


    About the Lecture

    The lecture Hypertension: Risks (Nursing) by Rhonda Lawes is from the course Hypertension (Nursing).


    Included Quiz Questions

    1. Smoking status
    2. Age
    3. Race
    4. Family history
    1. Family history
    2. Dietary sodium intake
    3. Being overweight or obese
    4. Tobacco usage
    1. Tobacco damages the arterial lining, leading to atherosclerosis.
    2. Smoking immediately lowers blood pressure, but cravings increase blood pressure.
    3. Smoking immediately increases blood pressure, but no long-term damage occurs.
    4. People with high blood pressure are more likely to start smoking as adults.
    1. Up to 1 drink a day for women and up to 2 drinks a day for men
    2. Up to 3 drinks a week for women and up to 1 drink a day for men
    3. No intake of drinks for men or women
    4. Up to 3 drinks a day for women and up to 4 drinks a day for men
    1. Increased body mass requires increased blood volume, leading to higher pressures.
    2. All overweight patients develop atherosclerosis.
    3. Overweight patients will develop diabetes, which lowers blood pressure.
    4. Only morbidly obese patients are at risk of hypertension, not overweight patients.

    Author of lecture Hypertension: Risks (Nursing)

     Rhonda Lawes

    Rhonda Lawes


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