Nursing diagnosis for hypertension. Current and potential problems with changes in blood pressure (hypertension). Principles of treatment. Care. Course of hypertension

State budgetary educational institution

secondary vocational education

"Krasnodar Regional Basic Medical College"

Ministry of Health of the Krasnodar Territory

Cyclic commission "Nursing"

Coursework for the professional module

“Participation in diagnostic, treatment and rehabilitation processes”

Topic: “Features of nursing care for hypertension in a hospital setting”

Introduction

1 Etiology of the disease

2 Pathogenesis

3 Symptoms

4 Clinical forms

5 Classification

6 Complications

7 Prevention

Chapter 2. Practical part

3 Practical part

Conclusion

List of sources

Introduction

Hypertension is very common these days, especially in industrialized countries. Our country is no exception; in Russia it is also the most common disease that doctors and hospital nurses encounter in their daily work.

High blood pressure often occurs already in adolescence; the disease rapidly grows younger, like most diseases of the cardiovascular system. Already, according to Rosstat, up to 38% of young people suffer from hypertension to one degree or another. As for older people, the statistics in this area are not at all reassuring; up to 75% of pensioners suffer from hypertension.

Hypertension is becoming the main cause of premature mortality in the population. This disease is characterized by a long and persistent course, the development of severe complications (myocardial infarction, cerebral stroke, heart and kidney failure), and is accompanied by a decrease in working capacity, including disability.

The insidiousness of the disease is that it can occur unnoticed by the patient himself. A person experiences headaches, irritability, dizziness, memory deteriorates, and performance decreases. Having rested, he temporarily ceases to feel these symptoms and, mistaking them for manifestations of ordinary fatigue, does not see a doctor for years. Over time, hypertension progresses. Headaches and dizziness, mood swings, and excessive irritability become constant. Significant deterioration in memory and intelligence, weakness in the limbs and a sharp deterioration in vision are possible.

Considering the danger of hypertension for modern people, I consider it important to consider this disease as part of my work.

The object of study of this work is the features of nursing activities for hypertension in a hospital setting.

The subject of the study is the problems of patients of different age groups with hypertension, assistance in their elimination and prevention. As well as the possibility of inheriting problems of the disease.

Objectives: Like any chronic disease, hypertension can be corrected only with constant and competent therapy. Therefore, I believe the main goal of this work is:

.Study of the main activities of a nurse in the treatment of hypertension in a hospital setting.

.To study the problems of a patient with hypertension.

.Identify problems of patients of different ages by studying symptoms.

.Note the main stages of the nursing process for hypertension.

3.Study modern medical data on hypertension.

The methods used in writing this work are, first of all, the analysis of medical information on the disease, as well as conducting a nursing examination and observation of two patients with hypertension, in this case a father and son.

Chapter 1. Characteristics of hypertension

Hypertension (hypertension) is a chronic disease characterized by constant, and in the initial stages, periodic increases in blood pressure. Hypertension is based on increased tension in the walls of all small arteries, resulting in a decrease in their lumen, making it difficult for blood to move through the vessels. At the same time, blood pressure on the walls of blood vessels increases.

Hypertension is divided into two large groups - essential (primary) and symptomatic (secondary) hypertension. Essential hypertension is a disease at the level of the whole organism. With secondary hypertension, there is damage to one or another organ, which leads to an increase in blood pressure. Secondary hypertension is divided into renal (glomerulonephritis, pyelonephritis, renovascular hypertension, etc.), endocrine (pheochromocytoma, paraganglioma, Cohn syndrome, Itsenko-Cushing syndrome), vascular (coarthation of the aorta), hypertension with damage to the central nervous system.

1 Etiology of the disease

The etiology of this disease has not yet been fully studied.

There are provoking and contributing factors for hypertension:

) Stress (as a result of stress, a huge amount of adrenaline is released into the blood, which leads to an increase in blood pressure);

) Age-related restructuring of endocrine organs;

) Taking certain medications (oral contraceptives with high hormone content, medications to reduce appetite, certain anti-inflammatory drugs);

) Smoking, drinking strong coffee, systematically drinking alcohol;

) Consuming excess salt (as a result of which sodium accumulates in the body, which brings with it excess water through the lining of the artery wall cells);

) Alimentary obesity and a sedentary lifestyle (as a result of which there is constant compression of blood vessels and obstruction of blood flow);

) Heredity is the most important factor. The following factors for the development of arterial hypertension are inherited:

a) Membrane pathology (membranes have excessive permeability of Ca and Na ions into the cell)

b) Morphologically more active development of the density of sympathoergic cells. As a consequence, there is a tendency to reduplicate smooth muscle cells responsible for vascular contraction.

c) Increased activity of nerve regulation centers.

d) Weakening of the regulatory function of the kidneys.

1.2 Pathogenesis

Development of hypertension according to G.F. Langu (according to the textbook “Internal Diseases” edited by A.S. Smetnev) is explained by three main provisions:

) hypertension occurs as a neurosis of the higher centers of neurohumoral regulation of blood pressure;

) developing neurosis is a manifestation of stagnation of irritable processes in the corresponding nerve centers of the hypothalamic region or the cerebral cortex;

) stagnation of irritable processes in these centers develops under the influence of negative emotions and effects. In the initial stages of the disease, an increase in the activity of the sympathoadrenal system contributes to an increase in cardiac output, which in itself causes hypertension, promotes an increase in the secretion of neurohormones of the renin-hypertensin-aldosterone link, and therefore there is a tendency to increase vascular tone. There is significant activation of the sympathetic innervation of the kidneys, leading to a decrease in renal blood flow and a moderate decrease in sodium and water excretion. In later stages, renal pressor mechanisms become more important. Increased secretion of renin leads to the formation of significant amounts of angiotensin, which stimulates the production of aldosterone. In the pathogenesis of hypertension, there is a parallel increase in the tone of the sympathoadrenal system, a change in the morphological structure of blood vessels and insufficiency of the depressor mechanisms of the prostaglandin, kinin, and baroreceptor systems.

Three parts of the pathogenesis of hypertension can be distinguished:

) central - a violation of the relationship between the processes of excitation and inhibition of the central nervous system;

)humoral - production of pressor substances and reduction of depressor effects;

) vasomotor - tonic contraction of arteries with a tendency to spasm and organ ischemia.

3 Symptoms

Symptoms of hypertension: increased blood pressure, which is clinically manifested by headache, tinnitus, flashing “spots” before the eyes, pain in the heart area, palpitations. When blood pressure increases, changes occur in various organs. The organs most susceptible to the effects of high blood pressure are called target organs. These are the brain, heart, blood vessels, retina, kidneys.

Headaches occur in the occipital region, more often in the morning, as well as in the parietal and temporal regions. The pain intensifies with mental and physical stress. Very severe pain occurs during hypertensive crises - a sudden and pronounced increase in blood pressure to critical values. At the same time, the patient is very worried about dizziness and disturbances in vision, and sometimes speech. Pain in the heart area with hypertension can be different - compressive, behind the sternum, such as angina, long-term aching, but also short-term, usually stabbing. Long-term hypertension makes it difficult for the heart to work; as a result, it contracts more often, the pulse quickens, the size of the heart increases, and dystrophic changes in the myocardium are observed.

1.4 Clinical forms

Hypertension is chronic, with periods of deterioration and improvement. Progression may vary in pace. A distinction is made between slowly and rapidly progressing disease. With the slow development of the disease, hypertension goes through 3 stages (according to the classification adopted by WHO). The stage of hypertension is characterized by relatively small increases in blood pressure in the range of 160-179/95-105 mm Hg. Art. The level of blood pressure is unstable; during the patient’s rest it gradually normalizes, but an increase in blood pressure inevitably occurs again. Some patients do not experience any changes in their health status. Scanty and unstable symptoms occur easily and pass quickly. Subjective symptoms of stage I are mainly reduced to functional disorders of the nervous system: mental performance decreases, irritability, headaches, and sleep disturbances appear. Sometimes there are no subjective symptoms at all. Increased blood pressure is usually detected incidentally. It is unstable and can periodically increase under the influence of emotional overload. Usually there are no signs of left ventricular hypertrophy, the electrocardiogram is not changed; hemodynamics are quite effective. Renal functions are not impaired, the fundus of the eye is practically unchanged. The stage of hypertension is characterized by a pronounced clinical picture. Patients with moderate severity make up the bulk of outpatients and, to a lesser extent, inpatients. They are often bothered by headaches, dizziness, sometimes angina attacks, shortness of breath during physical effort, decreased performance, and sleep disturbances. Their blood pressure is constantly elevated: systolic is 180-199 mm Hg. Art., diastolic - 104-114. Moreover, in some cases, hypertension is labile, that is, blood pressure periodically decreases spontaneously, but not to normal, while in others it remains stably at a high level and decreases only under the influence of drug treatment. Hypertensive crises are typical for this stage of the disease. Signs of target organ damage are revealed: left ventricular hypertrophy, weakening of the first sound at the apex of the heart, emphasis of the second tone on the aorta, in some patients the electrocardiogram shows signs of subendocardial ischemia. Cardiac output is either normal or slightly reduced in most; with physical activity it increases to a lesser extent than in healthy people. Indicators of vascular peripheral resistance are noticeably increased, and the speed of propagation of the pulse wave through the arteries clearly increases. However, in uncomplicated cases, manifestations of myocardial failure are rarely observed. The picture of the disease can change dramatically with deterioration of coronary circulation, the occurrence of myocardial infarction, and atrial fibrillation. On the part of the central nervous system in stage II of the disease, various manifestations of vascular insufficiency and transient ischemia are noted, often without consequences. More serious cerebrovascular accidents are the result of atherosclerosis. In the fundus, in addition to narrowing of arterioles, compression and expansion of veins, hemorrhages, and exudates are observed. Renal blood flow and glomerular filtration rate are reduced; although there are no abnormalities in the urine test, radiographs show more or less clear signs of a diffuse bilateral decrease in renal function. The stage of hypertension is characterized by a steady increase in blood pressure. Systolic blood pressure reaches 200-230 mm Hg. Art., diastolic - 115-129. However, at this stage, blood pressure may spontaneously decrease, in some cases quite significantly, reaching a lower level than in stage II. The condition of a sharp decrease in systolic blood pressure in combination with increased diastolic is called “decapitated” hypertension. It is caused by a decrease in the contractile function of the myocardium. If atherosclerosis of large vessels is added to this, then the level of diastolic blood pressure decreases. At stage III of hypertension, hypertensive crises often occur, accompanied by cerebrovascular accident, paresis and paralysis. But the vessels of the kidneys undergo especially significant changes, resulting in the development of arteriolohyalinosis, arteriolosclerosis and, as a consequence, the formation of a primary wrinkled kidney, which leads to chronic renal failure. More often, in stage III of hypertension, cardiac or cerebral pathology predominates, which leads to death before chronic renal failure develops. The clinical picture of heart damage is angina pectoris, myocardial infarction, arrhythmia, circulatory failure. Cerebral lesions - ischemic and hemorrhagic infarctions, encephalopathy. As for changes in the fundus of the eye, its examination reveals the “silver wire” symptom, sometimes acute retinal ischemia with loss of vision (this severe complication can occur as a result of vasospasm, thrombosis, embolism), swelling of the optic nerve nipples, retinal edema and its detachment, hemorrhages.

5 Classification

Hypertension is defined as an increase in systolic blood pressure to or above 140 mmHg. Art. and/or diastolic pressure up to and above 90 mmHg. Art. in persons not taking antihypertensive drugs.

Degrees of hypertension depending on systolic and diastolic pressure:

(in mmHg) (in mmHg)

Optimal< 120< 80

Normal< 130< 85

Increased normal 130-139 85-89

Stage I - mild hypertension 140-159 90-99

subgroup - borderline hypertension 140-14990-94

Stage II - moderate hypertension 160-179100-109

Grade III - severe hypertension > 180 > 110

Isolated systolic hypertension > 140 < 90

Subgroup - borderline hypertension 140-149 < 90

6 Complications

Damage to the blood vessels of the brain leads to cerebrovascular insufficiency. In such patients, thrombosis of blood vessels and the brain may occur, resulting in loss of consciousness, impaired speech, swallowing, breathing, and thromboischemic stroke. Sometimes bleeding in the brain occurs. As a result of the development of atherosclerotic changes in the vessels of the heart, signs of either chronic coronary circulatory insufficiency with angina pectoris and rest, or symptoms of acute coronary circulatory disorders (myocardial infarction), develop.

Damage to the renal vessels during hypertension leads to the development of renal arteriolosclerosis. Symptoms of renal failure develop: urine density becomes low, polyuria, iso- and hyposthenuria appear. In the late stage of the disease, the content of residual nitrogen in the blood increases, and uremia syndrome develops.

In addition to these complications, at any stage of hypertension a complication may occur - a hypertensive crisis.

Hypertensive crisis is a sudden increase in blood pressure, accompanied by disorders of the autonomic nervous system and increased disorders of the cerebral, coronary and renal circulation. It is important to increase blood pressure to individually high numbers. There are crises of types 1 and 2. Type 1 crisis occurs in stage 1 of hypertension and is accompanied by neurovegetative symptoms. Type II crisis occurs in stages II and III of hypertension.

Symptoms of a crisis: cutting headache, transient visual impairment, hearing impairment (stupefaction), heart pain, confusion, nausea, vomiting. The crisis is complicated by myocardial infarction and stroke. Factors provoking the development of crises: psycho-emotional stress, physical activity, sudden withdrawal of antihypertensive drugs, use of contraceptives, hypoglycemia, menopause, etc.

There are benign and malignant forms of hypertension. The benign variant is characterized by slow progression, changes in organs are at the stage of stabilization. The treatment is effective. Complications develop only in the later stages.

The malignant variant of hypertension is characterized by a rapid course, high blood pressure, especially diastolic, rapid development of renal failure and brain disorders. Changes in the fundus arteries with foci of necrosis around the optic nerve nipple and blindness appear quite early. When treating a malignant form of hypertension, it can be fatal if left untreated.

7 Prevention

Measures to prevent hypertension are the subject of intensive and in-depth research. Hypertension, as observations have shown, is one of the most common cardiovascular diseases in the world.

Patients with hypertension are more predisposed to the occurrence of atherosclerosis, especially of the arteries of the brain, heart, and kidneys. All this indicates the need for systematic measures of personal and public prevention of this disease and its timely treatment.

The role of nervous mechanisms in the origin of hypertension is evidenced by the following facts: in the vast majority of cases, in patients it is possible to establish in the past, before the onset of the disease, the presence of strong nervous “shocks”, frequent unrest, and mental trauma. Experience shows that hypertension is much more common in people exposed to repeated and prolonged nervous strain. Thus, the huge role of neuropsychiatric disorders in the development of hypertension is indisputable. Of course, personality traits and the reaction of the nervous system to external influences matter.

Heredity also plays a certain role in the occurrence of the disease. Under certain conditions, nutritional disorders can also contribute to the development of hypertension; Gender and age matter. Thus, women during menopause (40-50 years old) suffer from hypertension more often than men of the same age. Increases in blood pressure can occur in women during pregnancy, which can lead to serious complications during childbirth. Therefore, in this case, therapeutic measures should be aimed at eliminating toxicosis. Atherosclerosis of cerebral vessels can contribute to the development of hypertension, especially if it affects certain sections responsible for the regulation of vascular tone.

Renal dysfunction is very important. A decrease in blood supply to the kidneys causes the production of a special substance - renin, which helps to increase blood pressure. But the kidneys also have a so-called renoprivile function, which consists in the fact that the medullary zone of the kidneys produces a substance that destroys compounds in the blood that increase pressure (pressor amines). If for some reason this so-called antihypertensive function of the kidneys is impaired, then blood pressure rises and stubbornly remains at a high level, despite comprehensive treatment with modern means. In such cases, it is believed that the development of persistent hypertension is a consequence of impaired renal function of the kidneys.

Prevention of hypertension requires special attention to nutrition. It is recommended to avoid excessive consumption of meat and fats. The diet should be moderate in calories, with limited protein, fat and cholesterol. This helps prevent the development of hypertension and atherosclerosis.

Overweight people should periodically resort to fasting diets. A known dietary restriction must be consistent with work activity. In addition, significant malnutrition contributes to the development of hypertension, causing changes in the reactivity of the higher parts of the central nervous system. A proper diet without the formation of excess weight should be sufficient to prevent functional disorders of the higher nervous system. Systematic weight control is the best guarantee of a proper diet.

A person suffering from hypertension should be moderate in fluid intake. The normal daily need for water is satisfied by 1.5 liters of all water taken per day in the form of liquids, including liquid meals at lunch. In addition, a person receives about 1 liter of liquid from water, which is part of the products. In the absence of heart failure, the patient can afford to take fluid in the range of 2-2.5 liters (preferably no more than 1.2 liters). It is necessary to distribute the drink evenly - you cannot drink a lot at once. The fact is that liquid is quickly absorbed from the intestines, flooding the blood, increasing its volume, which increases the load on the heart. It must move more blood than usual until the excess fluid is removed through the kidneys, lungs and skin.

Overwork of a diseased heart causes a tendency to edema, and excess fluid aggravates it even more. The use of pickles should be avoided and table salt should be limited to 5 g per day. Excessive salt consumption leads to disruption of salt-water metabolism, which contributes to hypertension. Alcoholic drinks and smoking also accelerate the development of the disease, so they should be strictly prohibited for patients with hypertension. Nicotine is a poison for blood vessels and nerves. The appropriate distribution of work and rest hours is of great importance. Long and intense work, reading, mental fatigue, especially in people predisposed to hypertension, contribute to its occurrence and development.

Particular attention should be paid to physical culture. It is a kind of protective measure that trains the neurovascular system of patients with hypertension, reduces phenomena associated with disorders of the nervous system - headache, dizziness, noise and heaviness in the head, insomnia, general weakness. Exercises should be simple, rhythmic, and performed at a calm pace. Regular morning hygienic exercises and constant walking, especially before bed, lasting at least an hour, play a particularly important role.

Conclusion: Hypertension is a terrible vascular disease that can cause irreversible damage to the patient’s body. Like any chronic disease, it is easier to prevent than to treat. Therefore, prevention of hypertension is necessary, especially for people with a family history.

hypertension disease nursing

Chapter 2. Practical part

1 Nursing process plan for hypertension in a hospital setting

The goal of the nursing process in hypertension is to create for the patient all the conditions necessary for his recovery, to direct all his actions to preserve health, speedy recovery and prevent complications in the patient, alleviate suffering during the disease, and also help him fulfill all the needs and desires that he himself cannot realize the moment of illness.

)Conduct subjective and objective examinations of the patient.

)Identify real and potential problems, identify the patient’s violated needs.

Patient problems:

A) Existing (present):

headache;

dizziness;

sleep disturbance;

irritability;

absence of mandatory alternation of work and rest;

lack of adherence to a low-salt diet;

lack of constant use of medications;

lack of knowledge about factors contributing to increased blood pressure.

B) Potential:

risk of developing a hypertensive crisis;

risk of developing acute myocardial infarction or acute cerebrovascular accident;

early visual impairment;

risk of developing chronic renal failure

)In connection with the identified problems, set short- and long-term goals to maintain the health and encourage the patient to recover.

)To reduce the risk of possible complications, the nurse needs to make sure during the conversation that the patient understands the fact that the absence of symptoms of the disease is not a reason to refuse blood pressure control. The patient should be reminded that symptoms appear already in the advanced stage of the disease.

)Monitor the patient's weight. Strictly monitor blood pressure levels (3 times a day and if dizziness and pain occur), temperature (2 times a day), pulse (2 times a day). Record everything graphically on the temperature sheet and record the readings on the patient’s dynamic assessment sheet.

)Strictly follow the doctor’s instructions for medication and physiotherapeutic treatment of the patient. Inform the patient about the effects of the procedures and medications prescribed to him, convince him of the need for systematic and long-term use only in the prescribed doses and their combinations with meals.

)If the patient forgets to take medications on time, you can discuss with him ways to remember, for example, connection with a certain meal (breakfast, lunch, etc.).

)Conduct control of transferred products by relatives or other close people to inpatients.

)Convince the patient of the need for a gentle daily routine (improvement of work and home conditions, possible changes in working conditions, nature of rest, etc.).

)Teach the patient relaxation techniques to relieve tension and anxiety.

)Conduct a conversation about possible complications of hypertension, point out their causes.

)Conduct a conversation with the patient/family about the need to follow a diet with limited salt (no more than 4-6 g/day).

)Teach the patient (family):

determine heart rate; measure blood pressure;

recognize the initial symptoms of a hypertensive crisis;

provide first aid during crises.

2 Statistics on hypertension

Statistics on morbidity and mortality

Cardiovascular diseases and hypertension in particular are called the epidemic of the 21st century. Unfortunately, every fifth inhabitant of our planet (about one and a half billion people) suffers from hypertension, and in Russia, according to some data, every third. But if earlier in the world the disease was mainly diagnosed in people over forty, now about 33.4% of hypertensive patients are young people, 7.2% teenagers and 2% children.

As for Russia, our country ranks third in the incidence of hypertension, after the United States and the European Union. According to statistics from the Ministry of Health and Social Development and the Russian Academy of Medical Sciences, about 63% of the total population suffers from hypertension in our country. If we talk about the treatment of hypertension, then according to the same Ministry of Health and Social Development, more than 51% of men and 43% of women suffering from high blood pressure are not treated, and 32% are treated ineffectively. And only 9% of men and 12% of women in Russia achieve target (i.e. normal) blood pressure during treatment. The mortality statistics from hypertension are simply off the charts; in the last two years alone (1012 - 1013), the number of deaths amounted to more than 950 thousand people.

Regarding the Krasnodar region, we can say that it ranks seventh in the number of diagnosed cases of hypertension. In 2012, the region recorded a decrease in the overall incidence of hypertension among adolescents by 3.4% and adults by 4.0%; among children, the overall incidence of hypertension remained at the 2011 level (2.0 per 100 thousand population). Mortality decreased by 6.7%.

In Krasnodar itself there are no general statistics, but according to data from city hospital No. 3, it can be judged that today the incidence is approximately only 31% among the adult population of the city.

In forecasts, morbidity statistics look like this: as the population ages and the role of factors such as obesity, sedentary lifestyle, smoking and constant stress increases, by 2025 the incidence of hypertension is expected to increase to 45%, and the share of hypertension in the structure of population mortality will rise to 1,600,000 people.

Statistics on common problems with hypertension

When considering the frequency of occurrence of problems in patients with hypertension within hospital hospital No. 3, the following statistics can be derived:

.The most common physiological problems in patients are:

v High blood pressure level - 100%;

v Headaches - 100%;

v General weakening of the body - 95%;

v Disorders of nervous activity (sleep disorders, irritability, etc.) - 89%;

v Pain in the heart area - 70%;

v Pain in the eyes and decreased vision - 60%;

v Reduced kidney activity - 35%.

The most common psychological problems in patients are:

v Feeling of inferiority due to illness - 78%;

v Concern about the outcome of the disease - 70%;

v Lack of knowledge about the characteristics of nutrition and lifestyle associated with one’s illness - 60%

v Depression and apathy of patients associated with a lack of knowledge about the disease - 40%

v Fear of diagnostic tests - 50%.

Conclusion: Statistics show that the incidence of hypertension is gradually decreasing, although if the standard of living of the population does not improve, the incidence will increase again.

3 Practical part

Patient #1

Patient - Peter. Age sixteen.

He was admitted to the hospital for routine hospitalization with complaints of frequent headaches, fatigue, and high blood pressure. In addition, he is bothered by eye pain and pain in the heart, shortness of breath during physical exertion, frequent convulsions, restless sleep, and severe irritability.

Clinical diagnosis - Arterial hypertension.

Concomitant diagnosis - myocardial dystrophy, minor cardiac anomaly, retinal angiodystonia of both eyes. Suspicion of atherosclerosis of the lower extremities.

Anamnesis of life

Born in second birth, not full term (32 weeks), breastfed. As a child, he often suffered from sore throat and suffered from chickenpox. He is registered with a neurologist and cardiologist. Vaccinations according to age. Allergy history is not burdened. There are no bad habits.

Heredity: on the maternal side - the mother suffered from hypotension, oncology, the mother died at the age of 48 from metastasis of the kidneys and urinary system, the grandmother also had an incidence of hypertension, died at the age of 69 from a stroke. On the father's side, everyone had hypertension; the father suffers from hypertension, atherosclerosis of the lower extremities, and suffered a myocardial infarction and stroke.

He suffered an ankle fracture at the age of 11, there were no operations.

History of the disease

The disease was first diagnosed in 2005 at the age of eight years, after hospitalization in Children's Hospital No. 1 with suspected vegetative crisis. It manifested itself as a headache in the temples and rapid fatigue, as well as a rare increase in blood pressure to 130/85. Since this time, the patient has clearly observed emotional lability.

The cause of the disease was psycho-emotional shock, and possibly heredity.

The disease from borderline hypertension was actively developing. This was manifested by increased pain and increased blood pressure. A possible reason for the progression of the disease is an unstable emotional background in the family.

At the moment, the disease is in the first stage of its development. After annual planned treatment, short-term relief occurs.

Patient problems: the priority problem is high blood pressure. Other problems for the patient include difficulty in stable work and study, sleep and appetite disturbances, pain in the eyes and temples. From the patient's psychological point of view, problems are viewed quite critically.

Recommendations: the patient should learn relaxation methods, correctly build a daily routine so that active work is interspersed with rest, eliminate long-term physical and mental stress, monitor blood pressure levels, consult with a phytologist about herbal medicine for your disease and with a physiotherapist about prescribing massage or exercise therapy . The patient must also follow all recommendations given by the attending physician.

Patient #2

Patient - Alexey. Age sixty-five years.

He was admitted to hospital No. 3 urgently with a suspicion of hypertensive crisis. Upon admission, confusion was observed, speech was unclear, and a persistent increase in blood pressure to 230/120. .According to relatives, it became known that the patient had frequent headaches and constant high blood pressure.

Clinical diagnosis - Hypertensive crisis, which developed against the background of third-degree hypertension.

Concomitant diagnosis: atherosclerosis of the lower extremities, thrombophlebitis.

Complication: acute renal failure, angina pectoris.

Anamnesis of life

Born in the first labor, full term (36 weeks), breastfed. As a child, he suffered from chickenpox and bronchitis. He suffered a myocardial infarction at 45 years old and a stroke at 62 years old. He is registered with a cardiologist. Allergy history is not burdened. Bad habits: smoking (quit after a heart attack), addiction to alcohol.

Heredity: on the maternal side - the mother suffered from a mental disorder, suffered from hypertension, died of a stroke at the age of 72. On the paternal side, all men presumably had hypertension; the father suffered from atherosclerosis of the extremities, trophic ulcers and hypertension, and died at the age of 68 from a heart attack.

Lives in relatively normal environmental conditions. The psycho-emotional situation around the patient is not stable.

He suffered a fracture of his left leg (tibia) at the age of 42, and surgery to remove appendicitis at the age of 56.

History of the disease

The disease was first diagnosed in 1980 at the age of thirty-two, after visiting a neurologist at the place of residence. It was manifested by headaches, severe fatigue, increased blood pressure to 165/100, and the patient also experienced excessive irritability.

The cause of the disease was a number of factors: heredity, bad habits, work associated with emotional stress.

Over a long period of time, the disease progressed from the second stage to the third. This is manifested by an increase in headaches and higher blood pressure, as well as the appearance of complications in the form of angina and kidney failure. The reason for this was bad habits and an unstable emotional background in the family.

At the moment, the disease is at the last stage of development. The patient is examined for hypertension every year.

Patient's problems: The patient's priority problem is too high blood pressure (up to 230/140), which causes frequent and severe headaches. The patient is practically incapable of prolonged physical activity. Other problems include moral decline, sleep disturbances and lack of appetite, and a pathological decrease in diuresis (oliguria).

Recommendations: the patient should give up bad habits and try to properly adjust their daily routine to normalize sleep and appetite. You should also count blood pressure, respiratory rate and pulse at least three times a day, monitor daily diuresis, go on a special diet for weight loss, and the patient must follow all recommendations given by the attending physician.

Conclusion

After analyzing the medical literature on hypertension, I came to the conclusion that this disease is extremely dangerous these days. This is explained by the fact that the causes of development are those factors that are extremely difficult for a modern person to avoid (Stress and, as a consequence, bad habits, obesity, a sedentary lifestyle, poor ecology.) In addition, this disease, with prolonged absence of treatment and improper treatment, can cause serious and, as a rule, irreversible changes in the cardiovascular system.

Hypertension, like any chronic progressive disease, is easier to prevent than to treat. Therefore, the prevention of hypertension, especially for people with a family history, is an urgent task. A correct lifestyle and regular monitoring by a cardiologist help delay or mitigate the manifestations of hypertension, and often even prevent its development altogether.

The role of the nurse in caring for patients with hypertension cannot be overestimated in the recovery process. The nurse is responsible for the health and well-being of the patient in the hospital, and she must achieve a reduction in discomfort and normalization of the patient’s state of mind. And also to convey to the patient and his and his loved ones all the information necessary for treatment and prevention.

Based on morbidity statistics, we can conclude that so far the fight against hypertension has been successful, but if the standard of living of the population continues to remain without positive changes, we should expect a large increase in the number of people suffering from hypertension.

If we look at the statistics on the occurrence of problems in hypertensive patients, we can see that patients are more often concerned about physiological problems. Most of all, patients are concerned about such problems as headache, high blood pressure and weakness.

Based on the research work done, I made the following conclusions:

.At different stages of the disease, patients experience slightly different complaints and problems. As the disease progresses, the main symptoms (headache, high blood pressure) are supplemented by symptoms of complications (renal failure, atherosclerosis, circulatory disorders in the brain). Based on this, the nursing process will also vary slightly with different degrees of disease development. But in any case, the patient needs rest, normal nutrition, stable and proper rest, as well as constant monitoring of blood pressure and pulse.

.The disease progresses differently based not only on the degree of development of the disease, but also on age. At a younger age, the consequences of hypertension are tolerated somewhat easier than in older people. This is due to the fact that young people have more elastic blood vessels and increased protective and adaptive properties of the body. In adulthood, pain and weakness become much more noticeable for the patient.

I consider all my goals and objectives completed.

This work was carried out with the aim of educating the population on issues related to hypertension, as well as to improve the quality of nursing care for patients suffering from hypertension.

List of sources

1) Obukhovets T.P. Nursing in Therapy; Rostov-on-Don: “Phoenix”, 2003.

2) Averyanov A. Hypertension. Diagnostics, prevention and treatment methods; Moscow: TsPG, 2005.

3) Martynova A.I., Mukhina N.A., Moiseeva V.S.. Internal diseases: Textbook for universities. In 2 volumes; Moscow: GEOTAR Medicine, 2002.

4) “Internal Diseases” edited by A.S. Smetneva, V.G.Kukesa; Moscow: “Medicine” 2003.

5) Kobalava Zh.D. Arterial hypertension in questions and answers: a reference book for practicing physicians; Moscow, 2002.

) House doctor. Pocket Guide; Moscow: ZAO OLMA Media Group, 2010.

)Medical encyclopedia. Translation from English Luppo; Moscow: KRON-PRESS, 1998.

Hypertension is one of the dangerous diseases of the cardiovascular system, in which blood pressure increases. In this case, the patient's condition worsens significantly. That is why it is necessary to provide not only adequate treatment, but also nursing process for hypertension.

Nursing process in hypertension

Nursing care for hypertension is to create optimal conditions for the patient, through which relief of their condition will be observed. Thanks to it, the patient’s treatment process is accelerated. If a person has arterial hypertension, then nursing can maintain his health, as well as eliminate the possibility of developing undesirable effects.

The purpose of the nursing process in hypertension is to help patients realize their wishes and requirements. Initially, a complete examination of the patient is carried out. Thanks to the nursing process during a hypertensive crisis, it is possible to identify real and probable problems. The action of medical staff is aimed at identifying the violated needs of a sick person.

• fatigue;
• nervousness;
• dizziness;
• poor sleep;
• pain in the head.

Due to the peculiarities of nursing work in hypertension, it is necessary to learn how a person alternates between work and rest. The patient should tell whether he is on a low-salt diet. It is also recommended to provide information about taking certain medications.

The purpose of the nursing process for arterial hypertension is to determine the possibility of developing complications of the disease. In this case, the risk of renal failure is determined. The healthcare worker also needs to find out whether the patient has previously had vision problems. The procedure determines whether a person is likely to develop heart failure or a heart attack. During the examination, cerebrovascular accident (heart failure) is determined.

Important! The nurse should talk with the patient as often as possible, which will enable timely identification of possible complications.

The nurse's algorithm for a hypertensive crisis requires measuring blood pressure. This will make it possible to determine the severity of the disease. The health care provider should explain to the patient that normal blood pressure does not indicate the absence of disease.

Thanks to the data obtained, it is possible for the health worker to determine short-term and long-term goals. The appointment of independent nursing intervention during a hypertensive crisis is aimed at maximizing the acceleration of treatment of the pathological process.

Nursing care for hypertension involves providing advice to the patient. The health care provider should explain that the symptoms of the pathological condition appear in the later stages of the disease.

First aid

First aid for a hypertensive crisis consists of performing a whole algorithm of actions:

1. Initially, everything possible must be done to calm the patient down. This is explained by the fact that with anxiety, the patient’s condition worsens, as blood pressure rises. The nurse's algorithm requires giving the patient sedatives. This is a tincture of motherwort, valerian, corvalol.
2. The purpose of nursing intervention is to restore the patient's breathing. The nursing process requires convincing the patient to take a deep breath and exhale. The manipulation is repeated until the patient's condition is stabilized. In the room where the patient is located, windows and doors are opened, which will ensure an influx of fresh air.
3. The patient should be in a supine position. They provide him with peace.
4. If emergency assistance is needed for a hypertensive crisis, the algorithm of action consists of applying a cold compress to the head and mustard plasters to the feet.
5. In case of arterial hypertension, the nursing process requires giving the patient drugs that help lower blood pressure. If pain in the sternum and shortness of breath occurs, the patient is recommended to take Nitroglycerin in the amount of 1 tablet. In this case, an ambulance is called. After this, it is recommended to determine your blood pressure level. And also the nurse is required to constantly measure the pulse. If the symptoms do not go away, then give a few more tablets of Nitroroglycerin at intervals of 5 minutes.
6. If a patient experiences a hypertensive crisis, the nurse’s first aid is to give the patient certain medications. In this case, it is recommended to take antihypertensive drugs - Capoten, Corinfar, Nifedipine, Cordaflex. Before using these drugs for hypertension, it is recommended to consult a doctor, which will eliminate the possibility of developing undesirable effects.
7. In hypertension, changes in the arteries are observed quite often. Nursing requires defining an algorithm for measuring pressure. The procedure should be carried out every 20 minutes. The nurse should record blood pressure readings. If necessary, the patient is given antihypertensive medications.
8. Patient examination.
9. After the patient is admitted to the hospital, the nurse must carry out certain actions that will ensure a complete diagnosis of the pathological process. Initially, it is necessary to take the patient’s blood for testing. Before the procedure, the nurse washes his hands, puts on medical gloves and a mask. Blood sampling should only be carried out on an empty stomach, so it is necessary to first ask the patient about food intake. The pulse is felt on the radial artery. After this, the vein is treated with alcohol. Blood is drawn using a syringe. From it, the blood is placed into a test tube.
10. In order to determine the patient's condition, it is necessary to constantly measure blood pressure. In order to obtain the most accurate data, it is recommended to strictly adhere to the rules of this procedure. Blood pressure measurements should be taken at the same time of day. Before the procedure, the patient is strictly prohibited from smoking and drinking alcoholic beverages for an hour.
11. The patient should be in a calm state. The manipulation is performed using a special device - a tonometer. A special tourniquet is placed on the left arm above the elbow, which is inflated using a bulb. The pressure measurement is carried out within a few minutes. Before the procedure, the patient is advised to go to the toilet. This is explained by the fact that if the bladder is full, the readings will increase by 10 millimeters of mercury.
12. During the measurement period, the patient is not recommended to talk or move, as this will increase the readings. To obtain accurate results, two measurements must be taken several minutes apart. The results obtained are constantly entered into the diary. This will provide an opportunity for the doctor to examine them and prescribe adequate treatment.
13. An important indicator for hypertension is the pulse. It is felt in the area of ​​the anterior surface of the forearm. It is also found in the wrist, temples and elbows. A finger is placed on the surface of the wrist. They need to put pressure on the artery. During the manipulation, it is strictly forbidden to strain the muscles. The nurse then counts the number of pulse waves in 10 seconds. The data obtained is entered into a diary.

When a patient is admitted to a hospital, he must be examined, which will provide an opportunity to prescribe effective therapy.

Features of nursing care for hypertension in a hospital setting

The introduction to dependent nursing intervention for a hypertensive crisis is to assess the patient. In this case, the nurse must not only provide care for the patient, but also monitor his intake of medications prescribed by the doctor. Treatment of hypertension at home is often carried out using:

1. Beta blockers. With their help, the heart rate is reduced. In most cases, patients are prescribed Metoprolol, Atenolol and Betaxolol.
2. Diuretics. The action of medications is aimed at reducing the amount of circulating blood. Treatment is carried out with Furosemide, Indapamide, Hypothiazide.
3. Calcium antagonists. Thanks to these vasodilators, an increase in the diameter of the arteries is ensured. Patients are treated in most cases with drugs that have a long-term effect - Amplodipine or Felodipine. If the need arises, short-acting medications are used - Cordipin, Cordavleks, Corinfar.
4. Angiotensin-converting enzyme inhibitors - Enalaprin, Diroton, Ramipril. Thanks to medications, biologically active substances are blocked. The drugs are characterized by the presence of a vasodilator effect.
5. Peripheral vasodilators. To treat hypertension, patients are prescribed Apressin, Nitroglycerin, and Sodium nitroprusside.

Drug therapy should be prescribed only by a doctor in accordance with the individual characteristics of the patient’s body. Also, the specialist must first familiarize himself with the results of diagnostic measures.

During the first days of hospitalization, the nurse should ensure that the patient maintains bed rest, which will reduce the load on the heart. After the patient is placed in bed rest, he is recommended to perform gymnastic exercises. Physical therapy can be done individually or in groups.

The nurse should ensure that the patient adheres to a special diet. In most cases, for hypertension, table No. 10 is prescribed. The patient is advised to consume the liquid in moderation. Patients are allowed to consume meat and fish only in boiled form. Eating difficult-to-digest foods is strictly prohibited. Cooking is carried out without the use of salt.

Attention! In an inpatient setting, during the treatment of hypertension, the patient must be provided with appropriate care. This will ensure rational therapy of the pathological process and a speedy recovery of the patient.

Nursing interventions including working with the patient's family

The role of the nurse in the prevention and treatment of hypertension is very important. She should conduct conversations not only with the patient, but also with his family members. Patients are advised to follow a salt-restricted diet. The patient should consume no more than 6 grams of salt per day.

For hypertension, it is recommended to maintain a gentle daily regimen. In this case, it is necessary to improve service conditions. If the need arises, the nature of the rest can be changed. Actions should be aimed at ensuring adequate sleep for the patient. Patient care is about providing optimal conditions. In this case, in the evening it is necessary to ventilate the room. To avoid a rise in blood pressure, the patient is strictly prohibited from eating before bedtime.

Important! Nursing process for blood pressure requires teaching the patient relaxation techniques. This will allow him to relieve excessive stress and anxiety.

Regardless of what types of nursing interventions are used, the patient must be educated about the harmful effects of cigarettes and alcoholic beverages on the body. The patient must give up bad habits, which will eliminate the possibility of developing undesirable effects. The role of independent interventions in hypertension is very important. A medical professional must explain to the person the effects of prescribed medications and the need for long-term use.

Features of the nursing process for hypertension include conducting a conversation with the patient about the possibility of developing undesirable consequences. The patient must be told about the causes of complications.

The medical process requires constant monitoring of the patient's body weight. He must follow a diet, so the nurse checks the food that his relatives give him. If prohibited products are present, they must be confiscated.

Important! In case of a disease, the main symptom of which is an increase in blood pressure, it is recommended to measure it regularly. The nurse should also teach the patient and his family members how to measure the pulse.

In order to reduce blood flow, it is recommended to take medications prescribed by doctors. And also in this case it is necessary to use traditional medicine, which are not only effective, but also safe. Despite this, before using a certain folk medicine, the patient is recommended to consult a doctor.

Hypertension is the result of a pathological condition of high blood pressure. This disease is considered quite common, and some people may not even be aware of it.

Symptoms of hypertension:

• frequent headaches;
• dizziness;
• decreased performance;
• increased irritability;
• memory impairment;
• feeling of weakness in the limbs.

Possible complications:

• myocardial infarction;
• brain stroke;
• renal failure;
• acute heart failure.

The goal of treating hypertension is to lower blood pressure. This is achieved by the following methods:

• use of antihypertensive drugs;
• getting rid of bad habits (for example, smoking, drinking alcohol);
• weight loss;
• reducing the amount of table salt consumed;
• playing sports and performing massage treatments.

1. Conducting training for the patient and his relatives in the necessary skills that are aimed at maintaining the patient’s health.
2. Increasing scientific knowledge and research activities followed by practical application.
   

   The treatment process takes a long time. In the initial stages of the disease, the patient himself can adhere to the regimen established by the doctor, but there are cases when it is necessary to plan nursing care for hypertension.

   The nursing process for hypertension is a specially organized way of providing medical care for each patient on an individual basis.

   Functions of a nurse during the nursing process:

   1. Providing patient care, which consists of the following:
   • creating conditions for recovery;
   • carrying out all hygiene and preventive procedures;
   • assistance in fulfilling some of the patient's wishes.

   Stages of the nursing process for hypertension:

   • service;
   • diagnostics;
   • identifying the purpose of nursing intervention;
   • creating a care plan and implementing it;
   • analysis of results.

   It is worth considering that the nursing process is especially relevant for atherosclerosis and hypertension.

   The purpose of the first stage is to conduct a nursing examination, which involves the collection of subjective information, an objective analysis of the data obtained and the psychosocial situation of the patient.

   
   

   Problem
   Sleep disturbance
   Cardiopalmus
   Pain in the heart area
   Increased fatigue
   Decreased performance
   Nosebleed
   	Cardiac asthma, pulmonary edema.
   Poor eyesight	Change in the retina of the eye.
   Hearing impairment	As a result of hypertension.

   

   Stage 1 of the nursing process for hypertension is for the nurse to perform the following actions:

   • establishing a trusting relationship with the patient;
   • obtaining an answer to the question: “What can the patient expect as a result of the treatment?”;
   • analysis of all the necessary information that will allow you to create the correct plan of care for the patient.

   The goal of the second stage is to identify all the patient’s existing and potential problems with hypertension. The nursing process also includes making a diagnosis for each complaint. The patient’s problems can be physiological and psychological in nature, so for each complaint it is necessary to make a diagnosis.

   Problem
   Sleep disturbance	Damage to the nervous system due to hypertension.
   Cardiopalmus	Increased influence on the heart of the sympathoadrenal system.
   Pain in the heart area	Deterioration of coronary blood supply.
   Increased fatigue	As a result of hypertension.
   Decreased performance
   Nosebleed
   	Cardiac asthma, pulmonary edema.
   Poor eyesight	Change in the retina of the eye.
   Hearing impairment	As a result of hypertension.

   What else is involved in the nursing process for hypertension? The table of psychological problems and their diagnosis plays an important role here.

   The goals included in the hypertension nursing process assist in the development of an individualized treatment plan.

   Tasks can be short-term, which are designed for one week or a little more, and long-term, lasting throughout the entire treatment.

   To more accurately define the goals of nursing intervention, it is necessary that the objectives meet the following criteria:

   • reality and degree of achievement;
   • urgency of implementation;
   • patient participation in the discussion.

   Before setting all intervention goals, the nurse should identify:

   • what functions the patient can perform independently;
   • whether the patient can be taught self-care features.

   The purpose of this stage is to draw up a nursing intervention plan for treatment and implement it.

   The care plan is a table that includes the following items:

   • date of;
   • patient's problem;
   • what result is expected;
   • description of qualified assistance;
   • the patient's reaction to the nursing intervention;
   • date of goal achievement.

   The plan may include several possible solutions to the problem. This guarantees a high percentage of achieving a positive result.

   The nurse should adhere to the following guidelines when implementing the plan:

   • the developed plan must be carried out systematically;
   • it is necessary to involve the patient himself and his relatives in the implementation process;
   • at the slightest change in the patient’s well-being or the appearance/exclusion of new complaints (symptoms), it is necessary to make changes to the plan;
   • all planned procedures must be carried out strictly according to the algorithm.

   Competent analysis and assessment of the results of nursing intervention is an important stage for the development of a further regimen for the life of a patient with hypertension.

   During the assessment, you can get answers to the following questions:

   • whether there is any progress in the established treatment;
   • does the expected result correspond to what was achieved;
   • How effective is nursing intervention for each of the patient’s problems;
   • whether a revision of the plan is necessary.

   For more accurate results, the final assessment is carried out by the same nurse who performed the initial examination of the patient. Assessment of the feasibility of treatment will be incomplete if the following rules were not followed during nursing care:

   • all nursing interventions (major and minor) were not recorded;
   • actions were not immediately documented;
   • all deviations in the patient’s condition from the norm were not noted;
   • unclear terms were used;
   • there were empty columns in the plan.

   And most importantly, as a result of nursing care, the patient should feel better; he and his loved ones should learn the basic actions from the developed plan.

   ">"Nursing care for patients with a therapeutic profile" theory

   “>Nursing care for cardiovascular diseases (arterial hypertension, arrhythmias)

   Topic: “Nursing care for cardiovascular diseases (arterial hypertension, arrhythmias).”

   Hypertension (HTN, essential or true hypertension) a disease, the main symptom of which is an increase in blood pressure, caused by a violation of the regulation of vascular tone and heart function, and not associated with organic diseases of any organs or systems of the body.

   Symptomatic (secondary) arterial hypertension is a form of increased blood pressure that is causally associated with certain diseases of the internal organs (for example, diseases of the kidneys, endocrine system, etc.).

   The World Health Organization (WHO) at the United Nations considers elevated blood pressure (regardless of age) to be more than 140/90 mmHg. Art. Values ​​160/95 mmHg. Art. considered “threatened”; Persons with higher blood pressure are considered to have hypertension.

   The causes of headache are not precisely known. It is believed that HD develops:

   due to overstrain of the central nervous system;

   neuropsychic trauma in persons with pathological heredity (presence of hypertension in close relatives).

   Contributing factors:

   dysfunction of the endocrine glands, metabolic disorders;

   smoking, drinking alcohol (beer);

   eating increased amounts of table salt (especially in women);

   features of the profession (requiring great responsibility and increased attention);

   insufficient sleep;

   CNS injuries;

   stress at work and during leisure (for example, computer games);

   physical inactivity;

   obesity.

   There are 3 stages of HD (WHO):

   Stage 1 initial, when blood pressure rises for some time under the influence of adverse effects. The disease at this stage is reversible.

   Stage 2 steady increase in blood pressure, which does not decrease without special treatment, and a tendency to hypertensive crises appears. An enlargement of the left ventricle is detected.

   Stage 3 (sclerotic) BP is persistently elevated. Complications are possible: cerebrovascular accident, heart failure, myocardial infarction, and much less frequently, renal failure.

   Symptoms:

   Main complaint:

   headache due to increased blood pressure, more often in the morning, localized in the occipital region, combined with a feeling of a “heavy, stale head”,

   bad dream

   increased irritability

   decreased memory and mental performance

   heart pain, interruptions

   shortness of breath on exertion

   some have blurred vision due to a constant increase in blood pressure

   ECG (left ventricular enlargement)

   Echocardiological (left ventricular hypertrophy confirmed)

   Laboratory:

   urine test (traces of protein, single red blood cells; atherosclerosis of the kidneys develops)

   Examination by an ophthalmologist and neurologist (in stage 3, cerebrovascular accident is possible).

   At any stage of hypertension, a sharp increase in blood pressure may occur hypertensive crisis

   Signs: severe headache

   dizziness, nausea

   visual, hearing impairment (deafness)

   As a result of cerebral circulatory disorders that occur simultaneously with an increase in blood pressure, speech disturbances and movement disorders appear.

   In severe cases, cerebral hemorrhage or stroke occurs (confusion or loss of consciousness, movement disorders, hemiparesis).

   There are benign and malignant forms of headache.

   The benign variant is characterized by slow progression, changes in the body are at the stage of stabilization of blood pressure. The treatment is effective. Complications develop only in the later stages.

   The malignant variant of hypertension is characterized by a rapid course, high blood pressure, especially diastolic, rapid development of renal failure and brain disorders. The arteries of the fundus of the eye change early with foci of necrosis around the optic nerve nipple, blindness. The malignant variant more often affects the heart and more often leads to the death of the patient.

   Treatment: stage 1 headache. Non-medicinal methods.

   diet: limiting salt to 5-8 g/day, the energy value of food should not exceed the daily requirement (for overweight patients it should be lower), limiting alcohol intake, quitting smoking.

   optimal working and rest conditions (night shift work, work exposed to noise, vibration, and excessive attention are prohibited)

   constant physical activity (but agreed with a doctor)

   psychorelaxation

   rational psychotherapy,

   acupuncture,

   physiotherapeutic treatment,

   phytotherapy

   Drug treatment. long-term antihypertensive therapy with individual maintenance doses. In the elderly, blood pressure is reduced gradually, since a rapid decrease worsens cerebral and coronary circulation. Blood pressure should be reduced to 140/90 mmHg. Art. or to values ​​lower than the original ones by 15%. Treatment should not be stopped abruptly. Treatment should begin with known medications. There are 4 groups of medicinal substances used:

   Adrenergic blockers (propranolol, atenolol)

   diuretics (hypothiazide, furosemide, uregit, veroshpiron, arifon)

   calcium antagonists (nifedipine, verapamil, amlodipine, etc.)

   ACE inhibitors (cantopril, enalapril, sandopril, etc.)

   In case of hypertensive crisis:

   As prescribed by a doctor: IV Lasix, nitroglycerin, clonidine or Corinfar 1 tablet under the tongue. If there is no effect, clonidine intramuscularly, dibazol, aminophylline intravenous.

   It should be remembered that blood pressure must be reduced slowly, over an hour (with a rapid decrease, acute cardiovascular failure may develop), especially in the elderly (after 60 years, antihypertensive drugs are not administered intravenously, but only intramuscularly).

   Hypertension is treated over a long period of time and antihypertensive drugs are discontinued only when blood pressure has stabilized at the desired level over time.

   Hypertonic disease is a common disease characterized by increased blood pressure, which is not associated with any known disease of the internal organs. The World Health Organization (WHO) under the UN considers high blood pressure (regardless of age) above 140/90 mm Hg. Art.

   Lack of knowledge about factors contributing to increased blood pressure.

   B. Potential;

   Risk of developing a hypertensive crisis;

   Risk of developing acute myocardial infarction or acute cerebrovascular accident;

   Early visual impairment;

   Risk of developing chronic renal failure.

   1. Questioning the patient about the conditions of professional activity, relationships in the family and with colleagues at work.

   2. Questioning the patient about the presence of hypertension in close relatives.

   3. Study of the patient’s nutritional characteristics.

   4. Asking the patient about bad habits:

   5. Questioning the patient about taking medications: what medications he is taking, frequency, regularity of taking them and tolerability (Enap, atenolol, clonidine, etc.).

   6. Questioning the patient about complaints at the time of the examination.

   7. Examination of the patient:

   Skin color;

   Presence of cyanosis;

   Position in bed;

   Pulse study:

   Blood pressure measurement.

   1. Conduct a conversation with the patient/family about the need to follow a diet with limited salt (no more than 4-6 g/day).

   2. Convince the patient of the need for a gentle daily routine (improvement of work and home conditions, possible changes in working conditions, nature of rest, etc.).

   3. Provide the patient with adequate sleep. explain the conditions that promote sleep: ventilation of the room, inadmissibility of eating immediately before bed, undesirability of watching disturbing television programs. If necessary, consult a doctor about prescribing sedatives or sleeping pills.

   4. Teach the patient relaxation techniques to relieve tension and anxiety.

   5. Inform the patient about the effect of smoking and alcohol on blood pressure levels.

   6. Inform the patient about the effect of medications. prescribed by the attending physician, convince him of the need for systematic and long-term intake only in prescribed doses and their combinations with food intake.

   7. Conduct a conversation about possible complications of hypertension, point out their causes.

   8. Monitor the patient’s body weight, compliance with the regimen and diet.

   9. Conduct control of transferred products by relatives or other close people to inpatients.

   10. Teach the patient (family):

   Determine heart rate; measure blood pressure;

   Recognize the initial symptoms of a hypertensive crisis;

   Provide first aid in this case.

   Introduction………………………………………………………………………………. 3

   1. Etiology……………………………………………………………………………….4

   2. Clinic………………………………………………………………………………….5

   3. Diagnostics………………………………………………………………………………..7

   4. Treatment………………………………………………………………………………….8

   5. Nursing process for hypertension……………………..9

   Conclusion……………………………………………………………………………….15

   Literature………………………………………………………………………………..16

   Introduction

   Arterial hypertension is an increase in blood pressure in the arteries as a result of increased heart function or increased peripheral resistance, or a combination of these factors. There are primary (essential) and secondary arterial hypertension.

   Hypertension, or essential hypertension, is an increase in blood pressure not associated with organic damage to the organs and systems that regulate it. The development of hypertension is based on a violation of the complex mechanism that regulates blood pressure under physiological conditions.

   According to a survey of a representative sample (1993), the age-standardized prevalence of hypertension (>140/90 mm Hg) in Russia is 39.2% among men and 41.1% among women. Women are better informed about the presence of the disease than men (58.9% versus 37.1%), are treated more often (46.7% versus 21.6%), including effectively (17.5% versus 5. 7%). In men and women, there is a clear increase in hypertension with age. Before 40 years of age, hypertension is more often observed in men, after 50 years - in women.

   The development of hypertension can be divided into three parts:

   central - a violation of the relationship between the processes of excitation and inhibition of the central nervous system;

   increased production of pressor substances (norepinephrine, aldosterone, renin, angiotensin) and a decrease in depressor effects;

   tonic contraction of arteries with a tendency to spasm and organ ischemia.

   1. Etiology

   Hereditary burden is the most proven risk factor and is well identified in relatives of the patient of close kinship (the presence of HD in mothers of patients is of particular importance). We are talking, in particular, about the polymorphism of the ACE gene, as well as the pathology of cell membranes. This factor does not necessarily lead to headache. Apparently, genetic predisposition is realized through the influence of external factors.

   People with excess body weight have higher blood pressure. Epidemiological studies have convincingly shown a direct correlation between body weight and blood pressure. With excess body weight, the risk of developing hypertension increases 2-6 times (Quetelet index, which is the ratio of body weight to height, exceeds 25; waist circumference >85 cm in women and >98 cm in men). The factor of excess body weight is associated with a more frequent development of hypertension in industrialized countries.

   Metabolic syndrome (syndrome X), characterized by a special type of obesity (android), insulin resistance, hyperinsulinemia, lipid metabolism disorders (low levels of high-density lipoproteins - HDL - are positively correlated with increased blood pressure).

   Alcohol consumption. SBP and DBP in persons who consume alcohol daily are 6.6 and 4.7 mmHg, respectively. higher than in people who drink alcohol only once a week.

   Salt consumption. Many experimental, clinical and epidemiological studies have shown a connection between high blood pressure and daily consumption of table salt.

   Physical activity. People living a sedentary lifestyle are 20-50% more likely to develop hypertension than physically active people.

   Psychosocial stress. It has been established that acute stress load leads to an increase in blood pressure. It is assumed that long-term chronic stress also leads to the development of hypertension. The patient’s personality traits are probably also of great importance.

   2. Clinic

   The central symptom of hypertension is an increase in blood pressure, from 140/90 mm Hg. Art. and higher.

   Main complaints: headaches, dizziness, blurred vision, pain in the heart, palpitations. Patients may have no complaints. The disease is characterized by an undulating course, when periods of deterioration are replaced by periods of relative well-being.

   In the stage of functional disorders (stage I) there are complaints of headaches (usually at the end of the day), sometimes dizziness, and poor sleep. Blood pressure increases inconsistently, usually due to anxiety or fatigue (140-160/905-100 mm Hg).

   In the second stage. Complaints of constant headaches localized in the occipital region. Patients have poor sleep and dizziness. Blood pressure is persistently elevated. Attacks of pain in the heart appear.

   In stage 2 hypertension, the ECG shows signs of hypertrophy of the left ventricle of the heart and insufficient nutrition of the myocardium.

   In stage three hypertension, various organs are affected, primarily the brain, heart and kidneys. Blood pressure is persistently elevated (more than 200/110 mm Hg). Complications develop more often.

   Hypertensive crisis is a sudden increase in blood pressure, accompanied by disorders of the autonomic nervous system, increased disorders of the cerebral, coronary, and renal circulation and an increase in blood pressure to individually high numbers.

   There are crises of types I and II.

   Type I crisis occurs in stage I headache and is accompanied by neurovegetative symptoms.

   Type II crisis occurs in stages II and III of headache.

   Symptoms of a crisis: severe headache, transient visual impairment, hearing impairment (stupefaction), heart pain, confusion, nausea, vomiting.

   The crisis is complicated by myocardial infarction and stroke. Factors provoking the development of crises: psycho-emotional stress, physical activity, sudden withdrawal of antihypertensive drugs, use of contraceptives, hypoglycemia, menopause, etc.

   The benign variant of the development of hypertension is characterized by slow progression, changes in organs are at the stage of stabilization of blood pressure. The treatment is effective. Complications develop only in the later stages. For definitions of risk levels, see the table.

   The malignant variant of hypertension is characterized by a rapid course, high blood pressure, especially diastolic, rapid development of renal failure and brain disorders. Changes in the fundus arteries with foci of necrosis around the optic nerve nipple and blindness appear quite early. The malignant form of hypertension can be fatal if left untreated.

   3. Diagnostics

   Diagnosis of hypertension and examination of patients with hypertension is carried out in strict sequence, meeting certain objectives:

   Determination of the stability of blood pressure increase and its degree;

   Exclusion of symptomatic hypertension or identification of its form;

   Identifying the presence of other risk factors for cardiovascular diseases and clinical conditions that may affect prognosis and treatment, as well as classifying the patient into a particular risk group;

   Determining the presence of target organ lesions and assessing their severity.

   According to the 1999 WHO-ITF international criteria, hypertension is defined as a condition in which blood pressure is 140 mmHg. Art. or higher and/or ADD - 90 mm. rt. Art. or higher in individuals not receiving antihypertensive therapy.

   Headache is divided into primary, when headache and associated symptoms form the core of the clinical picture and are combined into an independent nosological form (migraine, tension headache, cluster headache), and secondary, when it becomes a consequence of obvious or masked pathological processes.

   Among primary headaches, the most common forms are tension-type headache (TTH) and migraine (M).

   In a patient with newly diagnosed hypertension, a thorough history must be taken, which should include: - the duration of hypertension and levels of elevated blood pressure in the history, as well as the results of previously used antihypertensive drugs, a history of hypertensive crises.

   Additional examination:

   OAK - increase in red blood cells, hemoglobin. BAC - hyperlipidemia (due to atherosclerosis). OAM - proteinuria, cylindruria (with chronic renal failure). Zimnitsky test - isohyposthenuria (with chronic renal failure). ECG - signs of left ventricular hypertrophy. Ultrasound of the heart - enlargement of the wall of the left ventricle. Examination of the fundus - narrowing of the arteries, dilatation of the veins, hemorrhages, swelling of the optic nerve nipple.

   4. Treatment

   Treatment of stage I hypertension is usually carried out using non-drug methods, which can be used at any stage of the disease. A hyposodium diet is used, body weight is normalized (fasting diets), limiting alcohol intake, quitting smoking, constant physical activity, acupuncture, rational psychotherapy, acupuncture, physiotherapeutic treatment, herbal medicine.

   If there is no effect from non-drug treatment for 6 months, drug treatment is used, which is prescribed in stages (starting with one drug, and if ineffective, a combination of drugs).

   In patients with stages I and II, the leading role in treatment belongs to systematic drug therapy, which should be comprehensive. At the same time, it is necessary to systematically carry out preventive measures, among which physical education occupied a significant place.

   Long-term antihypertensive therapy with individual maintenance doses is required. In elderly patients, blood pressure decreases gradually, since a rapid decrease impairs cerebral and coronary circulation. Blood pressure should be reduced to 140/90 mmHg. Art. or to values ​​lower than the original ones by 15%. Treatment should not be abruptly stopped; treatment should begin with known medications.

   Of the many groups of drugs with antihypertensive action, 4 groups have received practical use: β-blockers (propranolol, atenolol), diuretics (hypothiazide, indapamide, uregit, veroshpiron, arifon), calcium antagonists (nifedipine, adalat, verapamil, amlodipine) ACE inhibitors (captopril, enalapril, sandopril, etc.).

   5. Nursing process for hypertension

   lower blood pressure; reduce the need for antihypertensive drugs and maximize their effectiveness; favorably influence other existing risk factors; carry out primary prevention of hypertension and reduce the risk of concomitant cardiovascular disorders at the population level.

   Non-drug methods include:

   To give up smoking; - reduction and/or normalization of body weight (achieving BMI< 25 кг/м2); - снижение потребления алкогольных напитков менее 30 г алкоголя в сутки у мужчин и менее 20 г/сут у женщин; - увеличение физических нагрузок (регулярные аэробные (динамические) физические нагрузки по 30-40 минут не менее 4-х раз в неделю); - снижение потребления поваренной соли до 5 г/сутки;

   A comprehensive change in diet (increasing the consumption of plant foods, reducing the consumption of saturated fats, increasing the diet of potassium, calcium contained in vegetables, fruits, grains, and magnesium contained in dairy products).

   The target blood pressure level is a blood pressure level of less than 140 and 90 mm Hg. In patients with diabetes, it is necessary to reduce blood pressure below 130/85 mm Hg. Art., with chronic renal failure with proteinuria more than 1 g/day below 125/75 mm Hg. Achievement of target blood pressure should be gradual and well tolerated by the patient. The higher the absolute risk, the more important it is to achieve the target blood pressure level. With regard to concomitant hypertension and other associated risk factors, it is also recommended to achieve their effective control, and, if possible, normalize the corresponding indicators (Table 5. Target values ​​of risk factors).

   Achieving and maintaining target blood pressure levels requires long-term monitoring with monitoring of compliance with recommendations for lifestyle changes, regularity of antihypertensive therapy and its correction depending on the effectiveness and tolerability of treatment. During dynamic observation, it is crucial to achieve individual contact between the patient and the nurse, and a patient education system that increases the patient’s sensitivity to treatment.

   In a hospital setting, the entire rehabilitation process is based on three motor modes: bed: strict, extended; ward (semi-bed); free.

   During extended bed rest, the following tasks are solved: improving the neuropsychic status of the patient; gradual increase in the body’s adaptation to physical activity; decreased vascular tone; activation of the function of the cardiovascular system by training intra- and extracardiac circulatory factors.

   At the stage of ward (semi-bed) rest, the following tasks are solved: eliminating the patient’s mental depression; improving adaptation of the cardiovascular system to increasing loads through strictly dosed training; improvement of peripheral blood circulation, elimination of congestion; training in proper breathing and mental self-regulation.

   During the free regime, the tasks of improving the functional state of the central nervous system and its regulatory mechanisms are solved; increasing the overall tone of the body, the adaptability of the cardiovascular and respiratory systems and the whole body to various physical activities; strengthening the myocardium; improving metabolic processes in the body.

   This motor mode in a hospital setting is characterized by the greatest motor activity. The patient is allowed to walk freely around the department; it is recommended to walk up the stairs (within three floors) with pauses for rest and breathing exercises

   For hypertensive crisis, IV Lasix, nitroglycerin, clonidine or Corinfar, nifedipine - 1 table are used. under the tongue. If there is no effect - intravenous aminophylline, intravenous labetolol. Parenteral treatment is prescribed by a doctor.

   It should be remembered that blood pressure must be reduced slowly, over 1 hour; with a rapid decrease, acute cardiovascular failure may develop, especially in the elderly. Therefore, after 60 years, antihypertensive drugs are administered only intramuscularly.

   Treatment of hypertension is carried out over a long period of time and antihypertensive drugs are discontinued only when blood pressure stabilizes to the desired level over a long period of time (the doctor decides to cancel).

   Stage I – nursing examination based on objective and subjective complaints

   sick

   Stage II Stage III Stage IV Stage V

   Patient Problems Goals Nursing Interventions Evaluating Effectiveness

   joint venture (produced upon expiration of the delivery period)

   motivation

   Basic:

   Increased blood pressure

   Achieve a gradual decrease in blood pressure by the end of the first day

   Achieve stabilization of blood pressure by day 10 (at discharge) 1. Ensure physical and psychological rest

   In order to reduce blood flow to the goal. brain and heart

   To lower blood pressure

   For the timely providing emergency assistance in case of emergency. complications

   By the end of the first day, blood pressure is reduced - the goal has been achieved

   By day 10, blood pressure remained at a stable level - the goal was achieved

   Headaches, dizziness, tinnitus

   The patient will note a decrease in goals. pain and headaches

   weaponization by the end of 3 days

   The patient will not complain about the goal. pain and headaches

   care at the time of discharge 1. Ensure physical and mental rest

   2. Provide medication intake. Medicines prescribed by a doctor.

   3. If dizziness occurs, accompany the patient

   4. Ensure frequent ventilation of the rooms. By day 3 the patient has no headaches – the goal has been achieved

   At the time of discharge the patient does not complain of headaches; the goal has been achieved

   Related

   Sleep disturbance

   Within 7 days the patient will be able to fall asleep and sleep without awakening for 4-6 hours, if necessary with the help of sleeping pills

   By the time of discharge from the hospital, the patient will be able to sleep from 6 to 7 hours continuously without taking sleeping pills 1. Observe the patient’s sleep, assess sleep disturbances.

   2. Distract the patient from sleep during the day (which promotes nighttime sleep)

   3. Ensure that all types of food and drinks containing caffeine are excluded from the patient’s diet, including tea and coffee.

   4. Take measures to help the patient fall asleep, e.g.: rubbing the back, warm baths, airing the room before bed, warm non-stimulating drinks (milk), quiet music, relaxation exercises.

   5. Set a certain time for going to bed and do not violate this schedule.

   6. Assure the patient that if he needs anything, he will get the help he needs.

   7. As prescribed by the doctor, give the patient sleeping pills

   For the first 5 days the patient slept with the help of sleeping pills, from the 6th day he began to fall asleep without them - the goal was achieved.

   Reduce expressed

   vomiting by the end of 3 days

   Vomiting will not be a problem

   bed the patient 1. Provide the patient with everything necessary (basin, tray) for vomit, towel, mouthwash, if necessary

   medicines as prescribed by a doctor.

   On the 2nd day the patient no longer complains of vomiting - the goal has been achieved

   Annoy

   laziness, anxiety

   Reduce the patient's irritability and anxiety within 6 days

   The patient will not be irritable upon discharge

   1. Create a calm environment.

   2. Talk with the patient more often on various topics.

   3. Instill confidence in a favorable outcome of the disease

   By day 6, the patient became less irritable, the anxious state does not bother the patient - the goal has been achieved.

   Nursing process in hypertension

   Hypertonic disease(essential or true hypertension) is a disease, the main symptom of which is an increase in blood pressure, caused by a violation of the regulation of vascular tone and heart function and not associated with organic diseases of any organs or systems of the body.

   The term " arterial hypertension» used to indicate increased blood pressure(BP) of any origin, starting from 140 mmHg. (systolic) and/or 90 mmHg. (diastolic) and higher in persons not taking antihypertensive drugs, if this increase is stable, i.e. confirmed by repeated blood pressure measurements (at least 2-3 times on different days for 4 weeks). Symptomatic (secondary) arterial hypertension- these are forms of increased blood pressure associated with certain diseases of internal organs (kidney diseases, endocrine system).

   Causes:

   overstrain of the central nervous system;

   neuropsychic trauma in persons with pathological heredity.

   Contributing Factorsrisk:

   Increased intake of dietary sodium. Salt is not only a risk factor for hypertension, but also an independent risk factor for increased myocardial mass, which increases the likelihood of coronary artery disease. Salt restriction can delay the increase in blood pressure with age, prevent hypertension at borderline levels, and reduce the risk of strokes.

   Alcohol. The role of high doses of alcohol in the development of hypertension and accompanying strokes has been proven. When alcohol consumption is limited, a clinically significant decrease in blood pressure occurs. The protective effect of small doses of alcohol in relation to cardiovascular diseases is discussed.

   Obesity. The process of body weight correction is carried out more effectively with the participation of a nutritionist.

   Smoking. In mild hypertension, the antihypertensive effect of smoking cessation may exceed the effectiveness of drug therapy. A direct link between smoking and the development of malignant arterial hypertension with severe retinal damage has been proven.

   Psycho-emotional stress. To clarify the stability of such changes, daily monitoring or self-monitoring of blood pressure in an outpatient setting is used. Control of inadequate emotional reactions (drug or non-drug) provides an antihypertensive effect.

   Physical inactivity and dosed physical activity. Physical inactivity is a risk factor for all cardiovascular diseases. Any dosed physical exercises for mild to moderate arterial hypertension increase performance, and exercises aimed at training endurance (running and brisk walking) have an antihypertensive effect.

   dysfunction of the endocrine glands;

   features of the profession;

   insufficient sleep;

   CNS injuries.

   Pathogenesis

   Stress leads to an increase in the level of adrenaline and norepinephrine in the blood, which leads to high cardiac output, vasospasm, and an increase in peripheral resistance in the blood vessels.

   In the kidneys, high sympathetic NS activity stimulates the release of renin. Renin converts angiotensionogen to angiotensin I.

   Angiotensin II stimulates the secretion of aldesterone (an adrenal hormone) and vasopressin (an antidiuretic hormone in the hypothalamus). Under their influence, the reabsorption of sodium and water in the renal tubules increases and the reabsorption of potassium decreases, which leads to swelling of the vascular walls and an increase in circulating blood volume (CBV). These are factors that increase blood pressure.

   Classification of arterial hypertension depending on the level of blood pressure (WHO, 1993)

   Normal pressure – blood pressure level not exceeding 140 and 90 mm Hg.

   Mild arterial hypertension – high pressure range within 140-180 and/or 90-105 mm Hg.

   Borderline arterial hypertension(distinguished within the “mild hypertension” group) – blood pressure range 140-159 and/or 90-94 mm Hg.

   Moderate(in the presence of an increase in blood pressure to 180-210 and/or 100-115 mm Hg) hypertension.

   Heavy –(over 210 and/or 105 mm Hg) hypertension.

   Isolated systolic hypertension – is accompanied by an increase only in systolic blood pressure (over 140 mm Hg) with a diastolic level not exceeding 90 mm Hg.

   Moderate arterial hypertension within isolated systolic(borderline isolated hypertension) is an isolated increase in systolic values ​​within the range of 140-159 mmHg.

   Stages of HD (WHO):

   Stage I - elevated blood pressure is not constant (it normalizes under the influence of rest). Changes in internal organs (enlargement of the left ventricle) are not observed.

   Stage II - blood pressure increases steadily, drugs are required to reduce it, and an enlargement of the left ventricle is observed.

   Patient complaints:

   Headache, accompanied by dizziness, staggering, tinnitus (in the morning, localized in the occipital region, a feeling of a “heavy, stale” head).

   Neurotic disorders: emotional lability, irritability, tearfulness, fatigue.

   Pain in the heart area according to the type of angina.

   Heartbeat, interruptions in the heart (extrasystole).

   Visual impairment– fog before the eyes, the appearance of circles, spots, flickering of spots, loss of vision.

   Related complaints– weakness, decreased mental and physical performance.

   Bad dream.

   Stage I - elevated blood pressure.

   Stage II - blood pressure increases steadily, and there is an enlargement of the left ventricle. There are traces of protein and single red blood cells in the urine. Atherosclerosis of the coronary vessels (compressive pain behind the sternum).

   Stage III - blood pressure is persistently elevated. Complications are possible (cerebrovascular accidents, heart failure, MI, renal failure).

   Benign option

   The benign variant of the course of hypertension is characterized by: slow progression; wave-like alternation of periods of deterioration and improvement; slow heart damage; blood vessels of the brain, kidneys, retina; effectiveness of treatment, late development of complications.

   Malignant variant

   The malignant variant of the course of hypertension is characterized by: an increase in blood pressure of 230/130 mm Hg. Art., resistance to antihypertensive therapy, rapid development of complications from the kidneys, brain, and fundus vessels.

   Diagnostics

   General blood analysis

   General urine analysis

   Blood pressure measurement

   Blood sugar test

   Blood chemistry

   Phonocardiography

   Fundus examination (upon admission and subsequently as indicated)

   Ultrasound of the heart and kidneys

   X-ray of the chest organs

   Treatment

   Goals of patient treatment:

   Primary goal in the treatment of hypertension– maximum reduction in the overall risk of cardiovascular diseases in the long term.

   Physical activity. In the first days, the patient must remain in bed to reduce the load on the heart. When transferring to semi-bed rest, physical therapy classes are conducted individually or in groups, sitting and standing at a slow and then medium pace.

   Diet therapy. For hypertension, diet No. 10 is prescribed. The strictness of compliance depends on the stage of the disease. The diet is characterized by a slight decrease in energy value due to fats and partly carbohydrates; significant limitation of the amount of table salt, reduction of liquid intake. Cooking with moderate mechanical gentleness. Meat and fish are boiled. Difficult to digest foods are excluded. Food is prepared without salt. The temperature is normal. Diet: 5 times a day in relatively equal portions.

   Control of high blood pressure.

   Lifestyle modification (non-drug treatment). Lifestyle correction (elimination of risk factors) is indicated for all patients with arterial hypertension, regardless of the need for drug therapy.

   Programs of regular dosed physical exercises that train endurance are used. For elderly patients, a gradual, under medical supervision, increase in physical activity is indicated.

   In obesity, a decrease in body weight by 1 kg is accompanied by a decrease in blood pressure by 3 (systolic) and 1.2 (diastolic) mm Hg.

   Drug treatment

   The main goal of treatment of arterial hypertension is to reduce mortality from cardiovascular diseases.

   Treatment (drug or non-drug) must be started as early as possible and carried out continuously (usually throughout life). “Course treatment” of arterial hypertension is unacceptable.

   The ideal regimen is “one tablet per day,” which helps to increase the number of effectively treated patients.

   ACE INHIBITORS

   Suppresses the synthesis of angiotensin II;

   Reduce left ventricular hypertrophy;

   They have a positive effect on the condition of the vascular wall in asymptomatic atherosclerosis.

   captopril (capoten, tensiomin; daily dose – 12.5 – 150 mg, frequency of administration 2-4 times a day (in a tablet – 25 mg);

   enalapril (renitec, enap, berlipril, ednit; daily dose – 2.5 – 40 mg, frequency of administration 2-4 times a day);

   lisinopril (daily dose 5 – 40 mg);

   trandolapril (daily dose 0.5 – 2 mg once a day).

   ANGIOTENSIN-II RECEPTOR BLOCKERS

   Frequency of administration – 1 time per day:

   Losartan (cozaar, lozap; daily dose – 50 – 100 mg);

   Irbesartan (Aprovel; daily dose – 150 – 300);

   Eprosartan (teveten; daily dose – 400 – 800 mg);

   Telmisartan (micardis; daily dose – 20 – 60 mg);

   Valsartan (daily dose – 80 – 160 mg).

   CALCIUM ANTAGONISTS

   Dilatation of arterioles;

   Reducing increased total peripheral vascular resistance by blocking the entry of Ca2+ ions into the cell.

   verapamil prolonged action (daily dose – 240-480 mg, frequency of administration 1-2 times a day);

   long-acting diltiazem (daily dose – 120-360 mg, dosage frequency 1-2 times a day);

   Both drugs block slow channels in the sinus and atrioventricular nodes, and therefore can cause bradycardia and atrioventricular block.

   Dihydropyridine derivatives.

   Dihydropyridines (have more pronounced vasodilating effects than verapamil and diltiazem, which may be accompanied by facial flushing, headache, dizziness, tachycardia, peripheral edema):

   long-acting nifedipine (corinfar-retard, cordipin-retard, nifecard-retard, adalat SR, osmoadalat);

   amlodipine (amlor, norvasc; 2.5 – 5 mg 1 time per day);

   long-acting nicardipine (60–120 mg once a day);

   THIAZIDE OR THIAZIDE-LIKEDIURETICS

   Indications for use: old age, fluid retention in the body and signs of hypervolemia (edema, pastosity), associated with heart or kidney failure, osteoporosis.

   Prevents the development of cardiovascular complications in arterial hypertension (primarily stroke);

   They lead to a decrease in blood pressure by reducing the reabsorption of sodium and water.

   Basic diuretics

   1. Thiazide diuretics (dosage frequency: 1 time per day:

   Benzothiazide (daily dose – 12.5-50 mg),

   Hydrochlorothiazide (daily dose – 12.5-100 mg; 1 time per day);

   Chlorothiazide (daily dose – 125-500 mg);

   Cyclothiazide (1–2 mg per day is sufficient to correct blood pressure).

   2. Thiazide-like diuretics (dose frequency: 1 time per day):

   Indapamide (daily dose –2.5-5 mg);

   Clopamide (daily dose – 10-60 mg);

   BETA BLOCKERS

   Prevents the development of coronary circulatory disorders, including fatal ones, in persons who have suffered a myocardial infarction.

   Indications: young and middle age, tachycardia, high pulse pressure, concomitant ischemic heart disease (angina pectoris, myocardial infarction), hyperthyroidism, migraine.

   propranolol (obzidan, anaprilin; has membrane-stabilizing activity; daily dose – 20-160 mg, frequency of administration – 2-3 times a day);

   timolol (20-40 mg for 2 doses)

   atenolol (daily dose – 25-100 mg, frequency of administration – 1-2 times a day);

   metoprolol (daily dose – 50-200 mg, frequency of administration – 1-2 times a day, has membrane-stabilizing activity)

   bisoprolol (daily dose – 5-20 mg, frequency of administration – 1 time per day);

   labetalol (daily dose – 200-1200 mg, frequency of administration – 2 times a day);

   SECOND LINE ANTIHYPERTENSIVE DRUGS

   ALPHA BLOCKERS

   Vasoconstrictor effect

   doxazosin (cardura; 1 – 16 mg 1 time per day);

   prazosin (adversuten; minipress; 1 – 20 mg 2-3 times a day);

   SECOND-LINE DIURETICS

   Loop diuretics (frequency of administration – 1-2 times a day):

   Furosemide (Lasix) (daily dose – 40-240 mg, frequency of administration – 2-4 times a day).

   Ethacrynic acid (uregit) (daily dose 25-100 mg);

   Potassium-sparing diuretics :

   Spironolactone (aldactone, veroshpiron) (daily dose – 25-100 mg, frequency of administration – 2-3 times a day);

   Amiloride (daily dose 5-20 mg, frequency of administration – 1-2 times a day);

   Triamterene (daily dose 50-150 mg per day, frequency of administration - 1-2 times a day).

   Combinations of antihypertensive drugs:

   – thiazide diuretic and ACE inhibitor (for example, indapamide and enalapril),

   – thiazide diuretic and angiotensin II receptor blocker (for example, losartan and hypothiazide),

   – calcium channel blocker and ACE inhibitor (for example, amlodipine and perindopril),

   – calcium channel blocker and angiotensin II receptor blocker (for example, felodipine and candesartan),

   – calcium channel blocker and thiazide diuretic,

   – beta-blocker and calcium channel blocker of the dihydropyridine series.

   Prevention

   Primary: elimination of psycho-emotional overload, rational nutrition, reducing salt intake, healthy lifestyle, physical activity.

   Secondary: non-drug methods for correcting risk factors, rest in a horizontal position for at least 30 minutes every day, systematic antihypertensive therapy.

   Patient education.

   It is necessary to train patients in the techniques and rules for measuring blood pressure, early diagnosis of disease complications, and behavioral tactics when they occur.

   Patients keep diaries to assess the effectiveness of drug therapy (based on the results of self-monitoring of blood pressure), monitoring the effectiveness of physical activity, assessing quality of life, etc.

   To educate patients in medical institutions, schools for patients with hypertension are being created.

   Organization of nursing process

   A 40-year-old female patient was admitted for inpatient treatment to the cardiology department with a diagnosis of stage II hypertension, exacerbation.

   The patient complains of periodic severe headaches in the occipital region, weakness, and poor sleep. She has been ill for about 5 years, her condition has worsened over the last 2 months, after a stressful situation. He takes medications prescribed by the doctor irregularly, mainly when he feels unwell. He does not follow a diet, abuses spicy, salty foods, drinks a lot of liquids, and especially loves instant coffee. She doesn’t know how to measure her own blood pressure, but would like to learn. He notes that it has gotten worse in the last year, but tries not to pay attention to the disease and live as before.

   The patient is overnourished (height 162 cm, weight 87 kg). Respiratory rate - 20 per minute, pulse 80 per minute, rhythmic, tense, blood pressure - 180/100 mm Hg. Art.

   Objectively: the condition is of moderate severity, consciousness is clear, the skin is clean, of normal color.

   1. Patient's problems:

   Real: does not understand that it is necessary to change lifestyle with hypertension; has no idea how to eat properly with arterial hypertension; does not understand the need to limit salt and liquid, drinks a lot of coffee; does not know how to measure his or her blood pressure; does not understand that it is important to regularly take medications prescribed by a doctor; doesn't sleep well

   Potential: risk of developing hypertensive crisis, myocardial infarction, stroke.

   Priority issuepatients: does not understand that it is necessary to change lifestyle with hypertension.

   Target: the patient will demonstrate knowledge of the correct lifestyle for hypertension by the end of the week.

   Plan	Motivation
   1. Conversation about the need to follow diet No. 10.	To limit salt and fluid to lower blood pressure
   2. Conversation with the patient and relatives about eliminating risk factors.	In order to normalize blood pressure
   3. Conversation with the patient and relatives about the need to constantly take medications.	In order to maintain blood pressure at normal levels and prevent complications
   4. Teaching the patient how to measure blood pressure.	For continuous self-monitoring of blood pressure
   6. Weighing the patient and monitoring daily water balance.	To identify fluid retention and control body weight.

   Assessment: the patient demonstrates knowledge about diet, control of risk factors, and the need for constant medication use. The goal has been achieved.

   Effective treatment of hypertension involves not only strict adherence to medical recommendations for patients, but also daily medical procedures that are necessary for proper control of the disease. This fact emphasizes the relevance of nursing care to maintain a stable health status of hypertensive patients and prevent serious complications.

   Arterial hypertension (AH) develops with pathologically elevated blood pressure (BP). The pathology is so common that many hypertensive patients are not aware of their problems. Danger can be recognized by a whole range of signs:

   • Regular headache, mainly in the temporal and occipital region;
   • Dizziness, loss of coordination and orientation in space;
   • Low performance, increased fatigue and irritability;
   • Memory loss, numbness and weakness of the arms and legs.

   In the absence of adequate and timely treatment, serious complications are possible in the form of cerebral stroke, myocardial infarction, acute renal and cardiac pathologies.

   The main goal of treatment is to stabilize blood pressure. The result is achieved in different ways:

   • Prescribing antihypertensive drugs;
   • Giving up bad habits;
   • Correction of excess weight;
   • Limiting salt in the diet;
   • Physical activity and massage.

   The set of measures to normalize blood pressure is designed for a long time. At the first stage of the disease, a hypertensive patient is able to strictly follow all instructions; in more serious cases, nursing care for hypertension is planned.

   The nursing process for hypertension involves differentiated provision of medical services personally to each patient. The responsibilities of a nurse caring for hypertension include:

   • Organizing conditions for the patient’s recovery;
   • Carrying out all necessary manipulations - medical, hygienic, preventive;
   • Assistance in meeting the household needs of the ward;
   • Organization of training for hypertensive patients and their family members in self-care skills that maintain health;
   • Increasing the patient's level of awareness about the characteristics of his disease.

   The stages of nursing care include maintenance, diagnosis, development of goals for nursing participation, agreement on a care plan and its implementation, and analysis of achieved results. The service becomes especially relevant in cases of complications of hypertension in the form of atherosclerosis.

   The main task at the initial stage is to organize a nursing examination: monitoring subjective data, objective analysis of the information received and the patient’s psychosocial situation.

   The nurse tries to establish a trusting relationship with the patient, assesses his fears and expectations from the result of the proposed treatment, analyzes all the collected information in order to draw up a care plan for the hypertensive patient based on it.

   The next step is aimed at identifying the patient’s real and potential problems created by the peculiarities of the course of his disease. The nurse’s responsibilities include diagnosing all patient complaints.

   The patient’s complaints can have both a physiological and psychological basis, so it is important to adequately assess all his problems. The following table will help you make a correct diagnosis:

   Symptoms	Diagnosis
   Sleep disorders	CNS dysfunction due to hypertension
   Tachycardia	Impact of the sympathoadrenal system
   Heartache	Poor blood supply to the coronary vessels
   Fast fatiguability	Hypertension symptom
   Decline in performance	Sign of hypertension
   Nosebleeds	Increased blood pressure
   Dyspnea	Pulmonary edema
   Deterioration of vision	Problems of the eye vessels
   High level of anxiety	Lack of awareness of one’s disease, insufficient self-help skills

   The goal of the next step is to develop a personalized treatment plan for the patient. It is divided into several tasks - short-term, which involve implementation within a week, and long-term, designed for the entire course of treatment. To accurately determine your care goals, you can focus on general criteria:

   • The reality of the task and the degree of its implementation;
   • Time frame for achieving the goal;
   • Participation of the patient in the discussion of the plan.

   Before making a plan, the nurse tries to determine what functions the patient can do and what the patient cannot do on his own. You should also find out the degree of learning of your ward: whether it is possible to restore his self-service skills.

   At the next stage, the health worker draws up a nursing care plan aimed at organizing treatment. It is convenient to format the nursing process in the form of a table with the following sections:

   • Date of visit.
   • Hypertensive problem.
   • Expected Result.
   • Description of medical services.
   • The patient's reaction to the assistance provided.
   • Goal implementation date.

   The plan can indicate different options for solving problems, this will increase the percentage of its effectiveness. When carrying out planned activities, the health worker must follow certain rules:

   1. Systematically implement all points of the plan;
   2. Involve the patient and his family members in the process of its implementation;
   3. Adjust the plan in accordance with changes in the patient’s health status, taking into account any appearance of new complaints or exclusion of old symptoms;
   4. Strictly follow the algorithm for performing medical procedures.

   To adjust the patient’s lifestyle at this stage, it is very important to competently analyze and evaluate the results of nursing participation. When analyzing, you need to consider the following questions:

   • Is there any noticeable progress in the prescribed treatment regimen?
   • Does the expected forecast coincide with the achieved result;
   • Are the services of the health worker sufficiently effective for all specific problems of the ward;
   • Is there a need to revise the plan?

   For the objectivity of the assessment, the results must be summed up together with the health worker who examined the hypertensive patient at the first visit. The assessment of the need for all procedures will be incomplete if certain rules were not followed during the period of medical observation:

   • All (major and minor) services were not recorded;
   • The manipulations performed were documented later;
   • All health deviations throughout the process are not noted;
   • The entries use vague language;
   • Some sections were left blank.

   An innovative device for monitoring and adjusting blood pressure, developed by Russian scientists, can provide invaluable assistance to hypertensive patients in self-care.

   An antihypertensive is a device for normalizing high blood pressure. The first complex influence device in world medical practice normalizes the balance of differently charged ions in the human body.

   The device successfully passed all clinical tests. The Antihypertensive device received reviews as the safest among existing effective assistants for combating this insidious disease.

   The antihypertensive drug and its improved second-generation analogue actually improve blood pressure in hypertension. Pressure changes during hypertension are the main indication for their acquisition. The innovative device gives its owners a chance to return to normal life, even if previous treatment attempts were not effective enough.

   The Antihypertensive device will be useful both for patients with primary hypertension and for those with increased blood pressure caused by pathologies of the kidneys, blood vessels, and endocrine system.

   Good results from using the Antihypertensive device are demonstrated by reviews of patients with the third stage of the disease, who completely got rid of the symptoms of hypertension, the price of which determined a complete loss of interest in life.

   The antihypertensive drug has no contraindications: it is useful for patients of any age and length of illness. The device is also useful for patients with complications of hypertension in the form of nephropathy and optic nerve dystrophy. The device does not require a strict diet, restrictions on emotions or physical activity.

   You can buy Antihypertensive at a very affordable price on the Internet, where managers will always advise on its operation.

   The main result of nursing care is that a hypertensive patient feels better after qualified intervention, and his relatives have all the skills to help the patient noted in the developed plan.

State budgetary educational institution

secondary vocational education

"Krasnodar Regional Basic Medical College"

Ministry of Health of the Krasnodar Territory

Cyclic commission "Nursing"

Coursework for the professional module

“Participation in diagnostic, treatment and rehabilitation processes”

Topic: “Features of nursing care for hypertension in a hospital setting”

Introduction

1 Etiology of the disease

2 Pathogenesis

3 Symptoms

4 Clinical forms

5 Classification

6 Complications

7 Prevention

Chapter 2. Practical part

3 Practical part

Conclusion

List of sources

Introduction

Hypertension is very common these days, especially in industrialized countries. Our country is no exception; in Russia it is also the most common disease that doctors and hospital nurses encounter in their daily work.

High blood pressure often occurs already in adolescence; the disease rapidly grows younger, like most diseases of the cardiovascular system. Already, according to Rosstat, up to 38% of young people suffer from hypertension to one degree or another. As for older people, the statistics in this area are not at all reassuring; up to 75% of pensioners suffer from hypertension.

Hypertension is becoming the main cause of premature mortality in the population. This disease is characterized by a long and persistent course, the development of severe complications (myocardial infarction, cerebral stroke, heart and kidney failure), and is accompanied by a decrease in working capacity, including disability.

The insidiousness of the disease is that it can occur unnoticed by the patient himself. A person experiences headaches, irritability, dizziness, memory deteriorates, and performance decreases. Having rested, he temporarily ceases to feel these symptoms and, mistaking them for manifestations of ordinary fatigue, does not see a doctor for years. Over time, hypertension progresses. Headaches and dizziness, mood swings, and excessive irritability become constant. Significant deterioration in memory and intelligence, weakness in the limbs and a sharp deterioration in vision are possible.

Considering the danger of hypertension for modern people, I consider it important to consider this disease as part of my work.

The object of study of this work is the features of nursing activities for hypertension in a hospital setting.

The subject of the study is the problems of patients of different age groups with hypertension, assistance in their elimination and prevention. As well as the possibility of inheriting problems of the disease.

Objectives: Like any chronic disease, hypertension can be corrected only with constant and competent therapy. Therefore, I believe the main goal of this work is:

.Study of the main activities of a nurse in the treatment of hypertension in a hospital setting.

.To study the problems of a patient with hypertension.

.Identify problems of patients of different ages by studying symptoms.

.Note the main stages of the nursing process for hypertension.

3.Study modern medical data on hypertension.

The methods used in writing this work are, first of all, the analysis of medical information on the disease, as well as conducting a nursing examination and observation of two patients with hypertension, in this case a father and son.

Chapter 1. Characteristics of hypertension

Hypertension (hypertension) is a chronic disease characterized by constant, and in the initial stages, periodic increases in blood pressure. Hypertension is based on increased tension in the walls of all small arteries, resulting in a decrease in their lumen, making it difficult for blood to move through the vessels. At the same time, blood pressure on the walls of blood vessels increases.

Hypertension is divided into two large groups - essential (primary) and symptomatic (secondary) hypertension. Essential hypertension is a disease at the level of the whole organism. With secondary hypertension, there is damage to one or another organ, which leads to an increase in blood pressure. Secondary hypertension is divided into renal (glomerulonephritis, pyelonephritis, renovascular hypertension, etc.), endocrine (pheochromocytoma, paraganglioma, Cohn syndrome, Itsenko-Cushing syndrome), vascular (coarthation of the aorta), hypertension with damage to the central nervous system.

1 Etiology of the disease

The etiology of this disease has not yet been fully studied.

There are provoking and contributing factors for hypertension:

) Stress (as a result of stress, a huge amount of adrenaline is released into the blood, which leads to an increase in blood pressure);

) Age-related restructuring of endocrine organs;

) Taking certain medications (oral contraceptives with high hormone content, medications to reduce appetite, certain anti-inflammatory drugs);

) Smoking, drinking strong coffee, systematically drinking alcohol;

) Consuming excess salt (as a result of which sodium accumulates in the body, which brings with it excess water through the lining of the artery wall cells);

) Alimentary obesity and a sedentary lifestyle (as a result of which there is constant compression of blood vessels and obstruction of blood flow);

) Heredity is the most important factor. The following factors for the development of arterial hypertension are inherited:

a) Membrane pathology (membranes have excessive permeability of Ca and Na ions into the cell)

b) Morphologically more active development of the density of sympathoergic cells. As a consequence, there is a tendency to reduplicate smooth muscle cells responsible for vascular contraction.

c) Increased activity of nerve regulation centers.

d) Weakening of the regulatory function of the kidneys.

1.2 Pathogenesis

Development of hypertension according to G.F. Langu (according to the textbook “Internal Diseases” edited by A.S. Smetnev) is explained by three main provisions:

) hypertension occurs as a neurosis of the higher centers of neurohumoral regulation of blood pressure;

) developing neurosis is a manifestation of stagnation of irritable processes in the corresponding nerve centers of the hypothalamic region or the cerebral cortex;

) stagnation of irritable processes in these centers develops under the influence of negative emotions and effects. In the initial stages of the disease, an increase in the activity of the sympathoadrenal system contributes to an increase in cardiac output, which in itself causes hypertension, promotes an increase in the secretion of neurohormones of the renin-hypertensin-aldosterone link, and therefore there is a tendency to increase vascular tone. There is significant activation of the sympathetic innervation of the kidneys, leading to a decrease in renal blood flow and a moderate decrease in sodium and water excretion. In later stages, renal pressor mechanisms become more important. Increased secretion of renin leads to the formation of significant amounts of angiotensin, which stimulates the production of aldosterone. In the pathogenesis of hypertension, there is a parallel increase in the tone of the sympathoadrenal system, a change in the morphological structure of blood vessels and insufficiency of the depressor mechanisms of the prostaglandin, kinin, and baroreceptor systems.

Three parts of the pathogenesis of hypertension can be distinguished:

) central - a violation of the relationship between the processes of excitation and inhibition of the central nervous system;

)humoral - production of pressor substances and reduction of depressor effects;

) vasomotor - tonic contraction of arteries with a tendency to spasm and organ ischemia.

3 Symptoms

Symptoms of hypertension: increased blood pressure, which is clinically manifested by headache, tinnitus, flashing “spots” before the eyes, pain in the heart area, palpitations. When blood pressure increases, changes occur in various organs. The organs most susceptible to the effects of high blood pressure are called target organs. These are the brain, heart, blood vessels, retina, kidneys.

Headaches occur in the occipital region, more often in the morning, as well as in the parietal and temporal regions. The pain intensifies with mental and physical stress. Very severe pain occurs during hypertensive crises - a sudden and pronounced increase in blood pressure to critical values. At the same time, the patient is very worried about dizziness and disturbances in vision, and sometimes speech. Pain in the heart area with hypertension can be different - compressive, behind the sternum, such as angina, long-term aching, but also short-term, usually stabbing. Long-term hypertension makes it difficult for the heart to work; as a result, it contracts more often, the pulse quickens, the size of the heart increases, and dystrophic changes in the myocardium are observed.

1.4 Clinical forms

Hypertension is chronic, with periods of deterioration and improvement. Progression may vary in pace. A distinction is made between slowly and rapidly progressing disease. With the slow development of the disease, hypertension goes through 3 stages (according to the classification adopted by WHO). The stage of hypertension is characterized by relatively small increases in blood pressure in the range of 160-179/95-105 mm Hg. Art. The level of blood pressure is unstable; during the patient’s rest it gradually normalizes, but an increase in blood pressure inevitably occurs again. Some patients do not experience any changes in their health status. Scanty and unstable symptoms occur easily and pass quickly. Subjective symptoms of stage I are mainly reduced to functional disorders of the nervous system: mental performance decreases, irritability, headaches, and sleep disturbances appear. Sometimes there are no subjective symptoms at all. Increased blood pressure is usually detected incidentally. It is unstable and can periodically increase under the influence of emotional overload. Usually there are no signs of left ventricular hypertrophy, the electrocardiogram is not changed; hemodynamics are quite effective. Renal functions are not impaired, the fundus of the eye is practically unchanged. The stage of hypertension is characterized by a pronounced clinical picture. Patients with moderate severity make up the bulk of outpatients and, to a lesser extent, inpatients. They are often bothered by headaches, dizziness, sometimes angina attacks, shortness of breath during physical effort, decreased performance, and sleep disturbances. Their blood pressure is constantly elevated: systolic is 180-199 mm Hg. Art., diastolic - 104-114. Moreover, in some cases, hypertension is labile, that is, blood pressure periodically decreases spontaneously, but not to normal, while in others it remains stably at a high level and decreases only under the influence of drug treatment. Hypertensive crises are typical for this stage of the disease. Signs of target organ damage are revealed: left ventricular hypertrophy, weakening of the first sound at the apex of the heart, emphasis of the second tone on the aorta, in some patients the electrocardiogram shows signs of subendocardial ischemia. Cardiac output is either normal or slightly reduced in most; with physical activity it increases to a lesser extent than in healthy people. Indicators of vascular peripheral resistance are noticeably increased, and the speed of propagation of the pulse wave through the arteries clearly increases. However, in uncomplicated cases, manifestations of myocardial failure are rarely observed. The picture of the disease can change dramatically with deterioration of coronary circulation, the occurrence of myocardial infarction, and atrial fibrillation. On the part of the central nervous system in stage II of the disease, various manifestations of vascular insufficiency and transient ischemia are noted, often without consequences. More serious cerebrovascular accidents are the result of atherosclerosis. In the fundus, in addition to narrowing of arterioles, compression and expansion of veins, hemorrhages, and exudates are observed. Renal blood flow and glomerular filtration rate are reduced; although there are no abnormalities in the urine test, radiographs show more or less clear signs of a diffuse bilateral decrease in renal function. The stage of hypertension is characterized by a steady increase in blood pressure. Systolic blood pressure reaches 200-230 mm Hg. Art., diastolic - 115-129. However, at this stage, blood pressure may spontaneously decrease, in some cases quite significantly, reaching a lower level than in stage II. The condition of a sharp decrease in systolic blood pressure in combination with increased diastolic is called “decapitated” hypertension. It is caused by a decrease in the contractile function of the myocardium. If atherosclerosis of large vessels is added to this, then the level of diastolic blood pressure decreases. At stage III of hypertension, hypertensive crises often occur, accompanied by cerebrovascular accident, paresis and paralysis. But the vessels of the kidneys undergo especially significant changes, resulting in the development of arteriolohyalinosis, arteriolosclerosis and, as a consequence, the formation of a primary wrinkled kidney, which leads to chronic renal failure. More often, in stage III of hypertension, cardiac or cerebral pathology predominates, which leads to death before chronic renal failure develops. The clinical picture of heart damage is angina pectoris, myocardial infarction, arrhythmia, circulatory failure. Cerebral lesions - ischemic and hemorrhagic infarctions, encephalopathy. As for changes in the fundus of the eye, its examination reveals the “silver wire” symptom, sometimes acute retinal ischemia with loss of vision (this severe complication can occur as a result of vasospasm, thrombosis, embolism), swelling of the optic nerve nipples, retinal edema and its detachment, hemorrhages.

5 Classification

Hypertension is defined as an increase in systolic blood pressure to or above 140 mmHg. Art. and/or diastolic pressure up to and above 90 mmHg. Art. in persons not taking antihypertensive drugs.

Degrees of hypertension depending on systolic and diastolic pressure:

(in mmHg) (in mmHg)

Optimal< 120< 80

Normal< 130< 85

Increased normal 130-139 85-89

Stage I - mild hypertension 140-159 90-99

subgroup - borderline hypertension 140-14990-94

Stage II - moderate hypertension 160-179100-109

Grade III - severe hypertension > 180 > 110

Isolated systolic hypertension > 140 < 90

Subgroup - borderline hypertension 140-149 < 90

6 Complications

Damage to the blood vessels of the brain leads to cerebrovascular insufficiency. In such patients, thrombosis of blood vessels and the brain may occur, resulting in loss of consciousness, impaired speech, swallowing, breathing, and thromboischemic stroke. Sometimes bleeding in the brain occurs. As a result of the development of atherosclerotic changes in the vessels of the heart, signs of either chronic coronary circulatory insufficiency with angina pectoris and rest, or symptoms of acute coronary circulatory disorders (myocardial infarction), develop.

Damage to the renal vessels during hypertension leads to the development of renal arteriolosclerosis. Symptoms of renal failure develop: urine density becomes low, polyuria, iso- and hyposthenuria appear. In the late stage of the disease, the content of residual nitrogen in the blood increases, and uremia syndrome develops.

In addition to these complications, at any stage of hypertension a complication may occur - a hypertensive crisis.

Hypertensive crisis is a sudden increase in blood pressure, accompanied by disorders of the autonomic nervous system and increased disorders of the cerebral, coronary and renal circulation. It is important to increase blood pressure to individually high numbers. There are crises of types 1 and 2. Type 1 crisis occurs in stage 1 of hypertension and is accompanied by neurovegetative symptoms. Type II crisis occurs in stages II and III of hypertension.

Symptoms of a crisis: cutting headache, transient visual impairment, hearing impairment (stupefaction), heart pain, confusion, nausea, vomiting. The crisis is complicated by myocardial infarction and stroke. Factors provoking the development of crises: psycho-emotional stress, physical activity, sudden withdrawal of antihypertensive drugs, use of contraceptives, hypoglycemia, menopause, etc.

There are benign and malignant forms of hypertension. The benign variant is characterized by slow progression, changes in organs are at the stage of stabilization. The treatment is effective. Complications develop only in the later stages.

The malignant variant of hypertension is characterized by a rapid course, high blood pressure, especially diastolic, rapid development of renal failure and brain disorders. Changes in the fundus arteries with foci of necrosis around the optic nerve nipple and blindness appear quite early. When treating a malignant form of hypertension, it can be fatal if left untreated.

7 Prevention

Measures to prevent hypertension are the subject of intensive and in-depth research. Hypertension, as observations have shown, is one of the most common cardiovascular diseases in the world.

Patients with hypertension are more predisposed to the occurrence of atherosclerosis, especially of the arteries of the brain, heart, and kidneys. All this indicates the need for systematic measures of personal and public prevention of this disease and its timely treatment.

The role of nervous mechanisms in the origin of hypertension is evidenced by the following facts: in the vast majority of cases, in patients it is possible to establish in the past, before the onset of the disease, the presence of strong nervous “shocks”, frequent unrest, and mental trauma. Experience shows that hypertension is much more common in people exposed to repeated and prolonged nervous strain. Thus, the huge role of neuropsychiatric disorders in the development of hypertension is indisputable. Of course, personality traits and the reaction of the nervous system to external influences matter.

Heredity also plays a certain role in the occurrence of the disease. Under certain conditions, nutritional disorders can also contribute to the development of hypertension; Gender and age matter. Thus, women during menopause (40-50 years old) suffer from hypertension more often than men of the same age. Increases in blood pressure can occur in women during pregnancy, which can lead to serious complications during childbirth. Therefore, in this case, therapeutic measures should be aimed at eliminating toxicosis. Atherosclerosis of cerebral vessels can contribute to the development of hypertension, especially if it affects certain sections responsible for the regulation of vascular tone.

Renal dysfunction is very important. A decrease in blood supply to the kidneys causes the production of a special substance - renin, which helps to increase blood pressure. But the kidneys also have a so-called renoprivile function, which consists in the fact that the medullary zone of the kidneys produces a substance that destroys compounds in the blood that increase pressure (pressor amines). If for some reason this so-called antihypertensive function of the kidneys is impaired, then blood pressure rises and stubbornly remains at a high level, despite comprehensive treatment with modern means. In such cases, it is believed that the development of persistent hypertension is a consequence of impaired renal function of the kidneys.

Prevention of hypertension requires special attention to nutrition. It is recommended to avoid excessive consumption of meat and fats. The diet should be moderate in calories, with limited protein, fat and cholesterol. This helps prevent the development of hypertension and atherosclerosis.

Overweight people should periodically resort to fasting diets. A known dietary restriction must be consistent with work activity. In addition, significant malnutrition contributes to the development of hypertension, causing changes in the reactivity of the higher parts of the central nervous system. A proper diet without the formation of excess weight should be sufficient to prevent functional disorders of the higher nervous system. Systematic weight control is the best guarantee of a proper diet.

A person suffering from hypertension should be moderate in fluid intake. The normal daily need for water is satisfied by 1.5 liters of all water taken per day in the form of liquids, including liquid meals at lunch. In addition, a person receives about 1 liter of liquid from water, which is part of the products. In the absence of heart failure, the patient can afford to take fluid in the range of 2-2.5 liters (preferably no more than 1.2 liters). It is necessary to distribute the drink evenly - you cannot drink a lot at once. The fact is that liquid is quickly absorbed from the intestines, flooding the blood, increasing its volume, which increases the load on the heart. It must move more blood than usual until the excess fluid is removed through the kidneys, lungs and skin.

Overwork of a diseased heart causes a tendency to edema, and excess fluid aggravates it even more. The use of pickles should be avoided and table salt should be limited to 5 g per day. Excessive salt consumption leads to disruption of salt-water metabolism, which contributes to hypertension. Alcoholic drinks and smoking also accelerate the development of the disease, so they should be strictly prohibited for patients with hypertension. Nicotine is a poison for blood vessels and nerves. The appropriate distribution of work and rest hours is of great importance. Long and intense work, reading, mental fatigue, especially in people predisposed to hypertension, contribute to its occurrence and development.

Particular attention should be paid to physical culture. It is a kind of protective measure that trains the neurovascular system of patients with hypertension, reduces phenomena associated with disorders of the nervous system - headache, dizziness, noise and heaviness in the head, insomnia, general weakness. Exercises should be simple, rhythmic, and performed at a calm pace. Regular morning hygienic exercises and constant walking, especially before bed, lasting at least an hour, play a particularly important role.

Conclusion: Hypertension is a terrible vascular disease that can cause irreversible damage to the patient’s body. Like any chronic disease, it is easier to prevent than to treat. Therefore, prevention of hypertension is necessary, especially for people with a family history.

hypertension disease nursing

Chapter 2. Practical part

1 Nursing process plan for hypertension in a hospital setting

The goal of the nursing process in hypertension is to create for the patient all the conditions necessary for his recovery, to direct all his actions to preserve health, speedy recovery and prevent complications in the patient, alleviate suffering during the disease, and also help him fulfill all the needs and desires that he himself cannot realize the moment of illness.

)Conduct subjective and objective examinations of the patient.

)Identify real and potential problems, identify the patient’s violated needs.

Patient problems:

A) Existing (present):

headache;

dizziness;

sleep disturbance;

irritability;

absence of mandatory alternation of work and rest;

lack of adherence to a low-salt diet;

lack of constant use of medications;

lack of knowledge about factors contributing to increased blood pressure.

B) Potential:

risk of developing a hypertensive crisis;

risk of developing acute myocardial infarction or acute cerebrovascular accident;

early visual impairment;

risk of developing chronic renal failure

)In connection with the identified problems, set short- and long-term goals to maintain the health and encourage the patient to recover.

)To reduce the risk of possible complications, the nurse needs to make sure during the conversation that the patient understands the fact that the absence of symptoms of the disease is not a reason to refuse blood pressure control. The patient should be reminded that symptoms appear already in the advanced stage of the disease.

)Monitor the patient's weight. Strictly monitor blood pressure levels (3 times a day and if dizziness and pain occur), temperature (2 times a day), pulse (2 times a day). Record everything graphically on the temperature sheet and record the readings on the patient’s dynamic assessment sheet.

)Strictly follow the doctor’s instructions for medication and physiotherapeutic treatment of the patient. Inform the patient about the effects of the procedures and medications prescribed to him, convince him of the need for systematic and long-term use only in the prescribed doses and their combinations with meals.

)If the patient forgets to take medications on time, you can discuss with him ways to remember, for example, connection with a certain meal (breakfast, lunch, etc.).

)Conduct control of transferred products by relatives or other close people to inpatients.

)Convince the patient of the need for a gentle daily routine (improvement of work and home conditions, possible changes in working conditions, nature of rest, etc.).

)Teach the patient relaxation techniques to relieve tension and anxiety.

)Conduct a conversation about possible complications of hypertension, point out their causes.

)Conduct a conversation with the patient/family about the need to follow a diet with limited salt (no more than 4-6 g/day).

)Teach the patient (family):

determine heart rate; measure blood pressure;

recognize the initial symptoms of a hypertensive crisis;

provide first aid during crises.

2 Statistics on hypertension

Statistics on morbidity and mortality

Cardiovascular diseases and hypertension in particular are called the epidemic of the 21st century. Unfortunately, every fifth inhabitant of our planet (about one and a half billion people) suffers from hypertension, and in Russia, according to some data, every third. But if earlier in the world the disease was mainly diagnosed in people over forty, now about 33.4% of hypertensive patients are young people, 7.2% teenagers and 2% children.

As for Russia, our country ranks third in the incidence of hypertension, after the United States and the European Union. According to statistics from the Ministry of Health and Social Development and the Russian Academy of Medical Sciences, about 63% of the total population suffers from hypertension in our country. If we talk about the treatment of hypertension, then according to the same Ministry of Health and Social Development, more than 51% of men and 43% of women suffering from high blood pressure are not treated, and 32% are treated ineffectively. And only 9% of men and 12% of women in Russia achieve target (i.e. normal) blood pressure during treatment. The mortality statistics from hypertension are simply off the charts; in the last two years alone (1012 - 1013), the number of deaths amounted to more than 950 thousand people.

Regarding the Krasnodar region, we can say that it ranks seventh in the number of diagnosed cases of hypertension. In 2012, the region recorded a decrease in the overall incidence of hypertension among adolescents by 3.4% and adults by 4.0%; among children, the overall incidence of hypertension remained at the 2011 level (2.0 per 100 thousand population). Mortality decreased by 6.7%.

In Krasnodar itself there are no general statistics, but according to data from city hospital No. 3, it can be judged that today the incidence is approximately only 31% among the adult population of the city.

In forecasts, morbidity statistics look like this: as the population ages and the role of factors such as obesity, sedentary lifestyle, smoking and constant stress increases, by 2025 the incidence of hypertension is expected to increase to 45%, and the share of hypertension in the structure of population mortality will rise to 1,600,000 people.

Statistics on common problems with hypertension

When considering the frequency of occurrence of problems in patients with hypertension within hospital hospital No. 3, the following statistics can be derived:

.The most common physiological problems in patients are:

v High blood pressure level - 100%;

v Headaches - 100%;

v General weakening of the body - 95%;

v Disorders of nervous activity (sleep disorders, irritability, etc.) - 89%;

v Pain in the heart area - 70%;

v Pain in the eyes and decreased vision - 60%;

v Reduced kidney activity - 35%.

The most common psychological problems in patients are:

v Feeling of inferiority due to illness - 78%;

v Concern about the outcome of the disease - 70%;

v Lack of knowledge about the characteristics of nutrition and lifestyle associated with one’s illness - 60%

v Depression and apathy of patients associated with a lack of knowledge about the disease - 40%

v Fear of diagnostic tests - 50%.

Conclusion: Statistics show that the incidence of hypertension is gradually decreasing, although if the standard of living of the population does not improve, the incidence will increase again.

3 Practical part

Patient #1

Patient - Peter. Age sixteen.

He was admitted to the hospital for routine hospitalization with complaints of frequent headaches, fatigue, and high blood pressure. In addition, he is bothered by eye pain and pain in the heart, shortness of breath during physical exertion, frequent convulsions, restless sleep, and severe irritability.

Clinical diagnosis - Arterial hypertension.

Concomitant diagnosis - myocardial dystrophy, minor cardiac anomaly, retinal angiodystonia of both eyes. Suspicion of atherosclerosis of the lower extremities.

Anamnesis of life

Born in second birth, not full term (32 weeks), breastfed. As a child, he often suffered from sore throat and suffered from chickenpox. He is registered with a neurologist and cardiologist. Vaccinations according to age. Allergy history is not burdened. There are no bad habits.

Heredity: on the maternal side - the mother suffered from hypotension, oncology, the mother died at the age of 48 from metastasis of the kidneys and urinary system, the grandmother also had an incidence of hypertension, died at the age of 69 from a stroke. On the father's side, everyone had hypertension; the father suffers from hypertension, atherosclerosis of the lower extremities, and suffered a myocardial infarction and stroke.

He suffered an ankle fracture at the age of 11, there were no operations.

History of the disease

The disease was first diagnosed in 2005 at the age of eight years, after hospitalization in Children's Hospital No. 1 with suspected vegetative crisis. It manifested itself as a headache in the temples and rapid fatigue, as well as a rare increase in blood pressure to 130/85. Since this time, the patient has clearly observed emotional lability.

The cause of the disease was psycho-emotional shock, and possibly heredity.

The disease from borderline hypertension was actively developing. This was manifested by increased pain and increased blood pressure. A possible reason for the progression of the disease is an unstable emotional background in the family.

At the moment, the disease is in the first stage of its development. After annual planned treatment, short-term relief occurs.

Patient problems: the priority problem is high blood pressure. Other problems for the patient include difficulty in stable work and study, sleep and appetite disturbances, pain in the eyes and temples. From the patient's psychological point of view, problems are viewed quite critically.

Recommendations: the patient should learn relaxation methods, correctly build a daily routine so that active work is interspersed with rest, eliminate long-term physical and mental stress, monitor blood pressure levels, consult with a phytologist about herbal medicine for your disease and with a physiotherapist about prescribing massage or exercise therapy . The patient must also follow all recommendations given by the attending physician.

Patient #2

Patient - Alexey. Age sixty-five years.

He was admitted to hospital No. 3 urgently with a suspicion of hypertensive crisis. Upon admission, confusion was observed, speech was unclear, and a persistent increase in blood pressure to 230/120. .According to relatives, it became known that the patient had frequent headaches and constant high blood pressure.

Clinical diagnosis - Hypertensive crisis, which developed against the background of third-degree hypertension.

Concomitant diagnosis: atherosclerosis of the lower extremities, thrombophlebitis.

Complication: acute renal failure, angina pectoris.

Anamnesis of life

Born in the first labor, full term (36 weeks), breastfed. As a child, he suffered from chickenpox and bronchitis. He suffered a myocardial infarction at 45 years old and a stroke at 62 years old. He is registered with a cardiologist. Allergy history is not burdened. Bad habits: smoking (quit after a heart attack), addiction to alcohol.

Heredity: on the maternal side - the mother suffered from a mental disorder, suffered from hypertension, died of a stroke at the age of 72. On the paternal side, all men presumably had hypertension; the father suffered from atherosclerosis of the extremities, trophic ulcers and hypertension, and died at the age of 68 from a heart attack.

Lives in relatively normal environmental conditions. The psycho-emotional situation around the patient is not stable.

He suffered a fracture of his left leg (tibia) at the age of 42, and surgery to remove appendicitis at the age of 56.

History of the disease

The disease was first diagnosed in 1980 at the age of thirty-two, after visiting a neurologist at the place of residence. It was manifested by headaches, severe fatigue, increased blood pressure to 165/100, and the patient also experienced excessive irritability.

The cause of the disease was a number of factors: heredity, bad habits, work associated with emotional stress.

Over a long period of time, the disease progressed from the second stage to the third. This is manifested by an increase in headaches and higher blood pressure, as well as the appearance of complications in the form of angina and kidney failure. The reason for this was bad habits and an unstable emotional background in the family.

At the moment, the disease is at the last stage of development. The patient is examined for hypertension every year.

Patient's problems: The patient's priority problem is too high blood pressure (up to 230/140), which causes frequent and severe headaches. The patient is practically incapable of prolonged physical activity. Other problems include moral decline, sleep disturbances and lack of appetite, and a pathological decrease in diuresis (oliguria).

Recommendations: the patient should give up bad habits and try to properly adjust their daily routine to normalize sleep and appetite. You should also count blood pressure, respiratory rate and pulse at least three times a day, monitor daily diuresis, go on a special diet for weight loss, and the patient must follow all recommendations given by the attending physician.

Conclusion

After analyzing the medical literature on hypertension, I came to the conclusion that this disease is extremely dangerous these days. This is explained by the fact that the causes of development are those factors that are extremely difficult for a modern person to avoid (Stress and, as a consequence, bad habits, obesity, a sedentary lifestyle, poor ecology.) In addition, this disease, with prolonged absence of treatment and improper treatment, can cause serious and, as a rule, irreversible changes in the cardiovascular system.

Hypertension, like any chronic progressive disease, is easier to prevent than to treat. Therefore, the prevention of hypertension, especially for people with a family history, is an urgent task. A correct lifestyle and regular monitoring by a cardiologist help delay or mitigate the manifestations of hypertension, and often even prevent its development altogether.

The role of the nurse in caring for patients with hypertension cannot be overestimated in the recovery process. The nurse is responsible for the health and well-being of the patient in the hospital, and she must achieve a reduction in discomfort and normalization of the patient’s state of mind. And also to convey to the patient and his and his loved ones all the information necessary for treatment and prevention.

Based on morbidity statistics, we can conclude that so far the fight against hypertension has been successful, but if the standard of living of the population continues to remain without positive changes, we should expect a large increase in the number of people suffering from hypertension.

If we look at the statistics on the occurrence of problems in hypertensive patients, we can see that patients are more often concerned about physiological problems. Most of all, patients are concerned about such problems as headache, high blood pressure and weakness.

Based on the research work done, I made the following conclusions:

.At different stages of the disease, patients experience slightly different complaints and problems. As the disease progresses, the main symptoms (headache, high blood pressure) are supplemented by symptoms of complications (renal failure, atherosclerosis, circulatory disorders in the brain). Based on this, the nursing process will also vary slightly with different degrees of disease development. But in any case, the patient needs rest, normal nutrition, stable and proper rest, as well as constant monitoring of blood pressure and pulse.

.The disease progresses differently based not only on the degree of development of the disease, but also on age. At a younger age, the consequences of hypertension are tolerated somewhat easier than in older people. This is due to the fact that young people have more elastic blood vessels and increased protective and adaptive properties of the body. In adulthood, pain and weakness become much more noticeable for the patient.

I consider all my goals and objectives completed.

This work was carried out with the aim of educating the population on issues related to hypertension, as well as to improve the quality of nursing care for patients suffering from hypertension.

List of sources

1) Obukhovets T.P. Nursing in Therapy; Rostov-on-Don: “Phoenix”, 2003.

2) Averyanov A. Hypertension. Diagnostics, prevention and treatment methods; Moscow: TsPG, 2005.

3) Martynova A.I., Mukhina N.A., Moiseeva V.S.. Internal diseases: Textbook for universities. In 2 volumes; Moscow: GEOTAR Medicine, 2002.

4) “Internal Diseases” edited by A.S. Smetneva, V.G.Kukesa; Moscow: “Medicine” 2003.

5) Kobalava Zh.D. Arterial hypertension in questions and answers: a reference book for practicing physicians; Moscow, 2002.

) House doctor. Pocket Guide; Moscow: ZAO OLMA Media Group, 2010.

)Medical encyclopedia. Translation from English Luppo; Moscow: KRON-PRESS, 1998.

To properly implement caring for patients with hypertension and timely and competently plan the nursing process, we will analyze the definition of the disease itself. So, hypertension is a disease accompanied by a pathological condition such as hypertension or hypertension.

Arterial hypertension or hypertension is an increase in blood pressure, which is caused by non-natural reactions of the body to certain physiological situations (stress, heat, somatic disease). With arterial hypertension, an imbalance occurs in the systems responsible for maintaining blood pressure within normal limits.

According to WHO (World Health Organization) recommendations, high blood pressure is considered to be blood pressure of 140/90 mm Hg. Art. Hypertension is a disease whose leading symptom is a tendency to arterial hypertension. Risk factors for hypertension are considered to be:

• genetic predisposition;
• chronic stressful situations;
• frequent heavy physical activity;
• absence or very minimum physical activity;
• psychological trauma;
• unbalanced diet (including increased consumption of table salt);
• alcohol abuse;
• smoking;
• overweight and obesity.

Until recently, hypertension was considered a disease of people aged 40 years and older. However, in recent years, hypertension, like other cardiovascular pathologies, has become significantly “younger” and is quite common in young people (under 30 years of age).

Stages of hypertension

Stage I - unstable increase in blood pressure to 140/90 - 160/100 mm Hg. Art., maybe for several days in a row. Blood pressure levels return to normal after rest. However, relapses in blood pressure rise are inevitable. There are no changes in internal organs in stage I HD.

Stage II - blood pressure level is from 180/100 - 200/115, there are fixed changes in internal organs (often left ventricular hypertrophy, retinal angiopathy). Blood pressure levels cannot normalize on their own, but sometimes hypertensive crises . At this stage, drug therapy is mandatory.

stage iii - persistent increase in blood pressure, reaching the level of 200/115 - 230/130. There are lesions of the heart, kidneys, and fundus. At this stage, there is a high risk of acute cerebrovascular accident - stroke or acute myocardial infarction.

Proper care for a patient with hypertension consists of following several rules:

• creation of optimal working and rest conditions;
• organization of a balanced diet (diet low in salt and liquid);
• monitoring the general condition and well-being of the patient;
• monitoring timely compliance with drug treatment.

Even before providing full care and assistance to a patient with hypertension, the nurse needs to identify his real and potential problems. This is especially important to do at an early stage of the disease.

Problems of a patient with stage I hypertension

Present (existing):

• headache;
• dizziness;
• anxiety;
• irritability;
• sleep disorders;
• unbalanced diet;
• stressful rhythm of life, lack of proper rest;
• the need to constantly take medications, lack of serious attitude towards this issue;
• lack of knowledge about the disease and its complications.

Potential (probable):

• visual impairment;
• development of hypertensive crisis;
• development of renal failure;
• development of heart attack or stroke.

After identifying problems during the initial assessment, the nurse collects information about the patient.

Questioning a patient with hypertension

The nurse needs to find out:

• conditions of professional activity;
• relationships within the team with colleagues;
• family relationships;
• presence of hypertension in close relatives;
• nutritional features;
• presence of bad habits (smoking, drinking alcohol);
• taking medications: which ones you take, how regularly, how you tolerate them;
• complaints at the time of the study.

Physical examination of the patient

The nurse records:

• patient's position in bed;
• skin color, including the presence of cyanosis in certain areas$
• blood pressure level;
• heart rate.

Nursing interventions when caring for a patient with hypertension

Modern care for patients with hypertension includes the following nursing interventions:

Conversations with the patient and his relatives:

• on the need to comply with the work and rest regime, improve working conditions and improve the quality of rest;
• about the importance of following a salt-free diet with low cholesterol;
• about the importance of timely, systematic taking of medications;
• about the effect of smoking and alcohol on increases in blood pressure.

Patient and family education

• measuring blood pressure and pulse rate;
• recognizing the first signs of a hypertensive crisis;
• provision of first aid for hypertensive crisis;
• relaxation methods and their use in stressful situations and preventively.

Ensuring that the patient's hospital stay is as beneficial as possible

• control of daily routine, room ventilation, proper nutrition, including transfers, taking prescribed medications, conducting research and treatment procedures;
• control of body weight, motor mode;
• If a threatening complication of the disease occurs, urgently call a doctor, carry out all appointments, and care for the patient as if he were seriously ill.