Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

28  Chapter 2 • Cardiovascular Care The Silent Killer

Although patients may feel healthy, untreated or poorly controlled hypertension can damage their major organs. Organs at greatest risk are the brain, eyes, and kidneys.

BRAIN Stroke

EYE Hypertensive retinopathy

Stroke from blood clots occluding narrowed blood vessels or from hemorrhage of a weakened vessel wall (aneurysm) can be disabling or fatal.

Effects on the blood vessels within the retina can lead to hemorrhage, hard exudates, and swelling of the optic disk that may result in blindness.

Cotton-wool spot

Infarct

Hemorrhage

Flame-shaped hemorrhage

Blood clot

Swollen optic disk

Hard exudates

R E T I NA

Scarring

Hardened arteriole

KIDNEY Nephrosclerosis

Arterioles in the kidney harden and restrict oxygenation of the glomeruli, causing scarring and kidney failure.

GLOME RULUS

Recommended Screening • Adults 40 years or older should

• Ask the patient if they smoked, had a beverage containing caffeine, or was emotionally upset before the reading. • Advise patient to return for blood pressure testing at frequent regular intervals.

TIP: Hypertension or high blood pressure can affect the heart, brain, kidneys, eyes, and peripheral circu- lation.

have their blood pressure measured at least annually.

• Adults between 18 and 39 years should also be screened at least annually if they have risk factors for hypertension (i.e., obesity) or if their previously measured blood pressure was 130 to 139/85 to 89 mm Hg. • Adults between 18 and 39 years whose latest blood pressure was < 130/80 mm Hg and have no risk factors for hypertension should be screened at least every 3 years.

Nursing Considerations • When routine blood pressure

screening reveals elevated pressure, make sure the sphygmomanometer cuff size is appropriate for the patient’s upper arm circumference.