State budget 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 is rapidly getting 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, cardiac and renal failure), is accompanied by a decrease in working capacity up to 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.

Goals: Like any chronic illness, 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 initial stages- periodic increase 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 principles:

) 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 myocardium.

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 from the nervous system: mental performance decreases, irritability, headaches appear, sleep is disturbed. 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; during physical activity it increases to a lesser extent than in healthy people. Indicators of vascular peripheral resistance are noticeably increased, the rate of spread clearly increases pulse wave along the arteries. 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. Various manifestations of the central nervous system are observed in stage II of the disease. vascular insufficiency, transient ischemia, 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. Clinical picture heart lesions are 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 nipples optic nerve, retinal edema and 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. Such patients may experience thrombosis of blood vessels and brain, resulting in loss of consciousness, impaired speech, swallowing, breathing, thrombosis ischemic stroke. Sometimes a cerebral hemorrhage 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, 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.

Violation of kidney activity is very important. A decrease in blood supply to the kidneys causes the production of a special substance - renin, which increases 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. 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 becoming overweight should be sufficient to prevent functional disorders 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. Normal daily requirement in water, 1.5 liters of all water taken per day in the form of liquids is satisfied, 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 scary vascular disease, capable of causing 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: to create for the patient all the conditions necessary for his recovery, to direct all his actions to maintain health, a speedy recovery and prevent complications in the patient, to alleviate suffering during the disease, and also to 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.

)Reveal the 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 regular reception medicines;

lack of knowledge about factors contributing to increased blood pressure.

B) Potential:

risk of developing a hypertensive crisis;

risk of development acute heart attack myocardium 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 preserve 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 of them 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.

)Have a conversation about possible complications hypertension, indicate 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 initial symptoms 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 lower limbs.

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. Possible reason 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 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: maternal - mother suffered 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, if left untreated for a long time, improper treatment can cause serious and, as a rule, irreversible changes in cardiac vascular 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 later life pain syndrome and weakness appear 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 illnesses: 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 (HD) occurs in every third person of working age and in 65% of people over 60 years of age. The danger of this disease lies in the high frequency of complications with which it occurs. These complications pose a threat to the health and life of patients and make people disabled.

Nursing care: general principles

Adequate nursing care for patients with hypertension undergoing outpatient or inpatient treatment consists of several successive stages:

1. Interview and examination of the patient.
2. Conducting instrumental and laboratory research.
3. Creating comfortable conditions for patient treatment.
4. Diet food.
5. Drug treatment.
6. Monitoring changes in the patient's condition. Recommendations and rehabilitation measures.

First stage: filling out medical documentation

Medical documentation records all information about the onset and dynamics of the disease, examinations performed, prescribed treatment, its compliance and effectiveness, rehabilitation measures and recommendations.

The first data that is entered into the documentation are the patient’s complaints. In patients with hypertension, they depend on the stage of the disease, age, gender of the patient, bad habits, and place of work. The main complaints with hypertension include complaints of palpitations, chest pain, shortness of breath, headaches, tinnitus, blurred vision, dizziness, weakness, sweating, irritability, anxiety, sleep disturbance.

In addition to complaints, the nurse needs to collect an anamnesis of the patient’s life and illness. To do this, it is necessary to actively interview the patient about his daily routine, working conditions, family atmosphere, medication use, concomitant diseases, family history, and bad habits. In women, they are additionally interested in their obstetric and gynecological history, which in some cases is important for the doctor to make a diagnosis.

When examining a patient with hypertension, it is necessary to calculate the frequency and determine the characteristics of the pulse, and measure blood pressure twice.

Stage two: additional research

The main diagnostic tests for hypertension are blood tests (general, biochemical, glucose), urine, fundus examination by an ophthalmologist, ECG, EchoCG, ultrasound examination of the kidneys and heart, and chest x-ray. If necessary, the doctor can expand this list of diagnostic methods.

The nurse’s task at the second stage is to properly prepare the patient for tests and research.

To do this, the patient must be clearly explained that the day before submitting the biomaterial for analysis (blood, urine), you cannot change your usual diet and drinking regimen, take new medications or diuretics, or drink alcohol, spicy or fatty foods.

Stage three: comfortable conditions for the patient

Depending on the type of treatment (outpatient or inpatient), the patient requires different conditions for treatment. In the case of outpatient treatment, the patient must be explained what mode (bed, semi-bed or general) he needs to follow.

Nursing care for hypertension at the third stage is to provide comfortable conditions for the gradual recovery of the patient at each stage of treatment.

Bed rest provides for the presence of his relatives next to the patient, who will change his linen, give him medicine, help him cope with his physiological needs, eat or wash himself without getting out of bed. The patient is only allowed to turn over in bed or briefly assume a sitting position.

In semi-bed (ward) conditions, it is allowed to move around the apartment to visit the toilet, perform hygiene procedures, and eat food. During this period, the patient should begin physical therapy exercises (sitting or standing) at an average pace.

In the general (free) mode, the patient is allowed to move along the street for short distances, slowly walk up the stairs, and walk in the fresh air. Gradually you need to expand your physical activity regimen:

• gentle (includes walking, physical therapy, swimming);
• gentle training (includes excursions, outdoor non-sports games, walks);
• trainer (close-range tourism, sports games, gym classes).

Stage four: diet therapy

The main dietary ration for patients with hypertension is treatment table No. 10-g. This is a hyposodium diet, the main principles of which are:

• caloric restriction;
• exclusion of animal fats, replacing them with vegetable ones;
• reducing the daily volume of water consumed to 1.5 l;
• reducing the salt content in the daily menu to 1.5-2 g;
• regular consumption of sea fish and seafood;
• exclusion of foods that have a stimulating effect on nervous and cardiac activity (alcohol, carbonated drinks, coffee and tea, beans, peas, rich broths from meat and fish);
• refusal to consume semi-finished products, smoked foods, sausages, salted fish, canned food, pickles and marinades, mayonnaise;
• inclusion in the menu of foods enriched with magnesium and potassium (cereals, nuts, bran bread, raisins, dried apricots).

The task of the fourth stage is to normalize the patient’s weight and design his diet in such a way that he sticks to it for as long as possible (better - all his life).

Fifth stage: drug treatment

Only a doctor has the right to prescribe medications. The choice of medications depends on many factors: the type of hypertension (primary or secondary), the stage of the disease, and the severity of symptoms.

Nursing care at the stage of pharmacotherapy consists of explaining the features of taking medications and possible adverse reactions on them.

For the treatment of hypertension, diuretics, beta-blockers, ACE inhibitors, calcium antagonists, peripheral vasodilators and other groups of medications. Pharmacotherapy for hypertension usually begins with the prescription of one or two drugs.

It is necessary to explain to a hypertensive patient how and when he should monitor his blood pressure level, and also recommend recording pressure numbers in a diary (notebook, notebook).

Sixth stage: clinical observation

From the moment the diagnosis of hypertension is made, the patient must be registered at the dispensary. The frequency of dispensary observations depends on the level of blood pressure, the stage of the disease, the type of treatment and its effectiveness, and the dynamics of the disease. The frequency of examinations is set by the doctor based on current departmental instructions and can be once a year, 2 times a year, 1 time every 2 months.

The task of the nursing staff during dispensary observation is to collect the maximum possible amount of data about the patient’s condition for assessment by the doctor during the next examination.

It is necessary to explain to the patient in detail, or better yet, draw up a memo that should indicate:

• when should the patient visit the doctor next?
• what tests should he undergo before the examination (laboratory tests, fundus examination, ECG, EchoCG);
• what should be the algorithm of action in the event of life-threatening conditions (hypertensive crisis, myocardial infarction, stroke).

At the next visit, the dynamics of the disease are assessed, on the basis of which the issue of further treatment tactics is decided. If necessary, the patient is advised not to drug treatment(physiotherapeutic procedures, hydrotherapy, exercise therapy, Spa treatment). Hypertensive patients of the second or third stage in the presence of damage to two or more target organs are recommended to undergo MSEC.

The success of patient treatment largely depends on the coordinated actions of medical personnel. Proper and friendly nursing care for hypertension is no less important for the patient than the doctor’s literacy. But, no matter how professional and sensitive the doctors may be, it is impossible to cope with the disease without the desire of the patient himself.

Hypertension is a pathology of cardio-vascular system. Blood pressure during the disease is significantly higher than normal, and decreases only after taking strong medications. Correct treatment at home depends on following the doctor’s recommendations, and in a hospital setting - on competent nursing care.

The main causes of the disease include:

• Traumatic brain injuries,
• Smoking and drinking alcohol in large doses,
• Drug use
• Kidney pathology,
• physical inactivity,
• Poor nutrition
• Abuse of salt and fast food,
• Diseases of the heart and blood vessels,
• Heredity.

Statistics show that during menopause, women especially often develop hypertension.

Its danger lies in the increased risk of developing a hypertensive crisis - a sharp and significant increase in blood pressure. It can lead to stroke, heart attack, memory loss, coma and even death.

The approach of a crisis can be determined by:

• Sudden and severe headache,
• Dizziness, accompanied by nausea and vomiting,
• The appearance of stunned consciousness syndrome,
• Impaired speech, movement coordination,
• Cramps,
• Heart rhythm disturbances, shortness of breath.

According to the World Health Organization, an indicator of high blood pressure is a level of 140/90 mmHg. and higher.

When making a diagnosis, the patient’s age is not taken into account: same shape Both adults and children suffer from hypertension. WHO distinguishes three phases of hypertension, on which treatment depends. The initial phase is recognized as reversible. An increase in blood pressure is associated with the presence of unfavorable factors. By eliminating them, you can achieve positive dynamics and recovery. The second phase requires taking medications to lower blood pressure. The course of the disease is accompanied by hypertensive crises and the development of pathologies internal organs. The third phase is also called sclerotic. It is characterized by persistently elevated blood pressure. When blood pressure is elevated to a critical level, complications are possible: cerebrovascular accident, heart failure, myocardial infarction, renal and pulmonary failure, short-term or complete loss of vision and memory.

Treatment of hypertension is aimed at stabilizing blood pressure, and to achieve results the following is used:

• Antihypertensive drugs,
• Massage, acupuncture, physiotherapy, exercise therapy,
• Herbal medicine.

Complications of hypertension

If you follow your doctor's recommendations and healthy image life, the symptoms of hypertension are minimized. But it can be fatal in the absence of constant therapy and self-treatment, refusal of doctor’s orders, violation of the regime. To death dangerous complications hypertension include:

• Cardiac ischemia
• Papilledema,
• Stroke,
• Myocardial infarction,
• cardiac asthma,
• Kidney damage
• Systolic dysfunction of the left cardiac ventricle.

In combination with diabetes mellitus or another disease that destroys neurons, hypertension leads to the development of chronic renal failure. Its danger is that the organs stop removing toxins from the blood. Death is inevitable when more than 90% of the kidneys are affected. If the kidneys have lost their functions by 70% or less, then a person with arterial hypertension is diagnosed with renal hypertension. It is distinguished by the presence of a constant high level of diastolic and systolic pressure. In this case, treatment focuses on improving the kidneys and stabilizing blood pressure.

Objectives of nursing care in the treatment of hypertension

Patients with acute form diseases, as well as those recovering from a hypertensive crisis. Typically, assistance is provided during inpatient treatment, but a nurse can also visit an outpatient patient privately. A properly organized nursing process for arterial hypertension is needed for:

• Carrying out medical and preventive procedures,
• Assisting patients with hypertension in organizing living conditions in the ward,
• Monitoring your well-being and providing necessary medical care,
• Identification characteristic features diseases,
• Finding out the causes of its occurrence and factors contributing to increased blood pressure.

The importance of nursing care for hypertension is studied in medical institutes and colleges, and a special plan is drawn up to ensure that care is provided as effectively as possible.

Nursing care planning includes 4 stages of the nursing process and is based on standards of nursing practice. It is designed to work in the current situation, and not with a specific patient. And its goal is to obtain a positive result from nursing interventions in solving each patient’s problem.

First stage of the nursing process

At this stage, it is important to correctly draw up an anamnesis, which will include the following information:

• Working conditions, a person’s character, his lifestyle,
• Relationships with family and colleagues,
• Presence of hypertension in relatives,
• Diet and regimen
• Susceptibility to bad habits
• Name and frequency of taking medications,
• The prevailing level of emotional fatigue and physical stress,
• Previous, current and chronic diseases,
• Patient complaints.

The patient's complaints depend on the stage of the disease, age and gender, as well as many other factors.

The most common of them:

• Regular headaches, dizziness, tinnitus,
• Loss of orientation,
• Fast fatiguability,
• Decreased performance
• Hot temper,
• Tearfulness,
• Insomnia, less often - constant drowsiness,
• Memory problems
• Interruptions in the functioning of the heart,
• Shortness of breath even with slight exertion,
• Deterioration of vision,
• Frequent numbness of fingers.

During the conversation, it is recommended to clarify the expected outcome of care and treatment, and identify the patient’s concerns. In women, the presence of gynecological diseases is additionally determined: this factor does not necessarily lead to an increase in blood pressure. But the influence of these problems in the patient can only be excluded during diagnosis. This is followed by an examination, assessment of the color and condition of the skin, the presence or absence of cyanosis.

Responsibilities of the nurse at the first stage

The nurse's role is not limited to examination and conversation. Independent nursing interventions involve working with both the patient and his family. Explanatory work is being carried out about the need healthy eating and proper lifestyle. Recommendations are given on changing conditions and relationships at work and at home, on the need to maintain a rest regime and normal sleep. Responsibilities also include:

1. Ensuring normal rest, ventilating the room and preventing any attempts to disrupt sleep, distract the patient from watching TV shows and films,
2. Learning simple ways to relax
3. Informing the patient about the effect of medications prescribed by the doctor and the need to strictly adhere to the time of taking medications, doses and their combination with meals,
4. Explaining the causes of potential complications,
5. Control of products transferred by relatives,
6. Conducting explanatory conversations about the health hazards of excess weight, bad habits, sedentary lifestyle,
7. Training the patient or his relatives to measure pulse and pressure, recognize the primary symptoms of a hypertensive crisis, and provide first aid.

Second stage of the nursing process

The nurse is required to identify the patient's real and potential problems, which are determined individual characteristics pathogenesis of the disease. The nurse’s responsibilities include diagnosing all patient complaints. In case of hypertension, the diagnosis of symptoms is based on the analysis of the patient’s complaints, which may have a physiological or psychological basis. They are used to conduct adequate pre-medical diagnostics:

• Rapid fatigue, nosebleeds and decreased performance are the first symptoms of hypertension,
• Night sleep disturbance is caused by dysfunction of the central nervous system under the influence of hypertension,
• Shortness of breath is caused by pulmonary edema,
• Increased anxiety is associated with ignorance, unawareness of the presence of the disease, and inability to provide oneself with the correct help.

All the patient’s problems are divided into two groups: real and potential. The first group includes problems with sleep, headaches, irritability and frequent mood swings, insufficient rest, and poor diet. And potential problems include the risk of developing a hypertensive crisis, the risk of complications (disruption of the vascular and respiratory systems), heart attacks, strokes, coma.

The nurse must know all the symptoms of a hypertensive crisis and provide first aid to the patient.

Most often used during a crisis: Lasix, Verapamil, Nitroglycerin, Labetalol, Furosemide, Clonidine. The main goal of treatment or relief of a crisis is a slow and stable decrease in blood pressure, normalization of renal circulation and blood circulation in the brain.

The third stage of the nursing process

To confirm the diagnosis of hypertension, the attending physician prescribes diagnostic tests. These include donating urine and blood, x-rays of the lungs, ultrasound of the heart and kidneys, ECG, and examination by an ophthalmologist. The nurse is obliged to explain to the patient the rules for taking all tests and prepare the patient for the procedures. Preparation rules:

• The day before, it is not allowed to change the patient’s usual diet,
• It is forbidden to give the patient diuretics and new medications,
• It is prohibited to give the patient strong drinks (tea, coffee), alcohol, spicy or fatty foods.
• During the treatment process, nurses monitor the timeliness of food and medication intake, and carry out the necessary medical and hygienic procedures.

In therapeutic therapy, the nursing process consists of creating favorable conditions and developing tasks for the day, week, course of treatment. In hypertension, this process includes the following data:

• Date of patient's visit,
• The problem
• Expected Result,
• List of medical procedures,
• The patient's response to the care provided
• Goal implementation date.

The nurse is obliged to complete tasks on time and adjust them as the patient’s condition changes.

When determining bed rest for a hypertensive patient, either relatives or nurses should always be with the patient. They help him meet his physiological needs in a supine position. If ward or semi-bed rest is prescribed, then the patient is allowed to visit the toilet, wash and eat while sitting.

Most often, hypertensive patients are prescribed diet No. 10, which is based on:

• Low calorie food
• Consuming only vegetable fats,
• Regulating the water you drink per day (up to 1.5 l),
• Regulating the daily portion of salt (up to 2 g),
• Taking foods containing magnesium and potassium in large quantities
• Eating sea fish and seafood.

The fourth stage of the nursing process

This stage includes drug treatment. Medicines are prescribed by the attending physician based on:

• The presence of primary or secondary hypertension,
• Stages of the disease
• Symptoms.

Nursing responsibilities include explaining medications and side effects. Hypertensive patients are advised to monitor blood pressure levels and keep a blood pressure diary. Upon discharge from the hospital, the results of the entire nursing process are taken into account to determine recommendations for lifestyle adjustments.

The doctor analyzes the following points:

• Progress in the patient’s condition after the course of treatment,
• Coincidence of the actual result with the expected one,
• Effectiveness of nursing participation.

The patient is given a memo with the following information:

• Next visit time
• Necessary studies and tests that must be completed before admission,
• List of actions in case of complications.

During each visit, the dynamics of blood pressure, the course of the disease, and the manifestation of concomitant diseases are assessed. Based on the data obtained, conclusions are drawn about continuing treatment. The patient may be prescribed hydrotherapy or physiotherapy, exercise or sanatorium treatment. All these additional measures lead to strengthening muscle tissue, improving metabolism and the functioning of the cardiovascular and respiratory systems. They also improve mood and have a positive effect on the nervous system.

Hypertension is general disease, characterized by an increase in blood pressure that is not associated with any known disease of the internal organs. The World Health Organization (WHO) at the UN considers high blood pressure (regardless of age) above 140/90 mm Hg. Art.

Real problems:

Headache;

Dizziness;

Sleep disturbance;

Irritability;

Lack 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.

Potential problems:

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.

The main way to treat hypertension is to switch to a healthy lifestyle. Patients whose blood pressure is 160/100 mm Hg. Art. and above, you also need to take medications for hypertension. But if the patient does not want to give up bad habits, then the pills will be of little use.

9. Real and potential problems with myocardial infarction. Principles of treatment. Care.

Myocardial infarction is one of the clinical forms coronary disease of the heart, occurring with the development of ischemic necrosis of the myocardium due to the absolute or relative insufficiency of its blood supply. Real problems: sensations of “pressure”, “heaviness” and “burning” in the central part are more often described chest with irradiation to the shoulder girdle, arm, jaw, epigastric region. The patient is restless, puts his hand to the sternum. For an elderly patient with multiple concomitant pathologies, MI often manifests itself in signs of heart failure (increasing shortness of breath, edema, palpitations, atypical anginal pain ). Potential problems: cardiogenic shock, acute cardiovascular failure, arrhythmia, cardiac muscle rupture . Treatment: If a patient is suspected of having a myocardial infarction and experiences pain in the heart area, the nurse should call the physician for help. Before his arrival, she must reassure the patient, measure blood pressure and assess the state of the pulse. The patient needs to have mustard plasters placed in the area of ​​the heart and on the sternum. It is also necessary to give the patient nitroglycerin without fear. If the medication is in the form of tablets, then the patient must be given 5 milligrams of the drug, if there is one percent alcohol solution nitroglycerin should be given to the patient one drop on a validol tablet or a piece of sugar. Next, the nurse needs to give the patient Corvalol or Valocordin in the amount of 25-30 drops. Before the doctor arrives, it is necessary to carefully monitor the patient’s health condition. After the doctor arrives, the nurse tells him about the blood pressure and pulse readings, as well as the general condition of the patient. Based on these data, the doctor prescribes treatment. The nurse must feed the patient taking into account a strict diet. She should limit the amount of liquid consumed by the patient to 0.6-1 liters and salt to 4-5 grams per day. During this time, the patient can eat no more than 800 calories. If products contain a large amount of fiber and fat, then their consumption must be limited several times. Care: Patients with this disease will need to remain in bed and not strain themselves not only physically, but also mentally. Since movement is limited during this period, the patient must be helped to turn over in bed. Nursing care for myocardial infarction involves monitoring the pulse, timely supply of drink and food, regular measurement of blood pressure, and carrying out hygiene procedures. Strict bed rest during a heart attack quite often causes bedsores. It is necessary to carefully examine the patient’s skin every day and care for it - massages, antiseptic solution.

10. Current and potential problems with peptic ulcer stomach and 12 - duodenum. Principles of treatment. Care. Peptic ulcer is a disease in which defects (ulcers) form in the human stomach and (or) duodenum. Most often, men between 20 and 50 years old suffer from peptic ulcers. Most often, the ulcer makes itself felt in spring and autumn. Peptic ulcer duodenum It is much more common than gastric ulcer. The spiral-shaped microbe plays a leading role in the development of the disease. Helicobacter pylori. Real problems: Abdominal pain. Heartburn. Nausea. Vomiting. Constipation. Weakness. Weight loss. The need to follow a diet for a long time. The need to quit smoking and drinking alcohol. The need for long-term use of medications. Lack of information about the disease. Fear of developing complications. Lack of knowledge of diet therapy. Fear of the possibility of surgical treatment. Potential problems: Bleeding. Ulcer perforation. Development of pyloric stenosis. Change professional activity, places of work. Treatment: 1 Stop smoking - this shortens the time for scarring of ulcers and reduces the frequency of exacerbations of the disease, increases the effectiveness of anti-helicobacter therapy. 2 Alcohol consumption should be reduced if it is excessive (no more than 14 doses per week for women and no more than 20 doses for men), but complete abstinence (abstinence) is not necessary, but desirable.3. Stop taking non-steroidal anti-inflammatory drugs (aspirin, butadione, indomethacin, etc.) and steroids, if possible. But if taking them is vital to continue the course of treatment, then it is advisable to reduce the dose (for example, aspirin to 75-100 mg/day) and take them simultaneously with antisecretory drugs.4. Diet does not significantly affect the course of peptic ulcer disease, however, patients should be given advice on rational diet with the exclusion from the diet of food that increases the symptomatic manifestations of the disease. The use of mechanically and chemically gentle antiulcer diets is justified only in case of symptomatic manifestations of exacerbation of peptic ulcer disease (gentle diet type No. 1b). There are mandatory 5 meals a day, food is steamed. As the subjective signs of the disease disappear, a diet without mechanical sparing is indicated. Food is given boiled, not pureed (meat and fish - in pieces, crumbly porridge, vegetables - not pureed), parsley, dill, etc. are added. However, the patient must constantly, even in the remission phase, follow a regimen of fractional meals, excluding spicy, pickled and smoked foods.5. Patients with peptic ulcer disease can be treated on an outpatient basis, but it has been found that with the same method of anti-relapse treatment, the rate and frequency of remission is higher in patients treated in a hospital. Drug treatment. Main The following areas of drug therapy for peptic ulcer disease are recognized: reduction of intragastric acidity and sanitation of the mucous membrane from helicobacter pylori. As antisecretory agents, the use of H+K+ATPase inhibitors (omeprazole (Losec), rabeprazole, pantoprazole, lansoprazole) and histamine H2 receptor blockers (ranitidine) is justified or famotidine) according to the regimens presented in the table . Care: During an exacerbation, the patient must remain in bed (you can go to the toilet, wash, sit down at the table to eat) for 2-3 weeks. With a successful course of the disease, the regime gradually expands, but the mandatory limitation of physical and emotional stress remains. It is necessary to monitor the general condition of the patient: skin color, pulse, blood pressure, stool. Monitoring the complete and timely intake of medications prescribed by a doctor. In case of stomach bleeding, first of all, you need to call a doctor. The patient should be provided with complete rest and reassurance. Place an ice pack on the stomach area. To stop bleeding, hemostatic agents are administered. If all these measures do not produce results, then the patient is subject to surgical treatment.

11. Current and potential problems with changes in blood pressure (hypotension). Principles of treatment. Care. Hypotension (hypotension) is a violation of blood pressure in the vessels. Arterial hypotension– this is, accordingly, a violation of pressure in the arteries. Blood pressure depends on heart rate. The prefix “hypo-” indicates insufficient pressure, that is, blood in the arteries is not pumped as intensively as it should. We can talk about hypotension if the blood pressure is 20% lower than normal. The norm is 120/80, and if the reading is lower than 90/60, you should think about the presence of hypotension. Real problems: General weakness, lethargy, drowsiness; Increased sweating and thermoregulation disorders (cold extremities); Rapid pulse; Sleep disorders; Irritability, emotional instability; Meteosensitivity; Headache(mainly dull in the frontal and temporal regions), dizziness; Dyspnea. Potential problems: Fainting, which most often occurs with so-called orthostatic hypotension. Clinically this manifests itself sharp decline pressure when patients try to take a “standing” position from the initial “lying” or “sitting” position. Particularly dangerous at this moment is the possibility of injury (bruises, concussions, fractures) from a fall. It has been proven that patients with a hip fracture, forced to lie down for several months, die from heart failure. Blood that chronically does not reach vital regulatory centers in the brain can cause ischemic stroke. The danger arises precisely when, with orthostatic hypotension, a sharp drop in pressure occurs. Senile dementia or dementia can occur due to constant surges in blood pressure. If hypotension is diagnosed, consequences can also develop in the heart muscle. An ischemic form of myocardial infarction, or cardiogenic shock, can occur if blood stops flowing to the heart muscle. Disruption of peripheral arterial and venous blood supply, which can ultimately lead to impaired sensitivity in the legs and arms. As a result of long-term hypotension, the vessels are somewhat rebuilt and become narrower with age, causing a complication such as arterial hypertension . Treatment: In most cases, drug treatment for hypotension is not required. The most common causes of low blood pressure are poor lifestyle and stress. Physiological hypotension should not be treated, but it must be remembered in order to prevent pressure surges. If you are worried about one symptom of hypotension, for example, drowsiness, then, first of all, it is worth adjusting your daily routine. This alone is enough to cope with an unpleasant condition. Can be called upon to fight hypotension traditional medicine. Low blood pressure medications:“Askofen”, “Coffetamine”, “Ortho-taurine”, “Pyramein”, “Regulton”, “Saparal”, “Citramon”. Care: You can increase your blood pressure by consuming foods that contain caffeine and salt. It is these components that stimulate the blood vessels, and they narrow, stabilizing the blood pressure level at an acceptable level. Rest and proper sleep are also important for the typical patient.

12. Real and potential problems in chronic pyelonephritis. Principles of treatment. Care. Pyelonephritis is understood as nonspecific inflammatory process, which involves not only the pelvis and calyces of the kidney, but also, mainly, the renal parenchyma with predominant damage to its interstitial tissue.. Patient problems: a) Physiological: a triad of symptoms is characteristic: fever with chills, dysuria, pain in the lumbar region. b) Priority: fever with chills, dysuria. c) Potential: paranephritis, subphrenic abscess, peritonitis, hepatorenal syndrome, bacteriological shock, necrosis of the renal papillae with the development of acute renal failure. Treatment: 1. Increase fluid intake for the purpose of detoxification and mechanical sanitation of the urinary tract. Water load is contraindicated if there is: urinary tract obstruction, postrenal acute renal failure; nephrotic syndrome; uncontrolled arterial hypertension; chronic heart failure, starting from the second stage IIA; gestosis in the second half of pregnancy. 2. Antimicrobial therapy is the basic treatment of pyelonephritis. Exodus chronic pyelonephritis depends precisely on the competent prescription of antibiotics. 3. Treatment of pyelonephritis is supplemented, according to indications, with antispasmodics, anticoagulants (heparin) and antiplatelet agents (pentoxifylline, ticlopidine). 4. Herbal medicine is an additional, but not an independent method of treatment. It is used during the period of remission 2 times a year, as a preventive course (spring, autumn). Use for at least 1 month, combine with antiplatelet agents. You should not get carried away with taking medicinal herbs due to their possible damaging effect on the kidney tubules. 5. Physiotherapy and spa treatment of pyelonephritis. This treatment of pyelonephritis is used in the remission phase, using the antispasmodic effect of thermal procedures (inductothermy, DMV or SMV therapy, paraffin-ozokerite applications ). Care: sanitation of chronic foci of infection, avoid cooling, compliance with personal hygiene rules, timely emptying Bladder change underwear daily, do a general cleaning of the bladder 10 days of every month - use diuretic herbs; lifelong dispensary observation, sanatorium-resort treatment.

13. Current and potential problems in chronic heart failure. Principles of treatment. Care. CHF is circulatory failure associated with a decrease in myocardial contractility, as a result of which the supply of organs and tissues with substances necessary for their normal functioning is disrupted. The causes of chronic circulatory failure are diverse: hypertension, heart defects, atherosclerosis of the coronary arteries, anemia, intoxication, infections, endocrine diseases. Real: Shortness of breath (during physical activity and at rest). Heartbeat. Edema. Cough. Hemoptysis. Sleep disturbance. Constipation. Decreased physical activity. Difficulties in carrying out physiological functions in the usual position. The need to frequently visit the toilet due to frequent urination (when taking diuretics). Lack of knowledge about your health. Risk of falling. Potential: Risk of developing bedsores. Risk of developing congestive pneumonia. Risk of overdose medicines(cardiac glycosides). Loss of social status and role in society and family. Possibility of changing profession, disability. Treatment: Heart failure is much easier to prevent than to cure. Its prevention includes treatment of arterial hypertension, prevention of atherosclerosis, a healthy lifestyle, exercise, smoking cessation and diet. If heart failure does develop, a cardiologist prescribes treatment. This usually includes diuretics (to reduce the volume of blood pumped), ultraselective beta blockers (to reduce the heart's oxygen demand), metabolic therapy, and, of course, treatment of the underlying disease. Care: Together with the patient, choose a position in bed in which shortness of breath and palpitations will significantly decrease or disappear. Convince the patient to reduce physical activity and follow the regimen prescribed by the doctor. Ensure frequent ventilation of the room where the patient is located. Conduct a conversation with the patient/family and loved ones about the need to strictly follow a diet with limited salt and liquid. Support the patient's efforts to change eating habits and physical activity. Monitor respiratory rate, pulse and blood pressure. If the pulse slows below normal (overdose of cardiac glycosides), immediately notify the enemy. Perform oxygen therapy as prescribed by a doctor. Monitor the dynamics of edema, condition skin in the area of ​​edema. Carry out the prevention of bedsores, congestive pneumonia, constipation (as prescribed by a doctor - administer a cleansing enema).

14. Real and potential problems with heart defects. Principles of treatment. Care. Real problems: heart palpitations; dyspnea; swelling; cyanosis; pain and disturbances in the heart area; cough; hemoptysis; ascites; weakness. Potential problems: Development of heart failure (a condition in which the heart is unable to adequately supply blood to all organs and tissues). Heart rhythm disturbance (any heart rhythm other than normal). Thromboembolic complications (complications in which blood clots (blood clots in a vessel) can enter any vessel in the body through the bloodstream, block its lumen and cause organ dysfunction). Disability of patients. Lethal outcome (death ). Treatment: Conservative (drug) treatment of acquired heart disease is prescribed only with the goal of stabilizing the heart rhythm, preventing heart failure (a condition in which the heart is unable to provide normal blood flow to all organs), complications and relapses (recurrences) of the underlying disease that caused the heart disease. The main treatment method for acquired heart defects is surgery. Correction of a valve defect: valvotomy (dissection of fused heart valve cusps); valvuloplasty (restoration of valve function by cutting the valve walls and subsequent suturing of new leaflets). Prosthetic valve replacement (replacement with an artificial one). Care: The nurse ensures: clear and timely implementation of doctor’s orders; timely intake of medications; control of blood pressure, respiratory rate, pulse, body weight and daily diuresis; carrying out exercise therapy; if necessary, oxygen therapy. She also conducts: conversations with patients and their relatives about the possibility of surgical treatment of heart disease and the good results of such treatment; about the importance of systematic use of cardiac medications; about the importance of a diet with limited fluid and salt for the prevention of chronic heart failure; training patients in control (self-monitoring) of respiratory rate and pulse.

15. Real and potential problems in acute cholecystitis. Principles of treatment. Care. Acute cholecystitis - acute inflammation gallbladder. Real problems: incessant pain in the right hypochondrium (right upper abdomen), which can radiate to the right side of the chest, neck, right hand. Often, before the onset of pain, an attack of biliary colic occurs; nausea and vomiting, after which there is no relief; a feeling of bitterness in the mouth; increase in body temperature. Potential: purulent inflammation (gangrene, empyema) and perforation of the gallbladder, after which peritonitis may occur - inflammation of the peritoneum; the appearance of biliary fistulas that connect the gallbladder to the stomach, intestines or kidney; formation of a limited purulent focus (so-called subhepatic abscess); obstructive jaundice; acute pancreatitis . Treatment: Treatment of acute cholecystitis is carried out in a surgical hospital. For the first few hours, the patient lies under a “drip”. He is prescribed antispasmodics(baralgin), antibiotics, detoxification. If the manifestations of the disease subside, the patient is prepared for planned abdominal or laparoscopic surgery to remove the gallbladder (cholecystectomy

). If the attack of cholecystitis does not stop, surgery will have to be done urgently. If complications develop, surgical intervention is performed on an emergency basis. Cholecystectomy for cholecystitis

In most cases, cholecystectomy is performed, and if this is not possible due to concomitant diseases or the patient’s advanced age, cholecystotomy is performed (a hollow tube is inserted through the skin into the gallbladder, through which bile is discharged out). This procedure allows you to relieve the inflammatory process in gallbladder. Care: a) In the morning and evening the temperature is measured and the data is entered into the temperature sheet b) Blood pressure is measured and the data is also entered into the temperature sheet 2. Personal hygiene. a) Change bed linen once every 7-10 days or when soiled b) Straighten the patient’s bed in the morning, at night and before daytime rest c) Since a shower is contraindicated for the patient, it is necessary to rub down daily d) Perform a preventive examination of the patient for the presence of diaper rash and bedsores e) Prevent bedsores and diaper rash 3. Food a) Maintain proper diet, b) tell about diet No. 5, c) if necessary, help with eating.

16. Current and potential problems with bronchial asthma. Principles of treatment. Care. Bronchial asthma- This allergic disease, which is characterized by repeated attacks of suffocation (bronchospasm). Existing problems caused by bronchospasm. swelling of the mucous membrane, hypersecretion of mucus into the lumen of the bronchi: expiratory shortness of breath, participation of auxiliary muscles in the act of breathing. tachycardia, cough with viscous sputum. Potential problems: risk of atelectasis, emphysema, pneumothorax. heart failure. Treatment: Chronic asthma cannot yet be completely cured. There is a concept of a stepwise approach to treatment bronchial asthma. Its meaning is to change the dose of drugs depending on the severity of asthma. “Step up” is an increase in dose, “step down” is a decrease in dose. In the majority clinical recommendations There are 4 such “steps” that correspond to 4 degrees of severity of the disease. Treatment should be carried out under the constant supervision of a doctor. To treat bronchial asthma, basic therapy drugs are used that affect the mechanism of the disease, through which patients control asthma, and symptomatic drugs that affect only the smooth muscles of the bronchial tree and relieve an attack. Symptomatic therapy drugs include bronchodilators

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). At arterial hypertension There is an imbalance 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 optimal conditions work and rest;
• 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 on early stage development 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 examination 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;
• providing first aid during 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.