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Initial Physical examination- Take a reading of the body mass index (BMI)… Chest examination, check for evidence of heart failure (HF) in patients presenting with associated shortness of breath (SOB)… Cardiovascular disease or electro-physiology disorders, i.e. particularly look for left ventricular hypertrophy (LVH), arterial bruits or heart murmur sounds (S₁, S₂, S₃)… Check abdomen for bruits, also, enlarged kidneys and/or other masses present… Check for fundi oculi, (i.e., yellowing nails), also affects the interior of the eye wall… Initial investigation for acute (Ac3) diagnosed HPN- Include a blood test for urea and electrolytes, glucose, lipid panel, complete blood count (CBC). In addition, creatinine (BUN) and estimated glomerular filtration rate (eGFR)… Urinalysis for glucose and protein… Order an ECG: this cardio-diagnostic tool can detect LVH (sum of the S-wave in lead V₁ or V₂ and the R-wave in V₅ or V₆ >mm or atrial fibrillation (AF), (i.e., no visible P-waves are essentially normal, QRS waves are occurring at irregular intervals). Also, if your patient has a history of pulmonary hypertension and/or CHF, have the clinicians’ order an 2-D Echocardiograph with Color Flow Doppler, for a possible abnormal ejection fraction.19 Due to chronic, (i.e., 12 weeks or longer) elevation in pulmonary pressures, the clinical findings are usually based on several pieces of data. Symptoms, echocardiogram, and if necessary, a right heart catheterization. Findings- As a nurse, your communication skills, are an important factor when obtaining a thorough history from the patient and may lead to identifying a ‘remarkable feature, ’regarding the patient’s condition. As noted, by Aminoff and Kjellgren, et. al., (2001), 20,21 and observation puts both nurses and physicians’ in a ‘check and balance’ relationship, which is for the greater in identifying physical and social, (i.e., lifestyle issues). In observation, the patients have longer conversations with nurses than physicians do. Registered nurses will talk with patients about other vascular risk factors more frequently than physicians do. Doctor-patient consultations tend to be medication and/or physiological focused, (i.e., evidenced-based). Patients tend to raise more topics with nurses than physicians. One may suggest that nurses articulate with understanding by every-day patients. There may be common ground between nurses-to-patients and this could lead to a full humanity approach between the ‘art and science’ in reaching a medical conclusion. In addition, it is vital that adequate time allowed completing an assessment for HTP. According to the Nurses’ Hypertension Association, suggests that the initial appointment time of 30 minutes to assess cardiovascular history and give both dietary and lifestyle advice, while an annual review should allot, between 15-20 minutes. Note: Arterial pressure fluctuates in most people, whether they are normotensive or hypertensive. Some patients will be classified, as having labile hypertension are those who sometimes, but not always, have arterial pressures in the hypertensive range. These patients are often considered to have borderline HTN. Another important symptom for the registered nurse to identify during a women’s pregnancy (high or fluctuating B/P), would be the possibility of pre-eclampsia and eclampsia.22 There usually appear swelling at the extremities and extreme joint pain. Edema is one of the hallmarks of eclampsia, which is convulsion. The other signs may precede the convulsion such as nausea, vomiting, headaches, and in extreme matters, blindness.23 In the state of etiology (i.e., origin of disease), as secondary HPN differs widely amongst individuals within a large population setting. The term ‘essential hypertension’ is the form of HPN that by definition has no identifiable cause. Some studies suggest that HPN relates to the aging process24 and to some inherited genetic mutations.25 Renin, (i.e., angiotensin antagonist, an enzyme) released into the blood by the kidney in response to stress.26 Too much renin can cause a condition called ‘renal vascular hypertension’. HPN patients with low-baseline ‘plasma renin activity’ (PRA) are known to respond best to natriuretic drugs, and those with high PRA respond best to rein-angiotensin system (RAS) blockade. However, there has been recent speculation that B/P-lowering response to the renin inhibitor, Aliskiren or by trade name Tekturna, (i.e., renin inhibitor for hepatic or renal function impairment). This might be blunted in some patients with medium-to high baseline PRA.27 Obtaining reliable B/P measurements relies on following several rules and understanding the many factors that influence B/P readings. For example, the measurements in control of HPN should be at least one hour after caffeine consumption, and for smokers, thirty minutes after their last smoke or strenuous exercise plus without any stress. The cuff size is also important issue. The bladder should encircle and cover two-thirds of the length of the upper arm. The patient should be sitting upright in a chair with both feet flat on the floor or mat for a minimum time of five minutes prior to taking the reading. In addition, the patient should not be on any adrenergic stimulants, such as those found in many cold medications.
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