Hypertension Nursing Care Plan, Diagnosis and Interventions

Nursing Care Plan for Hypertension

Hypertension (HTN) or high blood pressure is a chronic medical condition in which the systemic arterial blood pressure is elevated. It is the opposite of hypotension. It is classified as either primary (essential) or secondary. About 90–95% of cases are termed "primary hypertension", which refers to high blood pressure for which no medical cause can be found. The remaining 5–10% of cases (Secondary hypertension) are caused by other conditions that affect the kidneys, arteries, heart, or endocrine system.

Persistent hypertension is one of the risk factors for stroke, myocardial infarction, heart failure and arterial aneurysm, and is a leading cause of chronic kidney failure. Moderate elevation of arterial blood pressure leads to shortened life expectancy. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of associated health complications, although drug treatment may prove necessary in patients for whom lifestyle changes prove ineffective or insufficient.


Causes

Essential Hypertension

Essential hypertension is the most prevalent hypertension type, affecting 90–95% of hypertensive patients. Although no direct cause has been identified, there are many factors such as sedentary lifestyle, smoking, stress, visceral obesity, potassium deficiency (hypokalemia), obesity (more than 85% of cases occur in those with a body mass index greater than 25), salt (sodium) sensitivity, alcohol intake, and vitamin D deficiency that increase the risk of developing hypertension. Risk also increases with aging, some inherited genetic mutations, and having a family history of hypertension. An elevated level of renin, a hormone secreted by the kidney, is another risk factor, as is sympathetic nervous system overactivity. Insulin resistance, which is a component of syndrome X (or the metabolic syndrome), is also thought to contribute to hypertension. Recent studies have implicated low birth weight as a risk factor for adult essential hypertension.

Secondary Hypertension


Secondary hypertension by definition results from an identifiable cause. This type is important to recognize since it's treated differently to essential hypertension, by treating the underlying cause of the elevated blood pressure. Hypertension results in the compromise or imbalance of the pathophysiological mechanisms, such as the hormone-regulating endocrine system, that regulate blood plasma volume and heart function. Many conditions cause hypertension, some are common and well recognized secondary causes such as Cushing's syndrome, which is a condition where the adrenal glands overproduce the hormone cortisol. In addition, hypertension is caused by other conditions that cause hormone changes such as hyperthyroidism, hypothyroidism (citation needed), and certain tumors of the adrenal medulla (e.g., pheochromocytoma). Other common causes of secondary hypertension include kidney disease, obesity/metabolic disorder, pre-eclampsia during pregnancy, the congenital defect known as coarctation of the aorta, and certain prescription and illegal drugs.

Nursing Care Plan for Hypertension

Nursing Diagnosis for Hypertension

1. High risk for decrease cardiac output related to increased vasoconstriction, myocardial ischemia, ventricular hypertrophy.
2. Impaired sense of comfort : pain (headache) are related to increased cerebral vascular pressure

Nursing Intervention for Hypertension

1. High risk for decrease cardiac output related to increased vasoconstriction, myocardial ischemia, ventricular hypertrophy.

Goal :
vasoconstriction did not occur, myocardial ischemia did not occur

Expected Results :
Patients participating in activities that lower blood pressure / workload of the heart, maintaining normal blood pressure, heart frequency showed stable within the normal range of patients.

Nursing Intervention :

• Monitor blood pressure, measured on both hands, use the cuff and appropriate measurement techniques.
• Note the presence, quality of central and peripheral pulses.
• Auscultation heart tone, and breath sounds.
• Observe skin color, moisture, temperature and capillary filling time.
• Note the general edema.
• Provide quiet environment, comfortable, reduce the activity.
• Maintain restrictions on activities such as rest in bed / chair.
• Helps perform self-care activities as needed.
• Perform good actions such as back and neck massage
• Encourage relaxation techniques, guide the imagination, the transfer activity
• Monitor response to medication to control blood pressure
• Give the restriction of fluid and sodium diet as indicated.
• Collaboration for the provision of drugs as indicated.

2. Impaired sense of comfort : pain (headache) are related to increased cerebral vascular pressure

Goal :
Cerebral vascular pressure did not increase.

Expected Results :
Patients did not reveal a headache and looked comfortable.

Nursing Intervention :

• Maintain bed rest, quiet environment, a little illumination
• Minimize environmental disturbances and stimulation.
• Limit activities.
• Avoid smoking or using nicotine.
• Give the analgesic and sedative drugs to order.
• Give a fun action according to indications such as an ice pack, comfortable position, relaxation techniques, guidance imagination, avoid constipation.

Source : http://nanda-nursing.blogspot.com/2011/01/nursing-care-plan-for-hypertension.html