Hypertension

Hypertension

 It is described as persistent elevation of the

systolic blood pressure at a level of 140
mmHg or higher and diastolic blood pressure
at a level of 90 mmHg or higher. It is
classified based on the severity from a high
normal to malignant hypertension.
Hypertension
 Pathophysiology
 Factors: Diet – high Na and fat
 Strain on arterial wall
 Loss of elasticity
 Increased collagen and calcification of arterial
media
 Atherosclerosis in intima
 Narrowing of blood vessel lumen
 Stiffness of aortic and peripheral arteriae
 Constriction of arterioles
 Elevation of blood pressure
Hypertension

Medications
Hypertension
 Diuretics- used to promote dieresis and block
reabsorption of sodium and water in the kidney.
 Chlorothiazide (Diuril), spironolactone (Aldactone),
Chlorthalidone (Hygroton). Hydrochlorothiazide (Esidrix),
triamterine (dyrenium), metolazone (zaroxolyn) ethacrinic
acid (edicrin), furosemide (lasix),
 Calcion ion antagonist – produces vasodilation on smooth
muscles.
 Verapamil (Calan), diltiazem (cardizem), Nifedine
(procardia)
 Adrenergic inhibitors – used to impair synthesis of
norepinephrine, suppression of sympathetic out flow by
central alpha adrenergic stimulation or blocking of
preganglionic to post ganglionic autonomic transmission.
 Reserpine, methyldopa (aldomet), propanolol (inderal).
Hypertension
ACE Inhibitors – inhibits conversion of angiotensin
1 to angiotensin 2 to prevent release of
aldosterone to inhibit increase in blood pressure
Captopril (capoten), enalapril (vasotec), fosinorel

(monopril)
Vasodilators – used to relax vascular smooth

muscles, decrease preload and afterload, decrease

oxygen demand, decrease systemic vascular
resistance, and increase venous capacitance.
Diazoxide (hyperstat), amyl nitrate, isosorbide

dinitrate (isordil), Nitroglycerin

Hypertension

NURSING CARE PLAN

1
Hypertension
 CUES

 S-Ø
 O – severe occipital headache
 - BP-140/90 mmHg
Hypertension
NURSING DIAGNOSIS

Acute pain related to

increase cerebral vascular
pressure
Hypertension
 PLANNING

 Long Term:
 After 8 hours of nursing intervention, the

client will be free from pain.

 Short Term:
 After 2 hours of nursing intervention, the

client’s headache will be decrease.

Hypertension
 IMPLEMENTATION
 INDEPENDENT:
 Maintain bed rest during acute phase. 
 Provide non-pharmacologic measures to relief of headache. E.g

cool cloth to forehead: back and neck rubs: quiet, dimly lit room,
relaxation techniques (guided imagery, distraction): and
diversional activities.
 Eliminate/minimize vasoconstricting activities that may aggravate

headache, e.g straining at stool, prolonged coughing, bending

over.
 Assist patient with ambulation as needed.

 DEPENDENT:
 Administer medications as indicated: analgesics
Hypertension
 RATIONALE
 Minimizes stimulation/ promotes relaxation.
 Measures that reduce cerebral vascular pressure and
which slow/block sympathetic response are effective in
relieving headache and associated complications.
 Activities that increase vasoconstriction accentuate the
headache in the presence of increased cerebral vascular
pressure.
 Dizziness and blurred vision frequently are associated
with headache. The patient may also experience
episodes of postural hypotension.
 Reduces/ controls pain and decreases stimulation of the
sympathetic nervous system.
Hypertension

EVALUATION
Goal partially met
Hypertension

NURSING CARE PLAN

2
Hypertension
 CUES

 S – She said she is fond of eating salty foods.

 She can consume 2 – 2 ½ cups of rice especially

with pork chop and catsup as her viand.

 O–Ø

 M - Cholesterol borderline
Hypertension

NURSING DIAGNOSIS
Altered nutrition more

than body requirements

related to high sodium,
fat and total calorie
intake
Hypertension

 SCIENTIFIC EXPLANATION
 High Na, fat and calorie intake

Excessive amount of the



Additives in the circulating body

 Altered nutrition
Hypertension
 PLANNING

Long Term:
After 2-3 days of nursing intervention, the client will

be able to demonstrate change in eating patterns.

Short Term:
After 1 hour of nursing intervention, the client will be

able to:
- verbalize understanding of proper nutrition
- state ways on how to change diet appropriate to her

condition
Hypertension
 IMPLEMENTATION

Independent:
Assess patient understanding of direct relationship between
hypertension and diet.
Discuss necessity for decreased caloric intake and limiting intake of fats

and salt as indicated.

 Review usual daily caloric intake and dietary choice. 
Encourage patient to maintain a diary of food intake including when and

where eating takes place and the circumstances and feelings around
which the food was eaten.
Instruct and assist in appropriate food selection, avoiding foods high in

saturated fat and cholesterol.

 
Collaborative:
Refer to dietitian as indicated.
Hypertension
RATIONALE
 Provides baseline information 
Faulty eating habits contribute to atherosclerosis and

obesity which predispose to hypertension and subsequent

complication. 
Aids in determining individual need for adjustments and

teaching.
 Provides a data base for both the adequacy of nutrients

eaten as well as the emotional condition of eating.

Avoiding foods high in saturated fat and cholesterol is

important in preventing progressing atherogenesis.

Provides counseling and assistance with meeting individual

dietary needs.
Hypertension
Goal met.

Long Term:
After 2-3 days of nursing intervention, the client

was able to demonstrate change in eating patterns.

Short Term:
After 1 hour of nursing intervention, the client was

able to:
- verbalize understanding of proper nutrition
- state ways on how to change diet appropriate to
Hypertension

NURSING CARE PLAN

3
Hypertension
CUES
S–Ø
O- statement of

misconceptions
Hypertension

 NURSING DIAGNOSIS
 Knowledge Deficit related to

lack of understanding of
medical condition
Hypertension
 SCIENTIFIC EXPLANATION
l 
 Hypertension is symptom-free
l
 It is called the “silent killer”
l
 Blood pressure exceeding 140/90 mmHg were

unaware of their elevated blood pressure

l
 Knowledge Deficit
Hypertension
 PLANNING

Long Term:
After 2-3 days of nursing intervention, the client will be

able to verbalize understanding of the disease and its

long-term effects on target organs.

Short Term:
After 1-2 hour of nursing intervention, the client will be

able to verbalize and demonstrate understanding of

information given regarding condition, medications and
treatment regimen. To also describe self-help activities to
be followed.
Hypertension
 IMPLEMENTATION

 Independent:

 1. Determine patient’s baseline of knowledge regarding

disease process, normal physiology, and function of the
heart.
 2. Involve the family or significant others.
 3. Provide time for individual interaction with patient.
 4. Instruct patient on procedures that may be
performed.
 5. Instruct on leg exercises and position changes.
  6. Instruct to rise slowly, allowing time between
position changes.
Hypertension
 RATIONALE
 - Provides information regarding patient’s understanding of condition as

well as a baseline from which to base teaching.

- So they can effectively provide support upon discharge.

- Promotes relationship between patient and nurse, and establish trust.

-Provides knowledge and promotes the ability to make informed

choices.

-Decreases venous pooling can be potentiated by vasodilators and

prolonged time in one position.

-Assists body to equilibrate and adjust in order to decrease the risk of

syncope.
Hypertension
 EVALUATION

 Goal met.
 Long Term:
 The client was able to verbalized understanding of the
disease and its long term effects on target organs.

 Short Term:
 The client was able to verbalized and demonstrated
understanding of information given regarding condition,
medications and treatment regimen and was able to
perform self-help activities.
FINITO. Muchas
gracias!