Wednesday, February 11, 2009

Nursing Care Plans For Hypertension

Nursing Care Plans For Patient With Hypertension
Hypertension is an intermittent or sustained elevation of diastolic or systolic blood pressure. Serial blood pressure measurements are used to classify hypertension:
  • Prehypertension: systolic blood pressure greater than 120 but less than 140 mm Hg or diastolic blood pressure greater than 80 but less than 90 mm Hg
  • Stage 1 hypertension: systolic blood pressure greater than 139 but less than 160 mm Hg or diastolic blood pressure greater than 89 but less than 100 mm Hg
  • Stage 2 hypertension: systolic blood pressure greater than 159 mm Hg or diastolic blood pressure greater than 99 mm Hg
Aside from characteristic high blood pressure, hypertension is classified according to its cause, severity, and type. The two major types are essential (also called primary or idiopathic) hypertension, the most common (90% to 95% of cases), and secondary hypertension, which results from renal disease or another identifiable cause. Malignant hypertension is a severe, fulminant form of hypertension that commonly arises from both types.

The cause of essential hypertension is unknown. however, it is known that the disease is associated with risk factors such as genetic predisposition, stress, obesity, and a high-sodium diet. Secondary hypertension results from underlying disorders that impair blood pressure regulation, particularly renal, endocrine, vascular, and neurological disorders; hypertensive disease of pregnancy (formerly known as toxemia); and use of estrogen-containing oral contraceptives.

Genetic Gender, ethnic/racial, and life span considerations, Hypertension is a complex disease combining the effects of multiple genes and environmental factors. Over 100 candidate genes may increase susceptibility to hypertension, and there may be many more. Genes have been located for several syndromes that include hypertension as a feature (Liddle’s syndrome, glucocorticoid-remediable aldosteronism, the syndrome of apparent mineralocorticoid excess), but genetic causes of primary hypertension have been elusive. The degree of risk for hypertension that can be attributed to genetics varies from 15% to 70% depending on the ethnicity of populations studied and the contributions of environmental factors.
African Americans and elderly people are most prone to hypertension and its complications. The prevalence and incidence of hypertension is increased by 50% in African Americans as compared with whites and Hispanics/Latinos.
Hypertension is a major cause of stroke, cardiac disease, and renal failure. Complications occur late in the disease and can attack any organ system. Cardiac complications include coronary artery disease, angina, myocardial infarction, heart failure, arrhythmias, and sudden death. Neurologic complications include cerebral infarctions and hypertensive encephalopathy.

Assessment Nursing Care Plans For Hypertension
In many cases, the hypertensive patient has no symptoms, flushing of the face may be present. In later stages, a fundoscopic examination of the retina may reveal hemorrhage, fluid accumulation, and narrowed arterioles. Palpate peripheral pulses; note pulsus alternans (alternating strength of the pulse) and bounding arterial pulses. An atrial gallop (S4 heart sound) on auscultation is suggestive of hypertensio
Inspection may reveal peripheral edema in late stages when heart failure is present. Ophthalmoscopic evaluation may reveal hemorrhages, exudates, and papilledema in late stages if hypertensive retinopathy is present.
Using a correctly sized blood pressure cuff, measure blood pressure in both arms three times 3 to 5 minutes apart while the patient is at rest in the sitting, standing, and lying positions. Three readings above 140/90 mm Hg indicate hypertension. Hypertension should not be diagnosed on the basis of one reading unless it is greater than 210/120 mm Hg.

Diagnostic tests Nursing Care Plans For Hypertension
The following tests may be used to find predisposing factors and help identify the cause of hypertension:
  • Blood urea nitrogen
  • Serum creatinine
  • Total cholesterol
  • Triglycerides
  • Electrocardiogram
  • Electrocardiography may show left ventricular hypertrophy or ischemia, and chest X-rays may show cardiomegaly.
  • Ophthalmoscopy reveals arteriovenous nicking and, in patients with hypertensive encephalopathy, edema.

The long-term goal of care is to limit organ damage. The primary goal is to reduce the blood pressure to less than 140/90. In prehypertension, if the patient has no more than one cardiac risk factor and no organ damage, a trial of nonpharmacologic management is usually initiated with regular follow-up for 6 months. Conservative medical management stresses diet, exercise, and changes in lifestyles. Since weight loss can result in a drop of 10 mm Hg in both systolic and diastolic blood pressure, patients are encouraged to reach a weight within 15% of their ideal body weight. Patients are placed on a low-sodium, low-cholesterol diet; reducing sodium intake by 2 g a day can lower systolic readings by 2.2 mm Hg. Advise patients to cease smoking and to reduce alcohol intake to one glass of wine or beer per day. Recommend an aerobic exercise regimen that builds up to 20 to 30 minutes three times a week. When these changes are not effective, drug therapy, along with these recommendations, becomes necessary.
Treatment for a patient with secondary hypertension includes correcting the underlying cause and controlling hypertensive effects. Severely elevated blood pressure (hypertensive crisis) may be refractory to medications and may be fatal. Hypertensive emergencies require parenteral administration of a vasodilator or an adrenergic inhibitor or oral administration of a selected drug (such as nifedipine, captopril, clonidine, or labetalol), to rapidly reduce blood pressure.

Diagnoses Nursing Care Plans For Hypertension
  • Deficient knowledge
  • Fatigue
  • Ineffective coping
  • Ineffective tissue perfusion: Cardiopulmonary
  • Noncompliance: Therapeutic regimen
  • Risk for injury

Key outcomes Nursing Care Plans For Hypertension
Knowledge: Diet, Disease process, Health behaviors, Medication, Prescribed activity, Treatment regime
  • Patient will identify appropriate food choices.
  • Patient will express that he has more energy.
  • Patient will demonstrate adaptive coping behaviors.
  • Patient will maintain adequate cardiac output and hemodynamic stability.
  • Patient will comply with his therapy regimen.
  • Patient will remain free from complications.

Discharge and home healthcare Patient teaching Nursing Care Plans For Hypertension:
Teach the patient to use a self-monitoring blood pressure cuff and to record the reading at least twice weekly in a journal for review by the physician at every office appointment. Tell the patient to take his blood pressure at the same hour each time with relatively the same type of activity preceding the measurement.
Make sure that the patient understands the need to control risk factors through medication therapy, dietary modifications, exercise guidelines, stress-reduction methods, and follow-up care.
Suggest stress-reduction groups, dietary changes, and an exercise program, particularly aerobic walking, to improve cardiac status and reduce obesity and serum cholesterol levels, Encourage a change in dietary habits.
Explain which signs and symptoms indicate a need to contact the physician. These symptoms include headache, blurred vision, dizziness, sleepiness, confusion, and changes in sexual performance. If the patient experiences altered sexual performance after starting a medication, encourage her or him to notify the physician immediately to have the medicationchanged rather than just stopping it without consultation.
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