hypertension

Hypertension
is the term used to describe high blood pressure. Hypertension is repeatedly elevated blood pressure exceeding 140 over 90 mmHg. It is categorized as primary or essential (approximately 90% of all cases) or secondary, which occurs as a result of an identifiable, sometimes correctable pathological condition, such as renal disease or primary aldosteronism.
Nursing Care Plans
Diagnostic Studies
• Hemoglobin/hematocrit: Not diagnostic but assesses relationship of cells to fluid volume (viscosity) and may indicate risk factors such as hypercoagulability, anemia.
• Blood urea nitrogen (BUN)/creatinine: Provides information about renal perfusion/function.
• Glucose: Hyperglycemia (diabetes mellitus is a precipitator of hypertension) may result from elevated catecholamine levels (increases hypertension).
• Serum potassium: Hypokalemia may indicate the presence of primary aldosteronism (cause) or be a side effect of diuretic ¬therapy.
• Serum calcium: Imbalance may contribute to hypertension.
• Lipid panel (total lipids, high-density lipoprotein [HDL], low-density lipoprotein [LDL], cholesterol, triglycerides, phospholipids): Elevated level may indicate predisposition for/presence of atheromatous plaques.
• Thyroid studies: Hyperthyroidism may lead or contribute to vasoconstriction and hypertension.
• Serum/urine aldosterone level: May be done to assess for primary aldosteronism (cause).
• Urinalysis: May show blood, protein, or white blood cells; or glucose suggests renal dysfunction and/or presence of diabetes.
• Creatinine clearance: May be reduced, reflecting renal damage.
• Uric acid: Hyperuricemia has been implicated as a risk factor for the development of hypertension.
• Renin: Elevated in renovascular and malignant hypertension, salt-wasting disorders.
• Urine steroids: Elevation may indicate hyperadrenalism, pheochromocytoma, pituitary dysfunction, Cushing’s syndrome.
• Intravenous pyelogram (IVP): May identify cause of secondary hypertension, e.g., renal parenchymal disease, renal/ureteral ¬calculi.
• Kidney and renography nuclear scan: Evaluates renal status (TOD).
• Excretory urography: May reveal renal atrophy, indicating chronic renal disease.
• Chest x-ray: May demonstrate obstructing calcification in valve areas; deposits in and/or notching of aorta; cardiac enlargement.
• Computed tomography (CT) scan: Assesses for cerebral tumor, CVA, or encephalopathy or to rule out pheochromocytoma.
• Electrocardiogram (ECG): May demonstrate enlarged heart, strain patterns, conduction disturbances. Note: Broad, notched P wave is one of the earliest signs of hypertensive heart disease.
Nursing Priorities
1. Maintain/enhance cardiovascular functioning.
2. Prevent complications.
3. Provide information about disease process/prognosis and treatment regimen.
4. Support active patient control of condition.
1. Decreased Cardiac Output
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Nursing Diagnosis
• Cardiac Output, risk for decreased
Risk factors may include
• Increased vascular resistance, vasoconstriction
• Myocardial ischemia
• Ventricular hypertrophy/rigidity
• Participate in activities that will prevent stress (stress management, balanced activities and rest plan).
Nursing Interventions Rationale
Review clients at risk as noted in Related Factors as well as individuals with conditions that stress the heart.
Check laboratory data (cardiac markers, complete blood ell count, electrolytes, ABGs, blood urea nitrogen and creatinine, cardiac enzymes, and cultures, such as blood, wound or secretions).
Monitor and record BP. Measure in both arms and thighs three times, 3–5 min apart while patient is at rest, then sitting, then standing for initial evaluation. Use correct cuff size and accurate technique.
Note presence, quality of central and peripheral pulses.
Auscultate heart tones and breath sounds.
Observe skin color, moisture, temperature, and capillary refill time.
Note dependent and general edema.

Provide calm, restful surroundings, minimize environmental activity and noise. Limit the number of visitors and length of stay.




Administer medications as indicated:
Thiazide diuretics:
Loop diuretics: furosemide (Lasix); ethacrynic
Potassium-sparing diuretics: spironolactone (Aldactone);
Alpha, beta, or centrally acting adrenergic antagonists:
Calcium channel antagonists: nifedipine (
Adrenergic neuron blockers: guanadrel (Hylorel);
Direct-acting oral vasodilators: hydralazine
Direct-acting parenteral vasodilators:diazoxide (Hyperstat),
Angiotensin-converting enzyme (ACE) inhibitors: captopril (Capoten);


2. Activity Intolerance
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Nursing Diagnosis
• Activity intolerance
May be related to
• Generalized weakness
• Sedentary lifestyle
• Imbalance between oxygen supply and demand

Nursing Interventions Rationale
Note presence of factors contributing to fatigue (age, frail, acute or chronic illness, heart failure, hypothyroidism, cancer and cancer therapies).
Evaluate client’s actual and perceived limitations or degree of deficit in light of usual status.
Assess the patient’s response to activity,



3. Acute Pain
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Nursing Diagnosis
• Pain, acute, headache
May be related to
• Increased cerebral vascular pressure
• .
Nursing Interventions Rationale
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Nursing Diagnosis
• Coping, ineffective
May be related to
• Situational/maturational crisis; multiple life changes
• Inadequate relaxation; little or no exercise, work overload
• Inadequate support systems
• Poor nutrition
• Inadequate coping methods