What is a nursing care plan hypertention
Nursing care plan hypertension is a roadmap to provide better nursing care to a patient suffering from hypertension, it also contains 5 nursing diagnoses and 5 interventions.
When cardiac output and peripheral vascular resistance are altered Hypertension occurs. Peripheral arterioles cause blood flow restriction, increasing blood pressure.
Risk factors hypertension
- Renal disease
- Endocrine disorders such as Cushing’s disease, thyroid disease, primary aldosteronism, pheochromocytoma.
Complications of hypertension
- Increased incidence of transient ischemic attack/stroke
- Cardiovascular disease
- Heart failure
- Aortic aneurysm and renal failure
- Arterial hypertension is classified according to the level of severity
Hypertension is defined as
Normal blood pressure:
Systolic blood pressure < 120 mm Hg and diastolic blood pressure < 80 mm Hg.
Systolic blood pressure 120-139 mm Hg or diastolic blood pressure 80-89 mm Hg
- Stage 1: systolic blood pressure140-159 mm Hg or diastolic blood pressure90-99 mm Hg
- Stage 2: systolic blood pressure > 160 mm Hg or diastolic blood pressure >100 mm Hg
Degree of severity
- Mild-140/90 to 159/99 mm Hg
- Moderate-160/100 mm Hg or higher
- Severe: systolic pressure greater than 180 and diastolic pressure greater than 110
- Very severe: systolic pressure of 210 or higher with diastolic pressure above 120
The goal of treatment of hypertension in persons 60 years of age or older is to achieve a blood pressure below 150/90.
In persons younger than 60 years, or in those with chronic kidney disease or diabetes, the goal of treatment is less than 140/90. and without any complication is less than 140/90.
- Maintain or improve cardiovascular function.
- Prevent complications.
- Provide information about the disease process, prognosis, and treatment regimen.
- Support active disease management by the client.
- BP within acceptable limits for the individuals.
- Cardiovascular and systemic complications prevented or minimized.
- Necessary lifestyle or behavioral changes initiated.
- Plan for meeting post-discharge needs.
- Risk for decreased Cardiac Output
- Activity Intolerance
- Imbalanced nutrition: more than body requirements.
- Deficient knowledge
- Risk for ineffective therapeutic regimen management
Risk for decreased Cardiac Output
- Increased systemic vascular resistance
- Ventricular hypertrophy or stiffness
- Myocardial ischemia
- Engage in activities that reduce BP and cardiac workload.
- Maintain BP within an individually acceptable range.
- Demonstrate a stable heart rate and rhythm within normal limits.
Observe the presence and quality of central and peripheral pulses.
Carotid, jugular, radial and femoral pulses could also be observed and palpated. Pulses in the legs and feet could also be decreased, reflecting the effects of vasoconstriction and venous congestion.
Auscultate for heart tones and breath sounds.
S4 tone is typically heard in severely hypertensive clients thanks to the presence of atrial hypertrophy. The development of S3 indicates ventricular hypertrophy and impaired cardiac function. The presence of crackles or wheezes may indicate pulmonary congestion secondary to chronic or developing heart failure.
Note skin color, humidity, temperature, and capillary refill time.
The finding of pallor, cool, clammy skin and delayed capillary refill time is also due to peripheral vasoconstriction or reflect cardiac decompensation and decreased output.
Note skin color, moisture, temperature and capillary refill time.
The presence of pallor, cool, clammy skin, and delayed capillary refill time may be due to peripheral vasoconstriction or reflect cardiac decompensation and decreased output.
Apply dietary restrictions, as indicated, such as reducing calories and avoiding refined carbohydrates, sodium, fat, and cholesterol.
Limiting sodium and sodium-rich processed foods may help control fluid retention and, with the associated hypertensive response, decrease myocardial workload. A diet rich in calcium, potassium and magnesium may help reduce BP.
It May be related to
- Generalized weakness
- Imbalance between oxygen supply and oxygen demand.
Possibly evidenced by
- Reports of fatigue; feeling of weakness
- Abnormal pulse rate or BP response to activity
- Exertional discomfort or dyspnea
- ECG changes reflecting ischemia or arrhythmias
- Engage in necessary and desired activities.
- Report a measurable increase in activity tolerance.
Assess the client’s response to activity by observing pulse rate more than 20 beats per minute faster than the resting rate; marked increase in BP (systolic increases of more than 40 mm Hg or diastolic increases of more than 20 mm Hg) during and after activity, dyspnea or chest pain, excessive fatigue and weakness, and diaphoresis, dizziness, and syncope.
Changes in baseline are useful in assessing physiologic responses to activity stress.
Instruct the client in energy conservation techniques, such as using a chair when showering, sitting to brush teeth or comb hair, and performing activities at a slower pace.
Energy-saving techniques reduce energy expenditure, thus helping to match oxygen supply and demand.
Encourage progressive activity and self-care when tolerated. Provide assistance when needed.
Gradual progression of activity avoids a sudden increase in cardiac workload. Provide assistance only when needed, which encourages independence in performing activities.
Imbalanced nutrition: more than body requirements.
It May be related to
- Excessive intake in relation to daily activity
Possibly evidenced by
- Weight 20% higher than ideal for height and build
- Triceps crease >15 mm in men or >25 mm in women
- Sedentary lifestyle
- Dysfunctional eating patterns
- Identify correlation between hypertension and obesity.
- Weight loss behavior
- Demonstrate a change in eating patterns, such as food choices and quantity, to achieve desirable body weight with optimal health maintenance.
- Initiate and maintain a physical exercise program appropriate for the individual.
Assess the client’s understanding of the direct relationship between hypertension and obesity.
Obesity is an added risk with hypertension because of the disproportion between fixed aortic capacity and the increased cardiac output associated with increased body mass. Weight reduction may reduce or eliminate the need for pharmacological treatment to control BP. Note: Research suggests that weight reduction to 15% of ideal weight may result in a 10 mm Hg decrease in both systolic and diastolic BP.
Discuss the need to decrease caloric intake and limit fat, salt, and sugar intake as indicated.
Improper dietary habits contribute to atherosclerosis and obesity, which can predispose to hypertension and subsequent complications, such as stroke, renal disease, and heart failure. Excessive salt intake enlarges intravascular fluid volume and can damage the kidneys, which can further aggravate hypertension.
Determine the client’s desire to lose weight.
Motivation for weight reduction is internal. The individual must want to lose weight or the program will most likely be unsuccessful.
Review daily caloric intake and dietary choices.
Identify the strengths and weaknesses of the dietary program. Helps determine individual need for adjustment and teaching.
Establishes a realistic weight-reduction plan with the client, such as weight loss of 1 pound per week.
Slow weight reduction is associated with fat loss with muscle preservation and usually reflects a change in eating habits.
- Lack of exposure
- Cognitive limitation
- Lack of recall
- Complexity of treatment
- Defining characteristics
- Inaccurate information verbalization
- Inaccurate flow of instruction
- Questioning members of the healthcare team.
Common expected outcomes
- Patient verbalizes understanding of the disease and its long-term effects on organs.
- Patient describes strategy to control hypertension.
Involve the family in teaching about hypertension.
Family members play an important role in supporting patients’ efforts to adopt new health behaviors for hypertension management.
Instruct the patient that hypertension cannot be diagnosed with a single measurement.
Clinical practice guidelines state that the diagnosis can only be established with the average of two or more BP readings on two or more occasions.
Instruct the patient to self-measurement of blood pressure and suggest home monitoring equipment as appropriate.
Self-measurement of BP may be helpful in identifying true hypertension versus white coat hypertension. the patient should be guided to only purchase home equipment that needs established accuracy criteria
Risk factors such as family history, obesity, diet high in saturated fat and cholesterol, smoking, and stress.
Implementation of lifestyle changes is the cornerstone of treatment.
Adopt an appropriate strategy to reduce weight.
All lifestyle changes for weight reduction has most consistently demonstrated BP-lowering effects.
A body mass index of 25 or higher is strongly correlated with increased BP e weight loss of only 10 pounds can reduce.
Justification strategies for adopting the dietary approach to curb hypertension diet.
The DASH diet is high in fruits and vegetables, high in low-fat dairy products, low in total and saturated fat, and high in potassium and magnesium protein and fiber.
Low sodium diet strategy
Dietary sodium course fluid retention and contributes to elevated BP.
Relaxation techniques to combat stress.
The physiological response to physical and emotional stress includes neuroendocrine changes associated with increased sympathetic nervous system activity and increased cortisol secretion. it produce vasoconstriction and increase sodium and water retention. Persistent unrelieved stress contributes to increased BP relaxation technique and positively influences physiological responses that reduce BP.
Important safety measures to reduce orthostatic hypotension include
Avoidance of sudden changes in position
Avoiding hot tubs
Avoid prolonged standing.
Orthostatic hypotension is a common side effect of many drugs used to control hypertension. Hypertension associated with rapid adoption of an upright position is especially evident in elderly patients with long-standing hypertension that declines rapidly.
Risk for ineffective therapeutic regimen management
Common risk factors
- Complexity of the therapeutic regimen
- Financial costs
- Lack of social support
- Fear of treatment and possible side effects.
Common expected outcomes
- Patients describe the medication intake system
- Patient verbalizes intent to follow the prescribed regimen
- Patient demonstrates continued adherence to treatment plan
Simplify medication regimen
Many patients require 3 or 4 BP-lowering medications to achieve treatment goals. A combination medication should be used when available.
Include the patient in treatment regimen planning.
Patients who become managers of their care have a greater interest in achieving a positive outcome.
Instruct the patient to self-monitor BP.
Self-monitoring provides the patient with immediate feedback and sense of control.