Hypertension

Nursing Care Plan and Interventions for Hypertension- A Student’s Guide

Introduction

Hypertension is a condition that affects the vast majority of adults in the United States and, if left untreated, can lead to serious health complications. This blog post aims to provide you with an overview of interventions and nursing care plans for hypertension while also highlighting critical points to create awareness about this topic. As you read, keep in mind that our top nursing writers are ready to help with your nursing assignment in case you get stuck or cant complete it due to other reasons such as a busy schedule. All you have to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

What is Hypertension?

Hypertension (high blood pressure) is a chronic medical condition that affects the body’s heart and circulatory system.

What Are the Causes for Hypertension?

Hypertension can be caused by various factors, including lifestyle choices (excess weight, smoking, alcohol consumption), genetics, or underlying physical problems like kidney disease.

Risk Factors for Developing Hypertension

There are several risk factors for developing hypertension:

  • Age- hypertension can develop even in childhood and adolescence; however, it is more prevalent among adults 50 years of age or older
  • Gender – hypertension is more common among men
  • Family history – having family members with high blood pressure or a first-degree relative who suffered from a stroke and coronary heart disease is a risk factor.
  • Obesity – people who are obese tend to have higher blood pressure levels
  • High salt intake
  • Smoking Liver problems
  • Medication use -certain medications such as steroids, birth control pills, and some antidepressants can cause hypertension.

How Can You Prevent Hypertension?

1. Don’t smoke – quitting smoking can reduce your blood pressure by up to 10 points.

2. Exercise regularly – Regular exercise helps keep your heart and arteries healthy, improves blood flow, and reduces stress. An exercise plan that includes cardio (such as walking) and strength training (such as free weights or weight machines) is recommended for any physical activity.

3. Eat healthy- a diet that is high in fiber, fruits, and vegetables can help relieve some of the symptoms associated with hypertension.

4. Maintain a healthy weight – if you are overweight, commit to losing weight through healthier eating and regular exercise.

5. Reduce stress– learn how to manage your emotions and develop better-coping skills for dealing with stressful experiences.

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What Are the Signs and Symptoms of Hypertension?

Hypertension is known to impact multiple organ systems. Common signs and symptoms include:

  • Frequent headaches or migraines
  • Chest pain
  • Crying spells
  • Feeling nervous or anxious
  • Vaginal bleeding
  • Irregular menstrual cycles
  • Fatigue
  • Lightheadedness and dizzy spells
  • Unexplained weight loss
  • Blurred vision
  • Difficulty concentrating
  • Constipation
  • Frequent urination
  • Nose bleeding
  • Unusual tiredness

Other signs and symptoms to look out for:

  • Tightness of the chest,
  • Night sweats,
  • Changes in mood or personality,
  • Nausea,
  • Vomiting and abdominal pain,
  • Fatigue and weakness
  • Irregular pulse
  • Rapid heartbeat
  • Unconsciousness

Classification of Hypertension

  * When the systolic blood pressure is greater than 140 mm Hg, or the diastolic blood pressure is greater than 90 mm Hg. 

* When the systolic blood pressure is between 130 and 139 mmHg, or the diastolic blood pressure is between 80mmHg and 89 mmHg.  

The World Health Organization has developed a classification system that categorizes people as having high blood pressure if the top number in their blood pressure reading is 140 mmHg or greater and/or the bottom number is 90mmhg or higher.  If your numbers are between 120-139 over 80-89 (120 80 mmhg, 139 89 mmhg) then it may indicate what is known as prehypertension. 

Nursing Diagnosis for Hypertension

1. Deficient Knowledge – the patient does not know how to manage their illness

2. Noncompliance  

3. Imbalanced Nutrition: Less Than Body Requirements- the patient is at risk of developing nutritional deficiencies that could lead to hypovolemic shock, acidosis, electrolyte imbalance, and malnutrition

4. Impaired Skin Integrity- the patient with hypertension is at risk of developing skin breakdown due to edema and increased pressure.

5. Insomnia

6. Sexual Dysfunction

7. Constipation

8. Decreased Cardiac Output – people with high blood pressure are at risk of having an inadequate cardiac output

9. Impaired Gas Exchange/ Ineffective Breathing Pattern- the patient may experience hypoxia secondary to respiratory failure due to pulmonary edema and inadequate oxygenation  

10. Impaired Social Interaction

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How Does Blood Pressure Change Overtime?

Blood pressure usually increases with age, but it can rise or decline during any stage of life. There are several causes of high blood pressure including:

  • Kidney disease
  • Endocrine disorders
  • Hyperthyroidism
  • Uncontrolled diabetes
  • Metabolic syndrome
  • Arteriosclerosis
  • Heart disease
  • Polycystic kidney disease (PKD)
  • Pheochromocytoma Vasculitis
  • Drug abuse

Is Hypertension High or Low Blood Pressure?

“Hypertension” is one word that describes high blood pressure. “Primary” hypertension refers to high blood pressure that has no apparent cause. “Secondary hypertension” occurs when elevated blood pressure results from another disease or condition, such as kidney or thyroid problems, an adrenal gland tumor; chronic lung disease; heart failure; and certain hormonal disorders.

Pregnant women are considered to have high blood pressure; however, this condition is known as preeclampsia.

Different Kinds of Hypertension

There are different kinds of hypertension:

  • Essential or primary hypertension  
  • Secondary hypertension  
  • Preeclampsia (toxemia) – a pregnancy-related disorder   
  • Chronic kidney disease (CKD) – high blood pressure despite normal kidney function      
  • Chronic hypertension

Nursing Interventions for Hypertension

– Determine the patient’s initial level of understanding about high blood pressure and how to manage it.

– Help the patient adopt lifestyle changes to maintain a healthy weight; increase exercise; decrease salt in the diet; eat fruits, vegetables, whole grains (primarily barley), and more fish; drink minimal alcohol (no more than one glass per day); limit red meats and decrease stress.

Develop a Teaching Plan

– Develop a teaching plan that addresses each of the following:

  • Identify various factors that contribute to high blood pressure.
  • Proper diet (low in sodium, low in saturated fats).
  • Adequate rest and sleep are critical.
  • Lack of exercise or failure to maintain an exercise program contributes to hypertension.
  • Understanding of blood pressure monitoring and the importance of keeping appointments for BP checks.
  • Regular follow-up to review symptoms and treatment plan with a physician. 
  • Health teaching related to CVD risk factors such as smoking, diet, exercise, stress management.
  • Teaching a patient ways to deal with anger, as anger is a common contributing factor in hypertension.

– Help the patient learn to cope with anger

-The nurse may need to provide support and reassurance for patients with high blood pressure.  They should be encouraged to discuss their feelings about having a chronic illness, as this will help them deal with the problem.   

 – Discuss the side effects of antihypertensive medications with a physician; ask if a medication adjustment is needed.      

– Encourage the patient to attend medical appointments; teach healthy lifestyle management skills (weight loss, exercise) and stress reduction techniques.

– After three consecutive months of regular BP monitoring with readings in an acceptable range, begin a gradual withdrawal of antihypertensive medication.  

– Provide referrals to support groups and other resources as appropriate.

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Nursing Care Plan Goal

This plan aims to lower blood pressure levels and reduce the risk of illness or injury from high blood pressure-related events such as stroke or heart attack.

 Hypertension Nursing Care Plans

 Hypertension (HTN) is a chronic disease that requires long-term, ongoing care and attention. It is associated with and increases stroke, heart disease, kidney failure, blindness, peripheral vascular disease, and death. Chronic HTN results from damage to the small arteries in the kidneys, heart, and brain, leading to multiple organ dysfunction. 

The nurse’s role in managing a patient with chronic HTN is as follows:

  • Monitor blood pressure and heart rate daily; measure weight weekly or bi-monthly; assess for headaches, dizziness, fatigue, weakness, and decreased exercise tolerance. 
  • Teach the patient to avoid triggers that may cause anxiety, stress, and anger. 

The home care nurse’s job is to work with the patient and their family or caregiver by providing education for self-care management of HTN.

To achieve this goal:

– The nurse should review medications, diet, and activity level; assess for side effects from chronic medicines.  The patient should be evaluated for changes to the physical condition and mental statuses such as weight gain, edema, or shortness of breath.

– Monitor blood pressure readings; assess for irregularities in blood pressure level even when medication is constant.  If so, make appropriate referrals to find an underlying cause of the abnormality. 

– Check medications for effectiveness; assess for side effects from medications, such as lightheadedness or dizziness.  Patients should be taught to monitor their blood pressure at home with a cuff appropriate for automatic BP monitors and properly self-administer the medication.

-The patient should be taught relaxation techniques (deep breathing, guided imagery, etc.) to control anxiety and anger.  

– Encourage the patient to eat a heart-healthy diet low in fat and cholesterol; teach the patient about the importance of lifelong weight management, exercising regularly.   

– Refer the patient to a physical therapist for an exercise program, including aerobic exercises (walking) and resistance training.    

– Discuss medications used to treat HTN; identify side effects of each drug, and make changes as needed.  Remind the patient that various other medicines may be used off-label for the treatment of HTN. 

– Teach the patient to monitor blood pressure at home with a cuff appropriate for automatic BP monitors and how to properly self-administer medication.  Check remaining supply of prescription and advise pharmacy to fill immediately; arrange for frequent exchanges of refills if there is concern about retention or adherence by the patient.

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What Is the Best Exercise for Lowering Blood Pressure?

Studies have found that the following helps lower blood pressure

-Stair Climbing

-Lifting weights

-Dancing

-Physical activity

What is the Complication of Hypertension?

The complications of hypertension consist mainly of target organ damage. Hypertension causes injury to the kidneys, eyes, heart, and brain. 

High blood pressure can lead to heart failure, stroke, or renal failure. The risk for these problems increases depending on how high a person’s blood pressure readings are and whether or not high blood pressure is well controlled.

-The kidneys are one of the body’s primary organs that help to excrete wastes. They also filter the blood and remove excess fluid from the body. High blood pressure can cause damage to these vital organs, which may lead to chronic kidney disease, failure, or even death. 

-Erectile dysfunction is an inability for a man to achieve or maintain a penile erection sufficient for sexual performance.  It is typically assessed by a health care professional with a physical examination and determined by the patient’s report of erections in certain situations, such as during waking hours.

Patients may get other complications, including;

-Stroke

-Peripheral Edema

-Myocardial infarction  

-Cerebral hemorrhage and ischemia  

-Death

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Treatment for Hypertension

Lifestyle Changes and Diet

-Hypertension can be managed with lifestyle changes, diet adjustments, and medications. There are proven ways to lower the numbers of systolic blood pressure (SBP) and diastolic blood pressure (DBP):

  • Maintain a healthy weight
  • Eat low-sodium foods
  • Do cardio exercises and participate in activities
  • Restrict alcohol consumption
  • Stop smoking
  • Manage stress
  • A Patient with hypertension should get a physical on an annual basis.

-Based upon their pressures, a patient should be seen by a primary care provider at least twice a year and have lab work completed.

Working in tandem with the patient’s physician is critical to lowering the blood pressure.

Medication:

The initial medications used are often similar, typically beginning with a thiazide diuretic or calcium channel blockers (CCB) plus an angiotensin-converting enzyme (ACE) inhibitor.

If those do not bring the desired outcome or cannot be tolerated due to side effects, a beta-blocker may be added. If there is still insufficient effect, they may add a “renin inhibitor.” Other drugs may be added, either at the same time or sequentially.

Other treatments include managing diabetes or thyroid conditions if present and providing support groups for patients who have difficulty adhering to their management plans due to life demands.

If significant renal impairment is present and a “rebound” test can prove hyperfiltration state, then a vasoconstrictor inhibitor (ACE-I) and/or a mineralocorticoid receptor antagonist (MRA) are added to the treatment regimen. These drugs may also be used in patients with resistant hypertension as part of multiple drug regimens or occasionally as additions to other blood pressure-lowering medications.

New Drug Therapies

New drug therapies are currently being explored that may address sleep apnea and insulin resistance issues, which were not considered when most hypertension guidelines were established

Conclusion

Hypertension is a condition in which the pressure of blood against artery walls, measured by systolic and diastolic readings, is high. Hypertension or high blood pressure occurs when the force of circulating blood against the walls of your arteries exceeds what the artery walls can withstand. HPN can be classified as primary or secondary depending on its cause. It’s essential to have hypertension under control because it can lead to other health problems such as heart disease and stroke.

The first step in any treatment plan for hypertension includes lifestyle changes such as reducing salt intake and increasing exercise. These changes can be challenging but are imperative in treating the symptoms of high blood pressure by decreasing stress on the heart. If these measures do not result in an adequate reduction of high blood pressure levels, then medications may be prescribed.

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