Hypertension Overview | Nursing Care Plan for Hypertension
Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated.
This requires the heart to work harder than normal to circulate blood through the blood vessels.
Blood pressure involves two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed between beats (diastole). Normal blood pressure at rest is within the range of 100-140mmHg systolic (top reading) and 60-90mmHg diastolic (bottom reading). High blood pressure is said to be present if it is persistently at or above 140/90 mmHg.
Hypertension is classified as either primary (essential) hypertension or secondary hypertension; about 90–95% of cases are categorized as "primary hypertension" which means high blood pressure with no obvious underlying medical cause. The remaining 5–10% of cases (secondary hypertension) are caused by other conditions that affect the kidneys, arteries, heart or endocrine system.
Hypertension is a major risk factor for stroke, myocardial infarction (heart attacks), heart failure, aneurysms of the arteries (e.g. aortic aneurysm), peripheral arterial disease and is a cause of chronic kidney disease.
Even moderate elevation of arterial blood pressure is associated with a shortened life expectancy. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of associated health complications, although drug treatment is often necessary in people for whom lifestyle changes prove ineffective or insufficient. (Wikipedia.org)
Below is an example of Nursing Care Plan for Hypertension.
Care Setting – Hypertension | Nursing Care Plan for Hypertension
- Although hypertension is usually treated in a community setting, management of stages III and IV with symptoms of complications/compromise may require inpatient care, especially when TOD is present. The majority of interventions included here can be used in either setting.
Related Concerns – Hypertension | Nursing Care Plan for Hypertension
- Cerebrovascular accident/stroke
- Myocardial infarction
- Psychosocial aspects of care
- Renal failure: acute
- Renal failure: chronic
Nursing Care Plan for Hypertension: Severe | Nursing Priorities; Discharge Goals
Nursing Priorities | Nursing Care Plan for Hypertension
- Maintain/enhance cardiovascular functioning.
- Prevent complications.
- Provide information about disease process/prognosis and treatment regimen.
- Support active patient control of condition.
Discharge Goals| Nursing Care Plan for Hypertension
- BP within acceptable limits for individual.
- Cardiovascular and systemic complications prevented/minimized.
- Disease process/prognosis and therapeutic regimen understood.
- Necessary lifestyle/behavioral changes initiated.
- Plan in place to meet needs after discharge.
Nursing Care Plan for Hypertension: Severe | Nursing Diagnosis for Hypertension
Nursing Care Plan for Hypertension | Nursing Diagnosis for Hypertension; Risk factors; Desired Outcomes
Nursing Diagnosis for Hypertension: Cardiac Output, risk for decreased
Risk factors may include
- Increased vascular resistance, vasoconstriction
- Myocardial ischemia
- Ventricular hypertrophy/rigidity
Possibly evidenced by
- [Not applicable; presence of signs and symptoms establishes an actual diagnosis.]
Desired Outcomes/Evaluation Criteria | Nursing Care Plan for Hypertension
Patient Will:
Circulation Status (NOC)
- Participate in activities that reduce BP/cardiac workload.
- Maintain BP within individually acceptable range.
- Demonstrate stable cardiac rhythm and rate within patient’s normal range.
Nursing Care Plan for Hypertension: Severe | Nursing Interventions for Hypertension
Nursing Care Plan for Hypertension | Nursing Interventions for Hypertension and Rationale;
Nursing Interventions for Hypertension and Rationale
Hemodynamic Regulation (NIC)
Nursing Interventions for Hypertension (Independent) | Nursing Care Plan for Hypertension
- Monitor BP. Measure in both arms/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. Rationale: Comparison of pressures provides a more complete picture of vascular involvement/scope of problem. Severe hypertension is classified in the adult as a diastolic pressure elevation to 110 mm Hg; progressive diastolic readings above 120 mm Hg are considered first accelerated, then malignant (very severe). Systolic hypertension also is an established risk factor for cerebrovascular disease and ischemic heart disease, when diastolic pressure is elevated.
- Note presence, quality of central and peripheral pulses. Rationale: Bounding carotid, jugular, radial, and femoral pulses may be observed/palpated. Pulses in the legs/feet may be diminished, reflecting effects of vasoconstriction (increased systemic vascular resistance [SVR]) and venous congestion.
- Auscultate heart tones and breath sounds. Rationale: S4 heart sound is common in severely hypertensive patients because of the presence of atrial hypertrophy (increased atrial volume/pressure). Development of S3 indicates ventricular hypertrophy and impaired functioning. Presence of crackles, wheezes may indicate pulmonary congestion secondary to developing or chronic heart failure.
- Observe skin color, moisture, temperature, and capillary refill time. Rationale: Presence of pallor; cool, moist skin; and delayed capillary refill time may be due to peripheral vasoconstriction or reflect cardiac decompensation/decreased output.
Nursing Interventions for Hypertension and Rationale
Hemodynamic Regulation (NIC)
Nursing Interventions for Hypertension (Independent) - Continuation | Nursing Care Plan for Hypertension
- Note dependent/general edema. Rationale: May indicate heart failure, renal or vascular impairment.
- Provide calm, restful surroundings, minimize environmental activity/noise. Limit the number of visitors and length of stay. Rationale: Helps reduce sympathetic stimulation; promotes relaxation.
- Maintain activity restrictions, e.g., bedrest/chair rest; schedule periods of uninterrupted rest; assist patient with self-care activities as needed. Rationale: Reduces physical stress and tension that affect blood pressure and the course of hypertension.
- Provide comfort measures, e.g., back and neck massage, elevation of head. Rationale: Decreases discomfort and may reduce sympathetic stimulation.
- Instruct in relaxation techniques, guided imagery, distractions. Rationale: Can reduce stressful stimuli, produce calming effect, thereby reducing BP.
- Monitor response to medications to control blood pressure. Rationale: Response to drug therapy (usually consisting of several drugs, including diuretics, angiotensin-converting enzyme [ACE] inhibitors, vascular smooth muscle relaxants, beta and calcium channel blockers) is dependent on both the individual as well as the synergistic effects of the drugs. Because of side effects, drug interactions, and patient’s motivation for taking antihypertensive medication, it is important to use the smallest number and lowest dosage of medications.
Nursing Interventions for Hypertension and Rationale
Hemodynamic Regulation (NIC)
Nursing Interventions for Hypertension (Collaborative) | Nursing Care Plan for Hypertension
- Administer medications as indicated:
- Thiazide diuretics, e.g., chlorothiazide (Diuril); hydrochlorothiazide (Esidrix/HydroDIURIL); bendroflumethiazide (Naturetin); indapamide (Lozol); metolazone (Diulo); quinethazone (Hydromox); Rationale: Diuretics are considered first-line medications for uncomplicated stage I or II hypertension and may be used alone or in association with other drugs (such as beta-blockers) to reduce BP in patients with relatively normal renal function. These diuretics potentiate the effects of other antihypertensive agents as well, by limiting fluid retention, and may reduce the incidence of strokes and heart failure.
- Loop diuretics, e.g., furosemide (Lasix); ethacrynic acid (Edecrin); bumetanide (Bumex), torsemide (Demadex); Rationale: These drugs produce marked diuresis by inhibiting resorption of sodium and chloride and are effective antihypertensives, especially in patients who are resistant to thiazides or have renal impairment.
- Potassium-sparing diuretics, e.g., spironolactone (Aldactone); triamterene (Dyrenium); amiloride (Midamor); Rationale: May be given in combination with a thiazide diuretic to minimize potassium loss.
- Alpha, beta, or centrally acting adrenergic antagonists, e.g., doxazosin (Cardura); propranolol (Inderal); acebutolol (Sectral); metoprolol (Lopressor), labetalol (Normodyne); atenolol (Tenormin); nadolol (Corgard), carvedilol (Coreg); methyldopa (Aldomet); clonidine (Catapres); prazosin (Minipress); terazosin (Hytrin); pindolol (Visken); Rationale: Beta-Blockers may be ordered instead of diuretics for patients with ischemic heart disease; obese patients with cardiogenic hypertension; and patients with concurrent supraventricular arrhythmias, angina, or hypertensive cardiomyopathy. Specific actions of these drugs vary, but they generally reduce BP through the combined effect of decreased total peripheral resistance, reduced cardiac output, inhibited sympathetic activity, and suppression of renin release. Note: Patients with diabetes should use Corgard and Visken with caution because they can prolong and mask the hypoglycemic effects of insulin. The elderly may require smaller doses because of the potential for bradycardia and hypotension. African-American patients tend to be less responsive to beta-blockers in general and may require increased dosage or use of another drug, e.g., monotherapy with a diuretic.
- Calcium channel antagonists, e.g., nifedipine (Procardia); verapamil (Calan); diltiazem (Cardizem); amlodipine (Norvasc); isradipine (DynaCirc); nicardipine (Cardene); Rationale: May be necessary to treat severe hypertension when a combination of a diuretic and a sympathetic inhibitor does not sufficiently control BP. Vasodilation of healthy cardiac vasculature and increased coronary blood flow are secondary benefits of vasodilator therapy.
- Adrenergic neuron blockers: guanadrel (Hylorel); guanethidine (Ismelin); reserpine (Serpalan); Rationale: Reduce arterial and venous constriction activity at the sympathetic nerve endings.
- Direct-acting oral vasodilators: hydralazine (Apresoline); minoxidil (Loniten); Rationale: Action is to relax vascular smooth muscle, thereby reducing vascular resistance.
- Direct-acting parenteral vasodilators: diazoxide (Hyperstat), nitroprusside (Nitropress); labetalol (Normodyne); Rationale: These are given intravenously for management of hypertensive emergencies.
- Angiotensin-converting enzyme (ACE) inhibitors, e.g., captopril (Capoten); enalapril (Vasotec); lisinopril (Zestril); fosinopril (Monopril); ramipril (Altace). Angiotensin II blockers, e.g., valsartan (Diovan), guanethidine (Ismelin). Rationale: The use of an additional sympathetic inhibitor may be required for its cumulative effect when other measures have failed to control BP or when congestive heart failure (CHF) or diabetes is present.
Nursing Interventions for Hypertension and Rationale
Hemodynamic Regulation (NIC)
Nursing Interventions for Hypertension (Collaborative) - Continuation| Nursing Care Plan for Hypertension
- Implement dietary sodium, fat, and cholesterol restrictions as indicated. Rationale: These restrictions can help manage fluid retention and, with associated hypertensive response, decrease myocardial workload.
- Prepare for surgery when indicated. Rationale: When hypertension is due to pheochromocytoma, removal of the tumor will correct condition.
This is a sample of Nursing Care Plan for Hypertension.
