Pressure inside blood vessels exceeds 140 mmHg systolic and 90 mmHg diastolicon more than one occasion resulting from a primary disease or no known cause.
Classifications of hypertension | Nursing Diagnosis for Hypertension
These are the classifications of hypertension:
- Normal <120 mmHg systolic / <80 mmHg diastolic
- Prehypertension: 120–139 mmHg systolic / 80–89 mmHg diastolic
- Stage 1 hypertension: 140–159 mmHg systolic / 90–99 mmHg diastolic
- Stage 2 hypertension: 160 mmHg / systolic 100 mmHg diastolic
- In diabetic patients: hypertension is defined as 130/80 or higher
Prognosis of Hypertension | Nursing Diagnosis for Hypertension
The vast majority of patients have primary hypertension, or high blood pressure, that is not caused by other disease. Patients are typically asymptomatic and need to understand the importance of treatment to avoid long-term complications. Endorgan damage can affect the heart, kidneys, brain, or eyes. Adequate control of blood pressure is possible with medications and lifestyle modification, but these need to be maintained for the long term, often for the rest of the patient’s life. Many patients will ultimately need to be on multiple medications to achieve adequate blood pressure control.
Hallmark Signs and Symptoms| Nursing Diagnosis for Hypertension
- Asymptomatic
- Headache
- Dizziness
Nursing Diagnosis for Hypertension: Interpreting Test Results and Treatment
Interpreting Test Results and Treatment | Nursing Diagnosis for Hypertension
- Blood pressure readings higher than 140/90 mmHg on at least three occasions.
- Ventricular hypertrophy depicted on EKG or chest x-ray.
- Blood test to look for associated cardiovascular risks.
- High cholesterol—often associated with hypertension.
- Check electrolytes for imbalance—sodium, potassium, chloride, CO2.
- Monitor BUN and creatinine for renal function, a sign of impaired organ damage.
- Chemistry to check for diabetes mellitus.
Treatment of Hypertension | Nursing Diagnosis for Hypertension
Treatment is aimed at decreasing the risk of CVA, CAD, heart failure, renal disease, and other long-term sequelae of hypertension. Risk factors need to be assessed:
- Smoking
- Dyslipidemia—elevated cholesterol, LDL, triglycerides, low HDL
- Diabetes
- Age greater than 60
- Men and postmenopausal females
- Family history
Non-pharmacologic interventions are tried first, and then medications are prescribed.
There is a four-step treatment plan:
Step 1:
- Lifestyle changes
- Reduce caloric intake and exercise to reduce weight
- Low-sodium diet
- No smoking
- Reduce alcohol intake
- Reduce caffeine intake
Step 2: Begin medication
- Administer diuretics to reduce circulating blood volume:
- furosemide, spironolactone, hydrochlorothazide, bumetanide
- Beta-adrenergic blockers to lower heart rate and cardiac output:
- propranolol, metroprolol, atenolol
- Calcium channel blockers to cause peripheral vasodilation, less tachycardia:
- verapamil, diltiazem, nicardipine
- Administer ACE to inhibit the rennin angiotensin aldosterone system. In diabetes, ACE inhibitors also delay the progression of renal disease.
- enalapril, lisinopril, benazepril, captopril, fosinopril, quinapril, perindopril
Step 3:
- Increase dosages of currently administered medication
Step 4:
- Combination of agents in above classes
- Multiple drugs may be needed to control blood pressure
Nursing Diagnosis for Hypertension and Nursing Interventions
Most Common Nursing Diagnosis for Hypertension
- Imbalanced nutrition: more than the body requires.
- Knowledge deficit
- Excess fluid volumes
Nursing Interventions for Hypertension
- Monitor blood pressure with multiple readings—lying, sitting, and standing, bilateral both arms.
- Record fluid intake and output.
- Reduce stress by providing a quiet environment.
- Explain to the patient:
- No smoking—smoking contributes to cardiovascular disease, raising blood pressure.
- Change to a low-sodium and low-cholesterol diet—salt adds to elevated blood pressure in some patients by contributing to fluid retention; lower cholesterol intake lowers risk for associated hyperlipidemia.
- Reduce alcohol intake—reduces risk for end organ damage from alcohol intake.
- Reduce weight—decreased risk for obesity, better BP control with better weight control.
- Exercise.
- Call physician when BP is elevated.
- Side effects of medications.
This is a sample of nursing diagnosis for hypertension.