Hypertension is common. However, despite being common, a lot of people aren’t fully aware of what it is, what damages it can cause, and why it happens.
Affecting about 121.5 million Americans, it’s important to draft the right nursing care plan for hypertension. This will help ensure that patients’ individual needs are met and proper care is delivered.
What Is Hypertension?
Hypertension is more commonly known as high blood pressure. It happens when the pressure of your blood that gets pumped through your arteries goes beyond the norm and what the body can handle.
Because there are usually no signs and symptoms, hypertension is popularly called as the “silent killer”. As patients don’t feel any dramatic change in how they feel, the constant pressure in the arteries usually ends up causing serious damage and health problems.
The list includes:
- Heart attack
- Metabolic syndrome
- Heart failure
- Aneurysm
- Narrowing and weakening of the blood vessels in the kidneys
- Narrowing and weakening of the blood vessels in the eyes
- Issues with memory
Hypertension can happen in one of three adults worldwide. Middle-aged men who are around 45 years of age frequently develop the condition. And it’s not just the adults who can have high blood pressure.
Children who are inactive, living an unhealthy lifestyle and those who are obese can be hypertensive, too.
Other risk factors for hypertension include:
Race
It’s been established that people with dark skin are more predisposed to getting high blood pressure than those who have pale skin.
Age
As you age, the walls of the arteries become less and less flexible. This prevents the walls of the arteries from opening effectively as they should. This greatly increases peripheral resistance.
Genetics
Having people in the family with hypertension increases your likelihood of developing it, too.
Diet
Having too much salt (1) as well as having too little potassium in your daily diet can cause your blood pressure to be constantly elevated. Drinking too much alcohol counts, too (2).
Obesity
Weighing more means needing more oxygen to supply nutrients and oxygen to your tissues. This increase in demand also increases the pressure on the artery walls.
Types of Hypertension
There are two major types of hypertension.
Essential hypertension
Essential hypertension is when you have a high blood pressure reading in three or more visit to the doctor. This is after all the possible causes of hypertension have been ruled out.
It’s typical for patients with essential hypertension to not experience any symptoms. However, there are patients who experience frequent headaches, dizziness and tiredness.
Secondary hypertension
Secondary hypertension refers to high blood pressure caused by other medical conditions, like diseases that affect the kidneys, endocrine system and heart. In some cases, one can also develop it during pregnancy.
Categories of Hypertension
Doctors usually categorize blood pressure into the following:
Normal blood pressure-120/80 mmHg and lower
Prehypertension- 120-139 / 80-89 mmHg
Stage 1 hypertension- 140-159 / 90-99 mmHg
Stage 2 hypertension- 160 / 100 mmHg or higher
Hypertension Nursing Care Plans
If you are caring for a hypertensive patient, you need to be thorough in planning your care. To help you get started, here are some of the essential nursing care plans for hypertension you need to prepare.
1Activity intolerance
May be related to
-Imbalance between oxygen supply and demand
-Generalized weakness
-Sedentary lifestyle
Possibly evidenced by
-Exertional discomfort
-Abnormal blood pressure in response to activity
-Verbal report of fatigue
Desired outcomes
-Demonstrate a decrease in physiological signs of intolerance
-Participate in the desired activity
-Use identified techniques to enhance activity tolerance
-Report an increase in physical activity
| Nursing Interventions | Rationale |
| Evaluate current limitations/degree of deficit in light of usual status. | Provides baseline information on interventions needed to improve the quality of life. |
| Assess cardiopulmonary response to physical activity, including vital signs before, during, and after activity. | Indicates the patient’s physiological response to the stress of the activity. |
| Assess emotional/psychological factors affecting the current situation. | Depression about changes in health can affect motivation to participate in activities. |
| Adjust activities to prevent overexertion (performing activities slowly, sitting down when brushing teeth and combing hair). | Reduces energy expenditures, aiding in balancing out oxygen supply and demand. |
| Increase exercise/activity levels gradually and plan rest periods between activities (resting for 3 minutes in a 10-minute walk). | Prevents a sudden increase in cardiac workload; reduces fatigue. |
| Promote comfort measures and provide for the relief of pain, if there’s any. | Enhances patient’s ability to participate in activities. |
2Knowledge, deficient regarding condition, treatment plan and lifestyle changes
May be related to
-Information misinterpretation
-Unfamiliarity with information resources
-Lack of knowledge
-Denial of diagnosis
Possibly evidenced by
-Verbalization of the problem
-Statements reflecting misconceptions
-Request for information
Desired outcomes
-Verbalize understanding of condition/disease process and treatment
-Initiate necessary lifestyle changes and participate in the treatment regimen
-Exhibit increased interest/assume responsibility for own health
-Maintain blood pressure within the normal range
| Nursing Interventions | Rationale |
| Assess the level of knowledge and be alert to signs of avoidance. | The patient must be ready to receive information for intervention to be effective. |
| Define and specify the desired blood pressure limits. | Enables patient to have a clear understanding of the normal values. |
| Describe what hypertension is and how it affects the heart, kidneys, brain and blood vessels. | Enables the patient to understand that high blood pressure can happen without any symptoms. |
| Assist patient in identifying modifiable risk factors and how to take control of them (drinking alcohol, smoking and having a sedentary lifestyle). | Gives the patient a clearer understanding of what caused the condition. |
| Emphasize the importance of adhering treatment plan. | Failure to comply is one of the most common reasons why treatment plans for hypertension fail. |
| Teach the patient or his relative on how to take proper blood pressure measurement. | Monitoring blood pressure at home can help determine if the existing treatment plan is working or not. |
| Make the patient aware of the signs and symptoms that would require an urgent visit to the physician (a persistent headache, a sudden spike in blood pressure, dizziness, chest pain, and fainting). | The earlier complications are detected and reported, the earlier proper interventions can be applied. |
3Imbalanced nutrition: more than body requirements
May be related to
-Excessive intake in relationship to metabolic need
-Sedentary lifestyle
As evidenced by
-Weight 20% over ideal for height and frame
-Triceps skinfold greater than 15 mm in men and 25 mm in
Women
-Weight 10% over ideal for height and frame
-Reports of dysfunctional eating patterns
Desired outcomes
-Demonstrate appropriate changes in lifestyle and behaviors,
including eating patterns, food quantity/quality, and exercise
Program
-Attain desirable body weight
| Nursing Interventions | Rationale |
| Record height, weight, body build, gender, and age. | Serves as baseline data. |
| Determine the patient’s desire to lose weight. Reassess dietary choices. | The motivation to lose weight is internal; the patient must be ready and willing to lose weight before the process begins. |
| Discuss the need to have a lower intake of calories, salt, fats, and sugar. | Provides a baseline for creating a dietary program. |
| Set realistic goals for weekly weight loss. | Excessive intake of salt causes an increase in intravascular fluid volume which can damage the kidneys and aggravate the condition. Too much sugar in the diet can lead to diabetes which can complicate hypertension. |
| Encourage patient to keep a log of food intake. | Drastic weight loss can put a strain on the heart; helps determine emotional conditions that can affect eating. |
| Aid in the selection of appropriate food and DASH (Dietary Approaches to Stop Hypertension), like increasing intake of whole grains, low-fat dairy, fruits, and vegetables. | DASH provides the patient with key nutrients that can aid in lowering blood pressure. |
| Refer to a dietitian as needed. | Provides assistance and additional counseling. |
Nursing Interventions for Hypertension:
4Assessment:
- Conduct a thorough assessment of the patient’s blood pressure readings, including both systolic and diastolic measurements.
- Assess the patient’s medical history, family history, lifestyle factors, and current medications to identify potential risk factors for hypertension.
- Perform a physical examination to assess for signs of end-organ damage, such as cardiac murmurs, retinal changes, or peripheral edema.
5Education and Lifestyle Modifications:
Educate the patient about hypertension, its risks, and the importance of blood pressure control.
Provide information on lifestyle modifications, including:
Dietary changes: Encourage a diet low in sodium, saturated fats, and cholesterol, and high in fruits, vegetables, whole grains, and lean proteins.
Weight management: Promote weight loss for overweight or obese patients through a combination of dietary modifications and regular physical activity.
Regular exercise: Encourage at least 30 minutes of moderate-intensity aerobic exercise on most days of the week.
Smoking cessation: Provide resources and support for smoking cessation.
Limiting alcohol consumption: Advise patients to limit alcohol intake to moderate levels or as recommended by their healthcare provider.
6Medication Management:
- Collaborate with the healthcare provider to ensure appropriate medication therapy for hypertension, including antihypertensive medications.
- Educate the patient about the prescribed medications, including the purpose, dosage, administration, potential side effects, and the importance of adherence.
- Monitor the patient’s response to medications, including blood pressure control and any adverse effects.
- Assist patients with medication adherence through education, reminders, and medication reconciliation.
7Regular Blood Pressure Monitoring:
- Teach patients how to monitor their blood pressure at home and maintain a record of readings.
- Encourage patients to follow a consistent schedule for blood pressure monitoring and report any significant changes to their healthcare provider.
- Reinforce the importance of regular follow-up visits for blood pressure monitoring and adjustment of medications, if necessary.
8Stress Management:
- Teach patients stress management techniques, such as deep breathing exercises, meditation, progressive muscle relaxation, or engaging in hobbies and activities that promote relaxation.
- Encourage patients to identify and avoid triggers that may contribute to stress and hypertension.
- Refer patients to support groups or counseling services, if needed, to help them cope with stressors.
9Collaboration and Referrals:
- Collaborate with the healthcare team, including dietitians, pharmacists, and other specialists, to provide comprehensive care for patients with hypertension.
- Refer patients to appropriate healthcare professionals, such as cardiologists or nephrologists, for further evaluation and management if necessary.
10Health Promotion and Continuity of Care:
- Promote regular health screenings for hypertension, including blood pressure measurements, cholesterol checks, and kidney function tests.
- Encourage patients to maintain regular follow-up appointments with their healthcare provider for ongoing monitoring and management of hypertension.
- Provide information on community resources, support groups, and educational programs related to hypertension management.
References:
1. Rust, P., & Ekmekcioglu, C. (2016). Impact of salt intake on the pathogenesis and treatment of hypertension. In Hypertension: from basic research to clinical practice (pp. 61-84). Springer, Cham.
2. Santana, N. M. T., Mill, J. G., Velasquez-Melendez, G., Moreira, A. D., Barreto, S. M., Viana, M. C., & Molina, M. D. C. B. (2018). Consumption of alcohol and blood pressure: Results of the ELSA-Brasil study. PloS one, 13(1).
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. Philadelphia: F.A. Davis.
