Nursing care plans for Hypertension; hypertension, high blood pressure, is the most common of all health problems in adults and is the leading risk factor for cardiovascular disorders. Hypertension is a systolic blood pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg over a sustained period, based on the average of two or more blood pressure measurements taken in two or more.

There are two kinds of hypertension; they are primary hypertension, meaning that the reason for the elevation in blood pressure cannot be identified.  Also known as essential hypertension. These terms mean simply that the hypertension is of unknown origin. In some patients with primary hypertension, there is a strong hereditary tendency.

And, Secondary hypertension or malignant hypertension is the term used to signify high blood pressure from an identified cause. The elevation of blood pressure results from some other disorder Such as kidney disease, renal artery stenosis.

Cause for Hypertension

Although the precise cause for most cases of hypertension cannot be identified, it is understood that hypertension is a multifactorial condition. Because hypertension is a sign, it is most likely to have many causes, just like fever has many causes. For hypertension to occur there must be a change in one or more factors affecting peripheral resistance or cardiac output. In addition, there must also be a problem with the control systems that monitor or regulate pressure.

1. Primary hypertension or essential hypertension (90% to 95% of Cases) Precise cause unknown
2. Secondary Hypertension or malignant hypertension causes by:

RENAL:  Acute glomerulonephritis, Chronic renal disease, Polycystic disease, Renal artery stenosis, Renal vasculitis,Renin-producing tumors.

CARDIOVASCULAR: Coarctation of aorta , Increased intravascular volume , Increased cardiac output, Rigidity of the aorta

ENDOCRINE:  Adrenocortical hyperfunction, Exogenous hormones e.g (glucocorticoids, estrogen including pregnancy-induced and oral contraceptives), Pheochromocytoma, Hypothyroidism, Hyperthyroidism, Pregnancy-induced

NEUROLOGIC:  Psychogenic, Increased intracranial pressure, Sleep apnea, Acute stress, including surgery

Complications for Hypertension

Hypertension is a major cause of stroke, cardiac disease, and renal failure. Complications occur late in the disease and can attack any organ system.

Cardiac complications include

• Coronary artery disease
• Angina
• Myocardial infarction
• Heart failure
• Arrhythmias
• Sudden death.

Neurologic complications:

• Cerebral infarctions and
• Hypertensive encephalopathy can cause blindness.
• Renovascular hypertension can lead to renal failure.

Treatment of Hypertension

Although essential hypertension has no cure, drug therapy and diet and lifestyle modifications can control it. Current guidelines for treating hypertension recommend, as a first step, lifestyle modifications that are aimed at increasing physical activity and weight loss in most patients. Unfortunately, many patients are unable to lose weight, and pharmacological treatment with antihypertensive drugs must be initiated.

Two general classes of drugs are used to treat hypertension:

• Vasodilator drugs that increase renal blood flow
• Natriuretic or diuretic drugs that decrease tubular reabsorption of salt and water.

Nursing Assessment Nursing care plans for Hypertension

Nursing History

• Family history of high Blood Pressure
• Previous episodes of high Blood Pressure
• Dietary habits and salt intake
• Target organ disease or other disease processes that may place the patient in a high-risk group  diabetes, CAD, kidney disease
• Cigarette smoking
• Episodes of headache, weakness, muscle cramp, tingling, palpitations, sweating, vision disturbances
• Medication that could elevate Blood Pressure:
  • Hormonal contraceptives, steroids
  • NSAIDs
  • Nasal decongestants, appetite suppressants, tricyclic antidepressants
• Other disease processes, such as gout, migraines, asthma, heart failure, and benign prostatic hyperplasia, which may be helped or worsened by particular hypertension drugs.

Physical Examination

• Auscultate heart rate and palpate peripheral pulses; determine respirations.
• If skilled in doing so, perform funduscopic examination of the eyes for the purpose of noting vascular changes. Look for edema, spasm, and hemorrhage of the eye vessels. Refer to ophthalmologist for definitive diagnosis.
• Examine the heart for a shift of the point of maximal impulse to the left, which occurs in heart enlargement.
• Auscultate for bruits over peripheral arteries to determine the presence of atherosclerosis, which may be manifested as obstructed blood flow.
• Determine mentation status by asking patient about memory, ability to concentrate, and ability to perform simple mathematical calculations.

• Blood Pressure Determination, Auscultate and record precisely the systolic and diastolic.

Nursing Diagnoses Nursing care plans for Hypertension

Common nursing diagnosis found in patient with hypertension

• Deficient Knowledge regarding the relationship between the treatment regimen and control of the disease process
• Ineffective Therapeutic Regimen Management related to medication adverse effects and difficult lifestyle adjustments

• Deficient knowledge (lifestyle modifications)
• Fatigue
• Ineffective coping
• Ineffective tissue perfusion: Cardiopulmonary
• Noncompliance: Therapeutic regimen
• Risk for injury

Nursing outcome nursing interventions and patients teaching Nursing care plans for Hypertension