Hypertension, Diagnosis of Hypertension, Treatment of Hypertension, and 3 Nursing Care Plan Examples for Hypertension.

This study guide is centered on hypertension, diagnosis of hypertension, treatment of hypertension, and 3 nursing care plan examples for hypertension. It can be employed in the development of educational nursing care plans for hypertension.

Hypertension

What is hypertension?

Hypertension is the term used to describe high blood pressure. Blood pressure is the result of the assistance of blood flowing in the arteries and the amount of blood that the heart pumps. High blood pressure occurs when the arteries become narrower and/or the heart pumps more blood. Consistent high blood pressure levels result to hypertension.

A person can have hypertension for months or even years without experiencing any signs and symptoms. Uncontrolled high blood pressure may cause complications such as heart disease, stroke, and heart attack. Despite the severity of its complications, high blood pressure is easy to detect. Simple blood pressure monitoring is helpful in the management of hypertension. Medications for hypertension are also well-researched and established.

What are the signs and symptoms of hypertension?

Hypertension may not be evident for a long time as the patient may lack or ignore signs and symptoms. The most common signs and symptoms as well as warning signs of hypertension include:

• Severe headaches
• Nosebleed (epistaxis)
• Fatigue or confusion
• Vision problems
• Chest pain
• Shortness of breath
• Irregular heartbeat
• Blood in the urine (hematuria)
• Pounding in the chest, neck, or ears

What are the causes of hypertension?

Hypertension can be divided into two types: primary or essential hypertension, and secondary hypertension. Each of these two kinds of high blood pressure has different causes.

• Primary (essential) hypertension. This type of hypertension does not occur with any identifiable cause (e.g. diet, underlying condition, medications, etc). Primary hypertension gradually develops over the years and may be linked to aging.

• Secondary Hypertension. This type of hypertension comes from an identifiable cause. Secondary hypertension usually appears suddenly and in more severe blood pressure levels than primary hypertension. Some medical conditions may predispose a person to hypertension, such as congenital blood vessel defects, kidney problems, adrenal gland tumors, thyroid disorders, and obstructive sleep apnea. There are medications that may put a person at a higher risk for hypertension. These include decongestants, over-the-counter pain relievers, some chemotherapy agents, birth control pills, and cold remedies. Illegal drugs like amphetamines and cocaine may also cause secondary hypertension.

What are the risk factors of hypertension?

• Age – Men: 64 years and below; Women: 65 years and above
• Family history or genetics
• Race -there are more hypertension-related cases in Africans than Whites
• Obesity – more weight means increased demand for oxygenated blood, which leads to increased blood volume and pressure in the arteries
• Sedentary lifestyle  – inactivity increases higher rate and the risk for obesity
• Smoking – the chemicals in the tobacco damage the arterial wall linings and also immediately shoot up the blood pressure
• Alcohol drinking – Men: more than 2 units a day; Women: more than 1 unit a day
• High salt/ sodium diet – this leads to fluid retention which then increases circulatory blood volume
• Low potassium diet – low serum potassium leads to high serum sodium levels
• Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure.
• Stress
• Pregnancy

What will happen if hypertension is left untreated?

Uncontrolled high blood pressure can lead to many complications, which include:

1. Myocardial infarction. Also known as heart attack, myocardial infarction or M.I. may result from uncontrolled high blood pressure. Consistently high blood pressure levels may lead to atherosclerosis, or the thickening and hardening of the arterial walls.
2. Heart failure. The left ventricle may thicken (hypertrophy) due to increased cardiac workload from uncontrolled high blood pressure level. The left ventricle may not be able to sustain this demand over time, which may result to heart failure.
3. Aneurysm. Blood vessels are at risk for weakening and bulging due to high blood pressure levels. These may suffer from aneurysm. Rupture of an aneurysm is a fatal situation.
4. Vision loss. High blood pressure in the blood vessels of the eyes may cause their thickening, narrowing and eventual damage, leading to loss of eyesight.
5. Dementia, memory problems or cognition disorders
6. Metabolic syndrome, which may lead to diabetes
7. Kidney dysfunction

Diagnosis for Hypertension

How do you diagnose hypertension?

Diagnosing hypertension involves the use of a blood pressure machine with a measuring gauge. The healthcare provider will put an inflatable arm cuff around the patient’s arm and turn the machine on, or manually pump air into the cuff. The blood pressure reading is measured in millimeters of mercury or mmHg. There are two numbers in a blood pressure reading. The upper number is called systolic pressure, which represents the pressure in the arteries when the heart beats. The lower number is called diastolic pressure, which represents the pressure in the cardiac arteries in between heart beats.

• Normal adult blood pressure: between 90/60 and 120/80 mmHg
• Elevated adult blood pressure: systolic 120 – 129 mmHg and diastolic below 90 mmHg
• Stage 1 Hypertension: systolic 130 to 139 mmHg and diastolic 80 to 89 mmHg
• Stage 2 Hypertension: systolic 140 mmHg or higher and diastolic 90 mmHg or higher

One high blood pressure reading is not enough to diagnose the patient with hypertension. At least two to three high blood pressure readings in different times are required for diagnosis. Blood pressure readings from both the left and the right arm are needed for comparison.

Because the patient might have elevated blood pressure levels when seeing the doctor or being the clinic or hospital (white coat hypertension), it is recommended to teach the patient on how to do blood pressure monitoring at home.

1. Medications. The primary treatment for hypertension is the use of anti-hypertensive medications. The category or type of drugs depend on your average blood pressure reading, underlying conditions, and complications.
2. Thiazide diuretics (e.g. hydrochlorothiazide) – eliminate sodium and water through urine, leading to a decline in blood volume
3. Angiotensin-converting enzyme (ACE) inhibitors (e.g. lisinopril) – block the formation of angiotensin, a peptide hormone that narrows blood vessels, leading to vasodilation
4. Angiotensin II receptor blockers (ARBs) (e.g. losartan) – block the action of angiotensin, leading to vasodilation
5. Calcium channel blockers (e.g. amolodipine and diltiazem) – promote vasodilation and reduction of heart rate. Grapefruit juice is contraindicated for patients on Calcium channel blockers.
6. Alpha blockers (e.g. doxazosin) – reduce the effect of angiotensin by decreasing the nerve impulses to the blood vessels
7. Alpha-beta blockers (e.g. carvedilol) – slow down the heartbeat, leading to reduction of cardiac workload
8. Beta blockers (e.g. atenolol) – open the blood vessels and reduces cardiac workload
9. Aldosterone antagonists (e.g. spironolactone) – block aldosterone, a hormone that promotes retention of salt and fluid which lead to high blood pressure
10. Renin inhibitors (e.g. aliskiren) – reduce the production of an enzyme called renin in the kidneys, leading to decreased blood pressure. These should not be combined with ARBs or ACE inhibitors due to increased risk for stroke
11. Vasodilators (e.g. hydralazine) – directly dilates the arterial walls
12. Central-acting agents (e.g. clonidine) – helps block brain-to-nervous system signaling in terms of narrowing blood vessels and increasing heart rate

Lifestyle Changes

Many cases of hypertension are due to bad habits and poor health management. Following a low salt diet (less than 2,300 mg per day) and Dietary Approaches to Stop Hypertension (DASH) diet will help lower blood pressure levels. Improve physical activity, maintain a healthy weight, stop smoking, and limit alcohol intake. Stress management (such as deep breathing exercises) and home blood pressure monitoring are also important to incorporate in daily living.

1. Decreased cardiac output 

Nursing Diagnosis: Decreased cardiac output secondary to increased vascular resistance as evidenced by high blood pressure level of 170/89, shortness of breath, fatigue and inability to do ADLs as normal

Desired outcome: The patient will be able to maintain adequate cardiac output.

Interventions	Rationale
Assess the patient’s vital signs and characteristics of heart beat at least every 4 hours.. Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor, cyanosis, and cool, clammy skin.	To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. The presence of signs of decreasing peripheral tissue perfusion indicate deterioration of the patient’s status which require immediate referral to the physician.
Administer prescribed medications for hypertension.	The category or type of drugs depend on your average blood pressure reading, underlying conditions, and complications. These include vasodilators (direct or indirect), diuretics, and cardiac workload reducers.
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.	To increase the oxygen level and achieve an SpO2 value within the target range.
Educate patient on stress management, deep breathing exercises, and relaxation techniques.	Stress causes a persistent increase in cortisol levels, which has been linked to people with hypertension. Chronic stress may also cause an increase in adrenaline levels, which tend to increase the heart rate, respiratory rate, and blood sugar levels. Reducing stress is also an important aspect of dealing with fatigue.

2. Acute Pain

Nursing Diagnosis: Acute Pain related to Increased cerebral vascular pressure as evidenced by pain score of 8 out of 10, verbalization of severe headache, throbbing pain on the suboccipital region,  blood pressure level of 170/90, nausea, and loss of appetite

Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and gaining a better appetite.

Interventions	Rationale
Administer prescribed pain medications. Administer anti-hypertensive medications.	To alleviate the severe headache. To treat the underlying cause of acute suboccipital pain, which is hypertension.
Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.	To monitor effectiveness of medical treatment for the pain relief. The time of monitoring of vital signs may depend on the peak time of the drug administered.
Put cool cloth on the forehead and perform gentle back rubs and neck rubs. Educate patient on stress management through deep breathing exercises, and relaxation techniques.	To decrease cerebral vascular pressure and promote blocking of sympathetic response
Place the patient in complete bed rest during severe headaches.	Stress causes a persistent increase in cortisol levels, which has been linked to people with hypertension. The effects of stress are likely to increase myocardial workload.