Hypertension

22 Hypertension




Overview/pathophysiology


The incidence of hypertension among adults in the United States is 29%-31%, affecting 58 to 65 million persons, with a continuing rise in incidence and prevalence. Half of individuals older than 65 years are affected by hypertension. Risk factors include age, heredity, race (incidence is higher in African Americans), renal disease, obesity, hyperlipidemia, smoking, and some endocrine disorders (e.g., Cushing’s disease, thyroid disease, primary aldosteronism, pheochromocytoma).


Complications of this disease include increased incidence of transient ischemic attack/stroke, retinopathy, coronary artery disease, heart failure, aortic aneurysm, and renal failure.


The seventh report of the Joint National Committee (JNC VII) defines hypertension (based on the average of two or more properly measured readings at each of two or more visits after an initial screen) as:


• Normal blood pressure: systolic blood pressure (SBP) less than 120 mm Hg and diastolic blood pressure (DBP) less than 80 mm Hg

• Prehypertension: SBP 120-139 mm Hg or DBP 80-89 mm Hg

• Hypertension


• Stage 1: SBP 140-159 mm Hg or DBP 90-99 mm Hg

• Stage 2: SBP 160 mm Hg or greater or DBP 100 mm Hg or greater


Health care setting


Primary care or cardiology clinic setting most commonly; patients with severe hypertension may require acute hospitalization





Nursing diagnosis:



Deficient knowledge


related to unfamiliarity with need for frequent blood pressure (BP) checks, adherence to antihypertensive therapy, and lifestyle changes


Desired Outcome: Following teaching, patient verbalizes knowledge of the importance of frequent BP checks and adhering to antihypertensive therapy and lifestyle changes.






















ASSESSMENT/INTERVENTIONS RATIONALES
Assess patient’s health care literacy (language, reading, comprehension). Assess culture and culturally specific information needs. This assessment helps ensure that information is selected and presented in a manner that is culturally and educationally appropriate.
Teach importance of assessing BP at frequent intervals and adhering to prescribed medication therapy. Frequent assessment provides feedback on response to therapy and may help improve adherence to therapy. In addition, self-assessment is useful for evaluating “white coat hypertension,” the phenomenon of increased BP when it is taken by a health care provider.
Provide teaching guidelines on importance of exercise, stress reduction, weight loss (if appropriate), decreased alcohol intake, and 2 g/day sodium diet. Review with patient how to read food labels and choose low sodium foods. Refer to nutritionist, exercise program, if appropriate. Primary treatment for this disease includes promotion of lifestyle modification, which can lower BP significantly if adhered to.
Teach medication actions, administration times, side effects, adverse effects, and importance of taking as prescribed. Include drug-drug, food-drug, and herb-drug interactions. Knowledge about and adherence to prescribed regimen can lower morbidity and mortality risk and improve patient outcomes.
Instruct patient about importance of seeking medical evaluation if BP reading is greater than 200/100 mm Hg or less than 90/60 mm Hg, or if headache, dizziness, lightheadedness, or blurred vision occurs. Severe hypertension or hypotension can be life threatening, compromising perfusion to vital organs.



ADDITIONAL NURSING DIAGNOSES/PROBLEMS:

















“Psychosocial Support” p. 69
“Coronary Artery Disease” for Imbalanced Nutrition: More Than Body Requirements p. 154
Deficient Knowledge (purpose, precautions, and side effects of beta-blockers) p. 157
Deficient Knowledge (relaxation technique effective for stress reduction) p. 158
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Jul 18, 2016 | Posted by in NURSING | Comments Off on Hypertension

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