NCP - Nursing Care Plan for Hypertension

Hypertension

Hypertension is the term used to describe high blood pressure.

Blood pressure is a measurement of the force against the walls of your arteries as the heart pumps blood through the body.

Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as two numbers -- for example, 120 over 80 (written as 120/80 mmHg). One or both of these numbers can be too high.

The top number is your systolic pressure.

• It is considered high if it is over 140 most of the time.
• It is considered normal if it is below 120 most of the time.

The bottom number is your diastolic pressure.

• It is considered high if it is over 90 most of the time.
• It is considered normal if it is below 80 most of the time.
  

Causes

Essential hypertension
Essential hypertension is the most prevalent hypertension type, affecting 90–95% of hypertensive patients. Although no direct cause has been identified, there are many factors such as sedentary lifestyle, smoking, stress, visceral obesity, potassium deficiency (hypokalemia), obesity (more than 85% of cases occur in those with a body mass index greater than 25), salt (sodium) sensitivity, alcohol intake, and vitamin D deficiency that increase the risk of developing hypertension. Risk also increases with aging, some inherited genetic mutations, and having a family history of hypertension. An elevated level of renin, a hormone secreted by the kidney, is another risk factor, as is sympathetic nervous system overactivity. Insulin resistance, which is a component of syndrome X (or the metabolic syndrome), is also thought to contribute to hypertension. Recent studies have implicated low birth weight as a risk factor for adult essential hypertension.

Secondary hypertension
Secondary hypertension by definition results from an identifiable cause. This type is important to recognize since it's treated differently to essential hypertension, by treating the underlying cause of the elevated blood pressure. Hypertension results in the compromise or imbalance of the pathophysiological mechanisms, such as the hormone-regulating endocrine system, that regulate blood plasma volume and heart function. Many conditions cause hypertension, some are common and well recognized secondary causes such as Cushing's syndrome,] which is a condition where the adrenal glands overproduce the hormone cortisol. In addition, hypertension is caused by other conditions that cause hormone changes such as hyperthyroidism, hypothyroidism (citation needed), and certain tumors of the adrenal medulla (e.g., pheochromocytoma). Other common causes of secondary hypertension include kidney disease, obesity/metabolic disorder, pre-eclampsia during pregnancy, the congenital defect known as coarctation of the aorta, and certain prescription and illegal drugs.


Symptoms

Most of the time, there are no symptoms. Symptoms that may occur include:

• Confusion
• Ear noise or buzzing
• Fatigue
• Headache
• Irregular heartbeat
• Nosebleed
• Vision changes

NCP - Nursing Care Plan for Hypertension

Nursing Assessment for Hypertension

Nursing History

• Previous episodes of high Blood Pressure
• Family history of high Blood Pressure
• Target organ disease or other disease processes that may place the patient in a high-risk group diabetes, CAD, kidney disease
• Dietary habits and salt intake
• Episodes of headache, weakness, muscle cramp, tingling, palpitations, sweating, vision disturbances
• Cigarette smoking
• 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 for bruits over peripheral arteries to determine the presence of atherosclerosis, which may be manifested as obstructed blood flow.
• Auscultate heart rate and palpate peripheral pulses; determine respirations.
• Examine the heart for a shift of the point of maximal impulse to the left, which occurs in heart enlargement.
• 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.
• Blood Pressure Determination, Auscultate and record precisely the systolic and diastolic.
• Determine mentation status by asking patient about memory, ability to concentrate, and ability to perform simple mathematical calculations.
  

Hypertension Nursing Interventions

Source :
www.nlm.nih.gov
en.wikipedia.org