A.

DEFINITION
Hypertension is a systolic pressure higher than 140 mmHg persistent or diastolic pressure>
90 mmHg. The diagnosis is confirmed by measuring the average of two or more blood pressure
engravings at separate times (Engram, 1998).
Hypertension is persistent blood pressure where the systolic pressure is above 140 mmHg
and the diastolic pressure is above 90 mmHg (Brunner and Suddarth, 2001).
Hypertension is an increase in systole, whose height depends on the age of the individual
affected. Blood pressure fluctuates within certain limits, depending on body position, age and
stress level experienced (Tamboyong, 2000).

B. ETIOLOGY (Sjaifoellah Noer, 2001)

Based on the cause of hypertension is divided into two:
1. Essential hypertension.
Namely hypertension, which has no known cause and covers 90% of all patients with
hypertension, factors that affect, among others
a. Genetics
The role of genetic factors in essential hypertension is proven that the incidence of
hypertension is more common in patients with monozygotic twins than
heterozygotes, if one of them suffers from hypertension. In 70% of cases of
essential hypertension is a history of essential hypertension.
b. Age
The incidence of hypertension increases with increasing age. Hypertension in those
under 35 years of age clearly increases the incidence of coronary artery disease and
premature death.
c. Obesity
The accumulation of fat especially in blood vessels results in a decrease in
peripheral resistance which increases sympathetic nerve activity which results in
increased vasoconstriction and decreased vasodilation where it can stimulate the
adrenal medulla to secrete epinerpin and norepineprin which can cause
hypertension.
d. Hypercholesterol
 Fat in various processes will cause the formation of plaque in blood vessels. This
development causes narrowing and hardening called atherosclerosis.
e. Sodium intake increases (sodium balance)
Damage to renal sodium excretion is the first change found in the process of HT.
Na + retention is followed by expansion of blood volume and then increased cardiac
output. Peripheral autoregulation increases peripheral vascular resistance and ends
with HT.
f. Cigarettes
Cigarette smoke contains nicotine which stimulates the release of adrenaline which
stimulates the heartbeat and blood pressure. Besides cigarette smoke contains
carbon monoxide which has a stronger ability than Hb in attracting oxygen. So the
network lacks oxygen including the heart.
g. Alcohol
Long-term use of alcohol or ethanol can cause an increase in lipogenesis
(hyperlipidemia occurs) synthesis of cholesterol from acetyl co enzyme A, changes
in seklerosis and fibrosis in small arteries.
h. Certain drugs or anti-pregnancy pills
Anti-pregnant pills contain the hormone estrogen which is also salt and water
retention, and can raise blood cholesterol and blood sugar.
i. Psychological stress
Stress can trigger the release of high levels of the hormone adrenaline and
catecholamine, which aggravates the work of the coronary arteries so that the
supply of blood to the heart muscle is disrupted. Stress can activate sympathetic
nerves that can increase blood pressure intermittently.
2. Hipertensi sekunder
Disebabkan oleh penyakit tertentu, misalnya :
a. Penyakit ginjal
Kerusakan pada ginjal menyebabkan renin oleh sel-sel juxtaglomerular keluar,
mengakibatkan pengeluaran angiostensin II yang berpengaruh terhadap sekresi
aldosteron yang dapat meretensi Na dan air.
b. Diabetes Mellitus
 Disebabkan oleh kadar gula yang tinggi dalam waktu yang sama mengakibatkan
gula darah pekat dan terjadi pengendapan yang menimbulkan arterosklerosis
meningkatkan tekanan darah.

C. PATHOPHYSIOLOGY
The mechanism that controls the constriction and relaxation of blood vessels is located in the
vasomotor center, in the medulla in the brain. From this vasomotor center begins the
sympathetic nerve pathway, which continues downward to the spinal cord and exits the column
of the spinal cord to the sympathetic ganglia in the thorax and abdomen. Vasomotor central
stimuli are delivered in the form of impulses that move down through the sympathetic nervous
system to the sympathetic ganglia. At this point, preganglionic neurons release acetylene,
which stimulates post-ganglion nerve fibers to blood vessels, where the release of
norepinephrine results in blood vessel construction. Various factors such as anxiety and fear
can affect blood vessel response to stimulating vasoconstrictors. Individuals with hypertension
are very sensitive to noepinifrin, although it is not clear why this can occur. At the same time,
the sympathetic nervous system stimulates blood vessels in response to emotional stimulation.
The adrenal gland is also aroused, resulting in additional activation of vasoconstriction. The
adrenal cortex secretes cortisol and other steroids, which can strengthen blood vessel
vasoconstrictor responses. Vasoconstriction which results in reduced blood flow to the
kidneys, causes release of rennin. Rennin stimulates the formation of angiotensin I, which is
then converted to angiotensin II, a powerful vasoconstrictor, which in turn stimulates
aldosterone secretion by the adenal cortex. This hormone causes retention of sodium and water
by the kidney tubules, causing an increase in intravascular volume. All of these factors trigger
the state of hypertension. (Bruner & Suddhart, 2001, p. 898).

D. CLASSIFICATION
According to WHO's classification of hypertension, namely:
1. Normal blood pressure that is if systolic is less or equal to 140 mmHg and diastolic is less
or equal to 90 mmHg
2. Border blood pressure (broder line) that is if systolic 141-149 mmHg and diastolic 91-94
mmHg
3. High blood pressure (hypertension) that is if the systolic is greater or equal to 160 mmHg
and the diastolic is greater or equal to 95mmHg.
Classification according to the Joint National Committee on Detection and Treatment of
Hypertension, namely:
1. Diastolic
a. <85 mmHg: Normal blood pressure
b. 85 - 99 mmHg: Normal high blood pressure
c. 90 -104 mmHg: Mild hypertension
d. 105 - 114 mmHg: Moderate hypertension
e. > 115 mmHg: Severe hypertension
2. Systolic (with a diastolic pressure of 90 mmHg)
a. <140 mmHg: Normal blood pressure
140 - 159 mmHg: Isolated border systolic hypertension
b. > 160 mmHg: Isolated systolic hypertension
The hypertension crisis is a sudden increase in blood pressure (cystole 80180 mmHg
and / or diastole ≥120 mmHg), in patients with hypertension, who need immediate
response characterized by very high blood pressure with the possibility of occurrence
or target organ abnormalities ( brain, eyes (retina), kidneys, heart and blood vessels).
The high blood pressure varies, the most important is the rapid rise in blood pressure,
including:
1. Emergency Hypertension
Situations where immediate blood pressure reduction is required with parenteral
antihypertensive drugs due to the presence of acute target organ damage or progressive
acute or progressive targets. Sudden BP increase accompanied by progressive target
organ damage and immediate BP reduction in minutes / hours.
2. Urgency Hypertension
Situations where there is a significant increase in blood pressure in the absence of
severe symptoms or significant progressive target organ damage without severe
symptoms or progressive target organ damage and blood pressure need to be reduced
 within a few hours. A reduction in BP should be carried out within 24-48 hours (a
decrease in blood pressure can be carried out more slowly (within hours to days).

Classification of Stage Hypertension According to Sjaifoellah Noer, (2001) consists of:

1. Stage 1 (light)
Systolic pressure between 140 - 159 mmHg. Diastolic pressure between 90-99 mmHg.
2. Stage 2 (medium)
Systolic pressure between 160 - 179 mmHg. Diastolic pressure between 100 - 109 mmHg.
3. Stage 3 (heavy)
Systolic pressure between 180 - 209 mmHg. Diastolic pressure between 110 - 119 mmHg.
4. Stage 4 (very heavy)
Systolic pressure is more than or equal to 210 mmHg. Diastolic pressure between> 120
mmHg.
This classification is not for someone who is taking antihypertensive drugs and is not acutely
ill. If the systolic and diastolic pressures are in different categories. Then a high category must
be chosen to classify a person's blood pressure status.

E. SIGNS AND SYMPTOMS

According to Tambayong (2000) symptoms and signs can be characterized as follows:
1. Headache
2. Pain or heaviness in the nape of the neck
3. Difficulty sleeping
4. Easily tired and angry
5. Tinnitus
6. Eyes are dizzy
7. Epistaxis
8. Shaking
9. Pulse quickly after activity
10. Shortness of breath
11. Nausea, vomiting
F. COMPLICATIONS
Complications according to Tambayong (2000) that may occur in hypertension are as follows:
1. Broken heart (heart failure)
2. Brain bleeding (stroke)
3. Malignant hypertension: retinal, renal and cerebral abnormalities
4. Hypertension encephalopathy: complications of malignant hypertension with brain
disorders.
5. Myocardial infarction
It can occur if an atherosclerotic coronary artery cannot supply enough chemiocardial
oxygen or if a thrombus is formed which blocks blood flow through the blood vessels.
6. Kidney failure
Because of progressive damage due to high pressure on the renal capillaries, the
glomerulus. With the destruction of the glomerulus blood will flow to the functional units
of the kidney. Nephrons are disrupted and can continue to become hypoxia and kemataian.
With the breakdown of the glomerular membrane, protein will pass through urine so that
the plasma colloid osmotic pressure is reduced, causing edema, which is often found in
chronic hypertension.

F. SUPPORT EXAMINATION
Investigations that can be used to diagnose hypertension according to Doenges (2000) include:
1. ECG: Left ventricular hypertrophy in advanced chronic conditions.
2. Potassium in serum: increases from the normal threshold.
3. Post prandial blood sugar examination if there is an indication of DM.
4. Urine:
a. Ureum, creatinine: increases in chronic conditions and continues from the normal
threshold.
b. Urine Protein: Positive

G. MANAGEMENT
According to Engram (1999), management includes:
1. Treatment of secondary hypertension prioritizes causal treatment.
 2. Treatment of essential hypertension is intended to reduce blood pressure with hypertension
drugs.
3. Treatment of hypertension is a long-term treatment even for life.
4. Treatment using standard triple therapy (STT) consists of:
a. Diuretics, for example: thiazide, furosemide, hydrochlorothiazide.
b. Betablocker: methyldopa, reserpine.
c. Vasodilators: dioxid, pranosine, hydralacin.
d. Angiotensin, Converting Enzyme Inhibitors.
5. Modification of lifestyle, with:
a. Weight loss.
b. Reduction of alcoholic intake.
c. Regular physical activity.
d. Reducing sodium input.
e. Stop smoking.

H. ASSESSMENT
Basic data assessment (Doenges, 2000)
1. Activity : weakness, fatigue, lethargy, tachypnea, increased HR, changes in heart
rhythm.
2. Circulation : history of hypertension, palpitations, elevated BP changes in skin color,
cold temperature, pale, cyanosis, diaporesis.
3. Ego integrity : anxiety, depression, anger, anxiety, tense facial muscles, increased
speech patterns.
4. Food / fluid : normal BB / obesity, edema.
5. Neurosensory : dizziness, headache, vision problems, epistaxis.
6. Pain : pain arises in the legs, headache, abdominal pain.
7. Respiratory : takipnea dyspnea, smoking history, additional breath sounds.
8. Elimination : current or past gunjal disturbances.
9. Security : coordination disorders, postural hypotension.
I. Nursing Diagnosis
1. Resiko tinggi terhadap penurunan curah jantung berhubungan dengan peningkatan
afterload, vasokonstriksi, hipertrofi/rigiditas ventrikuler, iskemia miokard.
2. Intoleransi aktivitas berhubungan dengan kelemahan, ketidakseimbangan suplai dan
kebutuhan oksigen.
3. Nyeri akut berhubungan dengan peningkatan tekanan vaskuler serebral.
4. Cemas berhubungan dengan krisis situasional sekunder adanya hipertensi yang diderita
klien.
5. Kurang pengetahuan berhubungan dengan kurangnya informasi tentang proses penyakit
 NURSING PLAN
NO NURSING DIAGNOSIS
GOAL (NOC) INTERVENTION (NIC)
DX AND COLLABORATION
1 High risk of decreased NOC : NIC :
cardiac output is associated Cardiac Pump Effectiveness Cardiac Care
with increased afterload, Circulation Status Evaluation of chest pain (intensity, location, duration)
vasoconstriction, ventricular Vital Sign Status Record the presence of cardiac dysrhythmias
hypertrophy / rigidity, Result Criteria: Note the signs and symptoms of decreased cardiac putput
myocardial ischemia Vital signs in the normal range (blood Monitor cardiovascular status
pressure, pulse, respiration) Monitor respiratory status which indicates heart failure
Can tolerate activity, there is no fatigue Monitor the abdomen as an indicator of decreased perfusion
There is no pulmonary, peripheral edema, Monitor fluid balance
and no ascites Monitor changes in blood pressure
There is no decrease in consciousness Monitor patient response to the effects of antiarrhythmic treatment
Set the period of exercise and rest to avoid fatigue
Monitor tolerance of patient activity
Monitor for dyspneu, fatigue, tekipneu and orthopneu
Advise to reduce stress

Vital Sign Monitoring

Monitor TD, pulse, temperature, and RR
Record blood pressure fluctuations
Monitor VS when the patient is lying down, sitting or standing
Auscultate BP in both arms and compare
 Monitor TD, pulse, RR, before, during, and after activity
Monitor the quality of the pulse
Monitor the presence of pulsus paradoxus
Monitor the presence of pulsus alterans
Monitor the amount and rhythm of the heart
Monitor heart sounds
Monitor the frequency and rhythm of breathing
Monitor lung sounds
Monitor abnormal breathing patterns
Monitor skin temperature, color and moisture
Monitor peripheral cyanosis
Monitor the presence of cushing triad (widening pulse pressure,
bradycardia, increased systolic)
Identify the causes of vital sign changes
2 Activity intolerance is NOC : NIC :
associated with weakness, Energy conservation Energy Management
imbalance in supply and Self Care: ADLs Observation of restrictions on clients in carrying out activities
oxygen demand. Result Criteria: Encourage the anal to express feelings towards limitations
Participating in physical activity without Assess for factors that cause fatigue
accompanied by an increase in blood Monitor nutrition and strong energy sources
pressure, pulse and RR Monitor patients for excessive physical and emotional fatigue
Monitor cardivascular responses to activity
 Able to do daily activities (ADLs) Monitor sleep patterns and length of sleep / patient rest
independently Activity Therapy
Collaboration with Medical Rehabilitation Workers in planning the
right therapy program.
Help clients identify activities that are capable of being done
Help to choose consistent activities that are in accordance with
physical, psychological and social abilities
Help to identify and get the resources needed for the desired activity
Help to get activity aid tools such as wheelchairs, crutches
Help to identify preferred activities
Help clients to make training schedules in their spare time
Help patients / families to identify deficiencies in activities
Provide positive reinforcement for those who are active in activities
Help patients develop self motivation and reinforcement
Monitor physical, emotional, social and spiritual responses
3 Acute pain is associated with NOC : NIC :
increased cerebral vascular Pain Level, Pain Management
pressure Pain control, Perform a comprehensive pain assessment including location,
Comfort level characteristics, duration, frequency, quality and precipitation factors
Result Criteria: Observation of nonverbal reactions from discomfort
Use therapeutic communication techniques to determine the patient's
pain experience
Able to control pain (know the cause of Assess culture that affects pain response
pain, be able to use non-pharmacological Evaluation of past pain experiences
techniques to reduce pain, seek help) Evaluation with patients and other health teams about the
Report that pain is reduced by using pain ineffectiveness of past pain control
management Help patients and families find and find support
Able to recognize pain (scale, intensity, Environmental controls that can affect pain such as room temperature,
frequency and signs of pain) lighting and noise
Expressing comfort after the pain has Reduce the factor of precipitation pain
diminished Choose and do pain management (pharmacology, non-pharmacology
Vital signs in the normal range and inter-personal)
Assess the type and source of pain to determine intervention
Teach about non-pharmacological techniques
Give analgesics to reduce pain
Evaluate the effectiveness of pain control
Increase rest
Collaborate with a doctor if there are complaints and pain actions are
not successful
Monitor patient acceptance of pain management

Analgesic Administration
 Determine the location, characteristics, quality, and degree of pain
before administration of the drug
Check the doctor's instructions about the type of drug, dosage, and
frequency
Check allergy history
Choose the analgesics needed or a combination of analgesics when
giving more than one
Determine analgesic choices depending on the type and severity of the
pain
Determine choice analgesics, route of administration, and optimal
dosage
Select IV administration route, IM for the treatment of pain regularly
Monitor vital signs before and after the first analgesic administration
Give analgesics on time, especially when pain is great
Evaluate the effectiveness of analgesics, signs and symptoms (side
effects)
4 Anxiety is associated with a After nursing actions for 3 x 24 hours, worry Anxiety Reduction
secondary situational crisis about the patient's reduced criteria for Use a calming approach
of hypertension suffered by results: Clearly express expectations of the perpetrators of the patient
the client Anxiety Control Describe all procedures and what is felt during the procedure
Coping Accompany patients to provide security and reduce fear
Vital Sign Status Give factual information about the diagnosis, prognosis
 Showing techniques to control anxiety Encourage families to accompany children
deep breathing techniques Perform back / neck rub
The patient's posture relaxes and the facial Listen attentively
expressions are not tense Identify the level of anxiety
Expressing anxiety decreases Help patients recognize situations that cause anxiety
TTV dbn Encourage patients to express feelings, fears, perceptions
TD = 110-130 / 70-80 mmHg Instruct patients to use relaxation techniques
RR = 14-24 x / minute Share drugs to reduce anxiety
N = 60 -100 x / minute
S = 365 - 375 0C
5 Lack of knowledge is related NOC : NIC :
to a lack of information Kowlwdge: disease process Teaching : disease Process
about the disease process Kowledge: health Behavior Give an assessment of the level of patient knowledge about the
Result Criteria: specific disease process
Patients and families express an Describe the pathophysiology of the disease and how it relates to
understanding of the disease, conditions, anatomy and physiology, in the right way.
prognosis and treatment program Describe the usual signs and symptoms in the disease, in the right way
Patients and families are able to carry out Describe the disease process, in the right way
the procedure correctly described Identify possible causes, with the right way
Patients and families are able to explain Provide information to patients about the condition, in the right way
again what the nurse / other health team Avoid empty expectations
explained.
Provide the family or SO with information about the patient's progress
in the right way
Discuss lifestyle changes that may be needed to prevent future
complications and / or disease control processes
Discuss treatment or treatment options
Support patients to explore or get a second opinion in the right way or
indicated
Exploration of possible sources or support, in the right way
Refer patients to groups or agencies in the local community, in the right
way
Instruct patients about signs and symptoms to report to health care
providers, in the right way
 DAFTAR PUSTAKA

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