Nursing Management OF A Patient With Hypertension

NURSING MANAGEMENT
OF
A PATIENT
WITH
HYPERTENSION
HYPERTENSION
HYPER – GREEK WORD – MEANS “OVER” /
“BEYOND”.
TENSION – LATIN WORD – MEANS “

STRETCHING” / “STRAINING”
HYPERTENSION MEANS “STRAINING BEYOND”. ( A

STRAIN ON BLOOD VESSELS)
WHAT IS BLOOD PRESSURE?
• Blood pressure is the force of the blood pushing against the artery
walls.
• The force is generated with each heartbeat as blood is pumped from
the heart into the blood vessels.
• systolic pressure, refers to the pressure inside the artery when the
heart contracts and pumps blood through the body.
• The bottom number, or diastolic pressure, refers to the pressure
inside the artery when the heart is at rest and is filling with blood.
DEFINITION OF HTN
”Hypertension, also known as high or raised blood pressure, is a condition

in which the blood vessels have persistently raised pressure.”
(WHO)
ETIOLOGY OF HYPERTENSION
PRIMARY HYPERTENSION SECONDARY HYPERTENSION

• Also known as Essential or Idiopathic • There is a specific cause for
Hypertension. elevated BP
• No identified cause for high BP • Cause can be identified & treated.
• Accounts for 90-95% cases. • Accounts for 5% - 10% cases.
• Risk factors include high SNS activity, • Coarctation of Aorta, renal artery
overproduction of sodium-retaining stenosis, endocrine disorders,
hormones, increased sodium intake, brain tumor, Head Injury, Sleep
obesity, diabetes,excessive alcohol
Apnea, Cocaine use, OCPs, NSAIDs,
consumption.
Liver Cirrhosis, PIH.
ESSENTIAL / PRIMARY HYPRTENSION
SECONDARY HYPERTENSION
WHY IS THERE A PERSISTENTLY HIGH
BP?
 Increase In Cardiac Output
 Increase In Systemic Vascular Resistance.

CLINICAL MANIFESTATIONS
• Silent Killer
• Frequently Asymptomatic Until It Becomes Severe And Target Organ
Disease Has Occurred.
• Symptoms occur due to
• Effects on blood vessels in the various organs and tissues.
• The increased workload of the heart.
• Headache,Fatigue, Reduced activity tolerance, Dizziness,
Palpitations, Angina, Dyspnea, Nose bleed.
DIAGNOSIS OF HTN
1. History & Physical Examination
2. Routine Urinalysis
3. Basic Metabolic Panel ( FBS, Na, K, Ca, BUN, Creatinine)
4. LFT
5. Complete Blood Count
6. Serum Lipid Profile
7. Serum Uric Acid
8. 12 lead ECG
9. 24hour Urinary creatinine clearance
10. 2D Echo
11. Thyroid Profile Studies.
12. Ambulatory BP Monitoring
COMPLICATIONS
Coronary Artery Disease
LVH
Congestive Cardiac Failure
TIA / Stroke
 Abdominal / Carotid Aneurysm
Proteinuria
Hemorrhages
Papilledema (retinal arterioles)
Prevention & Control of HTN
• Maintain a Healthy weight
• Reduce salt and sodium intake
• Increase level of physical exercise
• Limit consumption of alcohol to minimal levels
• Monitor BP
• Take prescribed medications regularly.
MANAGEMENT OF HTN
GOAL :
1. TO CONTROL BP
2. TO REDUCE OVERALL CARDIOVASCULAR

RISK
COLLABORATIVE THERAPY
Periodic BP Monitoring
Nutritional Therapy
Regular, Moderate Exercise
Cessation Of Smoking
Moderation Of Alcohol Consumption
Stress Management
Anti-hypertensive Drugs
Patient Education
Periodic BP Monitoring
BP CLASSIFICATION
BP CLASSIFICATION SBP DBP LIFESTYLE DRUG THERAPY
MODIFICATION
NORMAL <120 <80 ENCOURAGE NOT INDICATED
PRE-HYPERTENSION 120-139 80-89 YES NOT INDICATED
STAGE 1 HTN 140 -159 90 -99 YES THIAZIDE DIURETICS
STAGE 2 HTN > 160 > 100 YES 2 DRUG COMBINATION

(THIAZIDE + ACE
INHIBITOR/ARB/BB/CCB)
Periodic BP Monitoring
HOME BP AMBULATORY BP
MONITORING IF INDICATED
EVERY 3-6MONTHS
LIFE STYLE MODIFICATIONS
WEIGHT REDUCTION
DASH EATING PLAN
DIETARY SODIUM RESTRICTION
MODERATION OF ALCOHOL CONSUMPTION
REGULAR AEROBIC PHYSICAL ACTIVITY
AVOIDANCE OF TOBACCO (SMOKING & CHEWING)
NUTRITIONAL THERAPY
DASH DIET (Dietary Approach To Stop Hypertension)
Restrict Sodium ( <6g of Salt/day)
Restrict Cholesterol & Fat (<30g per day)
Maintain Adequate Intake Of Potassium( RDA – 1.6gm to 2g or 40
– 50 mEq per day)
Maintain Adequate Intake Of Calcium & Magnesium (Ca – 1g &
Mg- 0.2 – 0.3 g daily)
DASH DIET
1. GRAINS & GRAIN PRODUCTS ( 7-8 Servings daily) – Rich source of energy & fiber.
Eg:- Bread, Cooked rice, Pasta, Oats
2. VEGETABLES ( 4-5 Servings daily) – Rich source of potassium, Magnesium & fiber.
3. FRUITS ( 4-5 Servings daily) – Rich source of potassium, Magnesium & fiber.
4. DAIRY FOODS ( Low-fat/ Fat- free) ( 2-3 Servings daily) – major sources of Protein &
Calcium.
5. MEAT/POULTRY/FISH ( 2 or less Servings daily) – Major sources of Protein &
Magnesium.
6. NUTS/SEEDS ( 4- 5 servings per week) - Rich source of potassium, energy, protein,
magnesium & fiber.
7. FATS & OILS ( 1-2 Servings daily)
8. SWEETS – 2-3 Per Week ( 1 tbs of sugar/ 1 tbs of jam/ 1 oz bakery foods)
STRESS MANAGEMENT
• Relaxation Therapy
• Guided Imagery
• Yoga & Meditation
• Behavioural Modifications
DRUG THERAPY
• Mechanism of Action –
1. decrease volume of circulating blood
2. reduce SVR
. Drugs used are
1. Diuretics
2. Beta Adrenergic Blockers
3. Vasodilators
4. ACE Inhibitors
5. A – II Receptor Blockers (ARBs)
6. Calcium Channel Blockers
DIURETICS
 ACTION
• Promote sodium & water excretion
• Reduce Plasma Volume
 CLASSIFICATION
1. Thiazide diuretics (Inhibits NaCl reabsorption at DCT) Eg: HCT
2. Loop Diuretics (Inhibits NaCl reabsorption at Henle’s loop) Eg:- Lasix
3. Potassium Sparing Diuretics ( Reduce K+ exchange in the DCT & Collecting
Duct) Eg:- Triametrene, Amiloride
4. Aldosterone Receptor Blockers ( Inhibit the effects of aldosterone in the
DCT & Collecting Duct) Eg: Spironolactone
ADRENERGIC BLOCKERS
ACTION:
1. Produces vasodilation
2. Decreases SVR, CO and BP
CLASSIFICATION:
 Alpha Adrenergic Blockers (Decreases SVR ) Eg: Clonidine, Methyldopa, Doxazosin,
Prazosin.
 Beta Adrenergic blockers ( Decreases Renin Secretion & CO) Eg: Atenolol, Metaprolol,
Carvedilol, Propanolol, Labetalol
VASODILATORS
ACTION
 Activates Dopamine receptors resulting in systemic and renal vasodilation.
 Relaxes arterial and venous smooth muscles.
 Reduces pre-load & SVR
Examples
 Hydralazine
Minoxidil
NTG
Sodium Nitroprusside
ANGIOTENSIN
Role of Angiotensin
Angiotensin 1 :- No specific roles
Angiotensin 2 :-
Causes muscular walls of small arteries (arterioles) to narrow (constrict) thus increasing the BP.
It also triggers Aldosterone release from Adrenal Glands and ADH/Vasopressin from Pituitary
Glands.
Aldosterone :- causes Vasoconstriction and increases BP.
RAAS (RENIN – ANGIOTENSIN – ALDOSTERONE SYSTEM)
RENIN ( Produced by Kidney when Na is low).
Renin Converts Plasma Protein Angiotensinogen (produced by Liver) to Angiotensin 1.
ACE (formed in the Lungs/PCT) converts A1 to A2.
Aldosterone is produced when A1 to A2.

ANGIOTENSIN INHIBITORS
TWO TYPES
1. ACE Inhibitors (prevents conversion of A1 to A2, thus reduces
A2)
2. A-2 receptor Blockers (ARBs) (prevents A2 from binding to its
receptors in the walls of blood vessels.
EXAMPLES
ACE inhibitors – Enalapril, Perindopril, ramipril
ARBs – Losartan, Olmasartan, Temisartan
CALCIUM CHANNEL BLOCKERS
ACTION
1) Increase sodium excretion and
2) cause arteriolar vasodilation by preventing the movement of extracellular
calcium into cells.
Examples
Amlodipine
Dilitiazem
Nicardipine
Nifedipine
Verapamil
NURSING MANAGEMENT
Nursing Priorities
• Maintain/enhance cardiovascular functioning.
• Prevent complications.
• Provide information about disease process/prognosis and treatment
regimen.
• Support active patient control of condition.
Assessment
• Assess the patient’s health history

• Perform physical examination as appropriate.
• The retinas are examined to assess possible organ damage.
• Laboratory tests are also taken to check target organ damage.
Nursing Interventions
(Decreased Cardiac Output)
• Review clients at risk as noted in Related Factors and individuals
with conditions that stress the heart.
• Check laboratory data (cardiac markers, complete blood cell count,
electrolytes, ABGs, blood urea nitrogen and creatinine, cardiac
enzymes, and cultures, such as blood, wound, or secretions).
• Monitor and record BP. Measure in both arms and thighs three
times, 3–5 min apart while the patient is at rest, then sitting, then
standing for initial evaluation. Use correct cuff size and accurate
technique. Comparison of pressures provides a complete picture of
vascular involvement or the scope of the problem.
(Decreased Cardiac Output)
• Note the presence, and quality of central and peripheral pulses.
Bounding carotid, jugular, radial, and femoral pulses may be observed and
palpated. Pulses in the legs and feet may be diminished, reflecting the effects
of vasoconstriction (increased systemic vascular resistance [SVR]) and venous
congestion.
• Auscultate heart tones and breath sounds. The presence of crackles and
wheezes may indicate pulmonary congestion secondary to developing or
chronic heart failure.
• Observe skin color, moisture, temperature, and capillary refill time.
The presence of pallor; cool, moist skin; and delayed capillary refill time may
be due to peripheral vasoconstriction or reflect cardiac decompensation and
decreased output.
(Decreased Activity Tolerance)
• Note dependent and general edema.

May indicate heart failure, renal, or vascular impairment.
• Evaluate client reports or evidence of extreme fatigue, intolerance
for activity, sudden or progressive weight gain, swelling of
extremities, and progressive shortness of breath.
To assess for signs of poor ventricular function or impending cardiac
failure.
• Provide calm, restful surroundings, and minimize environmental
activity and noise. Limit the number of visitors and length of stay.
• Maintain activity restrictions (bedrest or chair rest); schedule

uninterrupted rest periods; assist patient with self-care activities as
needed.
• Provide comfort measures (back and neck massage, the elevation of
head).
• Instruct in relaxation techniques, guided imagery, and distractions.
• Monitor response to medications to control blood pressure.
• Administer medications as indicated
• Implement dietary sodium, fat, and cholesterol restrictions as
indicated.
NURSING INTERVENTIONS
• Instruct patient in energy-conserving techniques (using a chair when

showering, sitting to brush teeth or comb hair, carrying out activities
at a slower pace).
• Encourage progressive activity and self-care when tolerated. Assist
as needed.
• Encourage and maintain bed rest during the acute phase.
• Provide or recommend nonpharmacological measures to relieve
headache such as cool cloth to forehead; back and neck rubs; quiet,
dimly lit room; relaxation techniques (guided imagery, distraction);
and diversional activities.
NURSING INTERVENTIONS
(Acute Pain)
• Eliminate or minimize vasoconstricting activities that may aggravate

headache (straining at stool, prolonged coughing, bending over).
• Assist patient with ambulation as needed.Dizziness and blurred
vision frequently are associated with vascular headaches.
• Provide liquids, soft foods, and frequent mouth care if nosebleeds
occur, or nasal packing has been done to stop bleeding.
Discharge and Home Care Guidelines
• Following discharge, the nurse should promote self-care and
independence of the patient.
• The nurse can help the patient achieve blood pressure control
through education about managing blood pressure.
• Assist the patient in setting goal blood pressures.
• Provide assistance with social support.
• Encourage the involvement of family members in the education program
to support the patient’s efforts to control hypertension.
• Provide written information about expected effects and side effects.
• Encourage and teach patients to measure their blood pressures at home.
• Emphasize strict compliance of follow-up checkup.

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NURSING MANAGEMENT

TENSION – LATIN WORD – MEANS “

HYPERTENSION MEANS “STRAINING BEYOND”. ( A

”Hypertension, also known as high or raised blood pressure, is a condition

PRIMARY HYPERTENSION SECONDARY HYPERTENSION

 Increase In Cardiac Output

 Increase In Systemic Vascular Resistance.

2. TO REDUCE OVERALL CARDIOVASCULAR

NORMAL <120 <80 ENCOURAGE NOT INDICATED

PRE-HYPERTENSION 120-139 80-89 YES NOT INDICATED

STAGE 1 HTN 140 -159 90 -99 YES THIAZIDE DIURETICS

STAGE 2 HTN > 160 > 100 YES 2 DRUG COMBINATION

RENIN ( Produced by Kidney when Na is low).

Renin Converts Plasma Protein Angiotensinogen (produced by Liver) to Angiotensin 1.

ACE (formed in the Lungs/PCT) converts A1 to A2.

Aldosterone is produced when A1 to A2.

• Assess the patient’s health history

• Note dependent and general edema.

• Maintain activity restrictions (bedrest or chair rest); schedule

• Instruct patient in energy-conserving techniques (using a chair when

• Eliminate or minimize vasoconstricting activities that may aggravate

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