Family nursing Care plan for hypertension

Hypertension Nursing Care Plans Diagnosis and Interventions

Hypertension NCLEX Review and Nursing Care Plans

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.

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

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.

Risk Factors

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

Complications of Hypertension

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

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.
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.
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.
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.
Dementia, memory problems or cognition disorders
Metabolic syndrome, which may lead to diabetes
Kidney dysfunction

Diagnostic Tests for 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.

Treatment for Hypertension

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.

Thiazide diuretics (e.g. hydrochlorothiazide) – eliminate sodium and water through urine, leading to a decline in blood volume
Angiotensin-converting enzyme (ACE) inhibitors (e.g. lisinopril) – block the formation of angiotensin, a peptide hormone that narrows blood vessels, leading to vasodilation
Angiotensin II receptor blockers (ARBs) (e.g. losartan) – block the action of angiotensin, leading to vasodilation
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.
Alpha blockers (e.g. doxazosin) – reduce the effect of angiotensin by decreasing the nerve impulses to the blood vessels
Alpha-beta blockers (e.g. carvedilol) – slow down the heartbeat, leading to reduction of cardiac workload
Beta blockers (e.g. atenolol) – open the blood vessels and reduces cardiac workload
Aldosterone antagonists (e.g. spironolactone) – block aldosterone, a hormone that promotes retention of salt and fluid which lead to high blood pressure
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
Vasodilators (e.g. hydralazine) – directly dilates the arterial walls
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.

Hypertension Nursing Care Plan 1

Decreased cardiac outputsecondary 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.

Nursing Interventions for Hypertension	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.

Hypertension Nursing Care Plan 2

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.

Nursing Interventions for Hypertension	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.

Hypertension Nursing Care Plan 3

Nursing Diagnosis: Deficient Knowledge related to new diagnosis of secondary hypertension as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”

Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of hypertension and its management.

Nursing Interventions for Hypertension	Rationales
Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits)To address the patient’s cognition and mental status towards the new diagnosis of hypertension and to help the patient overcome blocks to learning.
Explain what hypertension is, its types (specifically secondary hypertension), and how it affects the vital organs such as the heart, kidneys, brain, and blood vessels. Avoid using medical jargons and explain in layman’s terms.	To provide information on hypertension and its pathophysiology in the simplest way possible.
Teach the patient the stages of hypertension and set the target range for his/her blood pressure levels to be classified as “well-controlled”. Demonstrate how to perform blood pressure monitoring	To give the patient enough information on the stages of hypertension and the desired limits of blood pressure levels. To empower patient to monitor his/her blood pressure levels at home.
Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to control hypertension, and explain how to properly self-administer each of them. Ask the patient to repeat or demonstrate the self-administration details to you.	To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.
Use open-ended questions to explore the patient’s lifestyle choices and behaviors that can be linked to the development of hypertension. Teach the patient on how to modify these risk factors (e.g. smoking, excessive alcohol intake, high sodium and/or cholesterol diet, obesity, sedentary lifestyle, etc).	To assist the patient in identifying and managing modifiable risk factors related to hypertension.

Hypertension Nursing Care Plan 4

Nursing Diagnosis: Activity Intolerance related to sedentary lifestyle as evidenced by fatigue, generalized weakness, blood pressure level of 180/90, and shortness of breath upon exertion

Desired Outcome: The patient will participate in necessary and desired activities and demonstrate increase in activity levels.

Nursing Interventions for Hypertension	Rationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.	To create a baseline of activity levels and mental status related to activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods.	To gradually increase the patient’s tolerance to physical activity.
Refer the patient to physiotherapy / occupational therapy team as required.	To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.

Hypertension Nursing Care Plan 5

Nursing Diagnosis: Imbalanced Nutrition: More than Body Requirements related to excessive caloric intake in relation to metabolic need, as evidenced by a BMI of 31, increased triceps skinfold (more than 25 mm in women and 15 mm in women), and verbalization of dysfunctional eating patterns

Desired Outcome: The patient will be able to reduce weight within his/her normal BMI range and will demonstrate healthy eating patterns and choices.

Nursing Interventions for Hypertension	Rationales
Explain to the patient the relationship between obesity and hypertension.	To help the patient understand why obesity is one of the most common risk factors of hypertension.
Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term goals of weight loss.	To effectively monitory the patient’s daily nutritional intake and progress in weight loss goals.
Help the patient to select appropriate dietary choices to follow a low salt, low cholesterol diet.	A diet rich in salt (sodium) and bad cholesterol (LDL) puts the patient at risk for uncontrolled hypertension.
Refer the patient to the dietitian.	To provide a more specialized care for the patient in terms of nutrition and diet.

Hypertension Nursing Care Plan 6

Decreased cardiac output secondary to increased vascular resistance as evidenced by high blood pressure level of 180/90, shortness of breath, fatigue, and pounding in the chest and neck

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

Nursing Interventions for Hypertension	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.

Hypertension Nursing Care Plan 7

Nursing Diagnosis: Acute Pain related to Increased cerebral vascular pressure as evidenced by pain score of 10 out of 10, verbalization of severe headache, throbbing pain on the suboccipital region, blood pressure level of 180/90, loss of appetite, and severe nausea

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.

Nursing Interventions for Hypertension	Rationale
Administer prescribed pain medications. Administer anti-hypertensive medications. Administer antiemetics as required for nausea/vomiting.	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.

With proper use of the nursing process, a patient can benefit from various nursing interventions to assess, monitor, and manage hypertension and promote client safety and wellbeing.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

What is the nursing care plan for hypertension patient?

Nursing care planning goals for hypertension include lowering or controlling blood pressure, adherence to the therapeutic regimen, lifestyle modifications, and prevention of complications.

How do you write a family nursing care plan?

Steps in Making Family Nursing Care Plan.

The prioritized condition/s or problems..

The goals and objectives of nursing care..

the plan of interventions..

The plan of evaluating care..

What is a nurse diagnosis for hypertension?

Hypertension is high blood pressure. The guidelines were updated by the American College of Cardiology in 2017, and a blood pressure of less than 120/80 mmHg is now considered normal. Anything above this is considered elevated, and stage 1 hypertension is diagnosed at 130/80 mmHg.

What are the 4 main parts of a nursing care plan?

Nursing care plan formats are usually categorized or organized into four columns: (1) nursing diagnoses, (2) desired outcomes and goals, (3) nursing interventions, and (4) evaluation. Some agencies use a three-column plan wherein goals and evaluation are in the same column.

Nursing care plan