Hemodynamic ValuesGrab the Free Cheatsheet"What's the Standard Cardiac Output level?" Want a Free Hemodynamics Values Cheatsheet?

Nursing Care Plan for Hypertension (HTN)

Pathophysiology

The pathophysiology of HTN is quite complex. Blood pressure is essentially the amount of blood the heart pumps, as well as the resistance to blood flow in the actual arteries. If there is more blood and/or smaller arteries, naturally the pressure will be higher.  When someone has higher pressure for an extended period of time, it begins to cause problems. HTN is called the silent killer because it can begin to cause problems without any symptoms. Some don’t realize this is happening until end-organ damage occurs, like kidney failure.  Many times it has been happening for years undetected. The way it is detected is with a simple blood pressure screening, hopefully done at an annual physical.  However, if someone does not regularly visit a physician and get checkups, then this may go undetected for a long period of time.

There is primary and secondary HTN.  Primary HTN is caused by a combination of genetic and environmental factors.  Secondary HTN comes from an identifiable cause (for example, sleep apnea or hyperthyroidism).

Keep in mind, higher blood pressure for a short period of time is normal. Your blood pressure will naturally increase during times of stress or pain, but the HTN we are discussing is chronically elevated even during times of relaxation.

Etiology

Primary HTN can be caused by many different factors. Certain ethnicities have a higher incidence of HTN (African Americans). The older a person is, the higher the likelihood of HTN. Family history, body weight, sedentary lifestyle, not enough of certain vitamins (like Vitamin D), not enough potassium, too much sodium, or excessive stress can all be a causative factor of primary HTN.

Secondary HTN arises from various conditions like kidney/adrenal/thyroid issues, congenital blood vessel defects, sleep apnea, various meds (decongestants are a big one!), street drugs (cocaine, methamphetamines), tobacco and excessive alcohol use, and more, can all cause secondary HTN.

Desired Outome

Control blood pressure down to a safe level appropriately. Please note, if a patient has had chronically elevated blood pressure for years or is in a hypertensive crisis , they may need their blood pressure lowered slowly, as they can have symptoms of hypotension at even normal blood pressure levels. Make sure you’re following orders very specifically and not decreasing the blood pressure too quickly in these instances.

Hypertension (HTN) Nursing Care Plan

Subjective Data:

**HTN frequently presents without symptoms, therefore the listed symptoms are not the typical presentation. If symptoms present, that means the disease process has most likely progressed significantly.**

Headaches

  • Headaches
  • Shortness of breath
  • Visual changes
  • Dizziness
  • Chest Pain/Angina

Objective Data:

**HTN frequently presents without symptoms, therefore the listed symptoms are not the typical presentation. If symptoms present, that means the disease process has most likely progressed significantly.**

  • Epistaxis
  • Kidney failure
  • ↓ LOC
  • Evidence of Stroke

Nursing Interventions and Rationales:

  1. Assess and monitor BP Use accurate size of blood pressure cuff: Width = 40% arm circumference, Length of bladder = 80% of arm circumference
    • You must know what the level is to know how to treat it.

      If we’re going to treat patients based on this number, it’s got to be accurate!

      If the cuff is too small, think about a tight pair of jeans and what that would do to the pressure - you’ll get a falsely elevated pressure.
      If the cuff is too large, it will be loose and you’ll get a false low blood pressure.

      The general rule is that the width should be about 40% of the arm circumference and the length of the bladder (that’s the part that actually inflates) should be about 80% of the arm circumference.

      A lot of blood pressure cuffs these days actually have indicators printed on them so you can make sure you’re using the right cuff - so always double check!
  2. Fluid restriction (if clinically appropriate)
    • More blood volume generally means a higher blood pressure, assuming the patient is not in heart failure. Offloading this fluid can help reduce preload and therefore reduce overall blood pressure.
  3. Perform a comprehensive cardiopulmonary assessment: Heart sounds, Lung sounds, Pulses, Edema
    • We need to know if there are any abnormalities, s/s fluid overload, edema, new murmurs or other changes as they can present without the patient feeling any symptoms.
  4. Promote rest, cluster care
    • We want to avoid blood pressure spikes and promote rest, especially if the blood pressure is very high
  5. Decrease stress
    • Lowering stress levels will help bring down blood pressure

      Yoga

      Meditation

      Relaxation/Breathing Exercises
  6. Administer BP lowering agents at appropriate time. May need to adjust timing to avoid larger drops in BP.
    • BP meds may need to be spaced out so they all don’t peak at the same time and cause a drop in blood pressure. It’s better to have consistent control throughout the day and night.

      You can speak with a pharmacist about optimal medication timing and notify the provider if you feel changes are needed.
  7. Assess BP and HR before and after BP lowering meds are administered
    • Important to ensure that the BP is stable before administering a medication. Many BP meds also will impact the HR, so it’s essential to understand where you are before you drop the pressure.
  8. Assess and control pain
    • Pain will increase blood pressure. Control as much as possible and time appropriately with activity.

      Patient may also experience angina - be sure to do a full pain assessment and intervene as appropriate.
  9. Educate about disease process, treatment regimen, dietary changes
    • Education is key because you cannot feel HTN. Patients must understand how important compliance is to prevent major events in the future.

      Medication Instructions
      Continue meds even if you feel better

      Diet - DASH
      Low Sodium
      No processed/canned foods
      Limit caffeine/alcohol

      Lifestyle changes
      Exercise
      Smoking cessation
      Reduce weight

      Follow-Up
      Annual check-ups
      Cardiology visits
      At-Home BP monitoring

References

Date Published - Jun 4, 2017
Date Modified - Oct 29, 2018