Nursing Interventions for Hypertension- A Student’s Guide

What is Hypertension?

High blood pressure (hypertension) is a chronic medical disorder that affects the heart and circulatory system of the body.

One of the most frequent lifestyle conditions today is hypertension. People from many areas of life are affected. Let us learn more about hypertension by looking at its definitions.

A systolic blood pressure of more than 140 mmHg and a diastolic blood pressure of more than 90 mmHg is considered hypertension.

This blog post discusses various nursing diagnoses, causes, symptoms, preventions, care plans and interventions for hypertension. As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor if you’re looking for medical advice.

This is based on the average of two or more accurate blood pressure measures taken during two or more visits to the doctor.

Hypertension Classifications

Normal. The normal range for blood pressure is between, less than 120 mmHg and less than 80 mmHg.

Elevated. Elevated stage starts from 120 mmHg to 129 mmHg for systolic blood pressure and less than 80 mmHg for diastolic pressure.

Stage 1 hypertension. Stage 1 starts when the patient has a systolic pressure of 130 to 139 mmHg and a diastolic pressure of 80 to 89 mmHg.

Stage 2 hypertension. Stage 2 starts when the systolic pressure is already more than or equal than 140 mmHg and the diastolic is more than or equal than 90 mmHg.

Risk Factors for Developing Hypertension

There are several risk factors for developing hypertension:

Age- hypertension can develop even in childhood and adolescence; however, it is more prevalent among adults 50 years of age or older.

Gender – hypertension is more common among men.

Family history – having family members with high blood pressure or a first-degree relative who suffered from a stroke and coronary heart disease is a risk factor.

Obesity – people who are obese tend to have higher blood pressure levels.

High salt intake

Smoking Liver problems

Medication use -certain medications such as steroids, birth control pills, and some antidepressants can cause hypertension.

Pathophysiology

When the heart contracts, pressure is transferred from the heart muscle to the blood, and subsequently the blood exerts pressure as it flows through the blood arteries in a normal circulation.

The pathophysiology of hypertension is described below.

Hypertension is caused by a number of factors.

Renal sodium retention occurs when sodium consumption is excessive, resulting in increased fluid volume, increased preload, and increased contractility.

Obesity contributes to hypertension by causing hyperinsulinemia, which leads to structural hypertrophy and increased peripheral vascular resistance.

Genetic changes can also contribute to the development of hypertension because when cell membranes are altered, functional constriction can occur, resulting in increased peripheral vascular resistance.

Epidemiology

Hypertension is steadily gaining ground as one of the world’s leading causes of morbidity. Here are some of the most recent statistics on hypertension in several of the world’s most developed countries.

• In the United States, hypertension affects about 31% of adults.
• African-Americans, with a prevalence rate of 37 percent, have the highest prevalence rate.
• 90% to 95% of people with hypertension in the United States have primary hypertension, or high blood pressure caused by an unknown cause.
• The remaining 5% to 10% of this group has secondary hypertension, or high blood pressure caused by unknown factors.
• Because 24 percent of persons with blood pressures greater than 140/90 mmHg were unaware that their blood pressures were elevated, hypertension is known as the “silent killer.”

Causes

It’s difficult to pinpoint the exact cause of hypertension. Primary hypertension is when hypertension has no known cause, or there is no evidence to link it to a specific cause. About 90% of all hypertension cases are caused by primary hypertension. Secondary hypertension refers to elevated blood pressure that has a known etiology.

 The factors that are implicated as causes of hypertension are:

• Increased sympathetic nervous system activity. Sympathetic nervous system activity increases because there is dysfunction in the autonomic nervous system.
• Increase renal reabsorption. There is an increase reabsorption of sodium, chloride, and water which is related to a genetic variation in the pathways by which the kidneys handle sodium.
• Increased RAAS activity. The renin-angiotensin-aldosterone system increases its activity leading to the expansion of extracellular fluid volume and increased systemic vascular resistance.

Decreased vasodilation of the arterioles. The vascular endothelium is damaged because of the decrease in the vasodilation of the arterioles.

Clinical Manifestations

• Frequent headaches or migraines
• Chest pain
• Crying spells
• Feeling nervous or anxious
• Vaginal bleeding
• Irregular menstrual cycles
• Fatigue
• Lightheadedness and dizzy spells
• Unexplained weight loss
• Blurred vision
• Difficulty concentrating
• Constipation
• Frequent urination
• Nose bleeding
• Unusual tiredness

Prevention

Prevention of hypertension mainly relies on a healthy lifestyle and self-discipline.

1. Quit smoking — stopping smoking can lower your blood pressure by as much as ten points.
2. Exercise consistently — Keeping your heart and arteries healthy, improving blood flow, and reducing stress are all benefits of regular exercise. Any physical activity should involve a combination of cardio (such as walking) and strength training (such as free weights or weight machines).
3. Eat well-balanced meals- a diet rich in fiber, fruits, and vegetables can help alleviate some of the symptoms of hypertension.
4. Maintain a healthy weight – if you are overweight, make a commitment to decreasing weight by eating healthier and exercising regularly.
5. Learn to manage your emotions and create better coping skills for dealing with difficult situations to reduce stress.

• Moderation of alcohol consumption. Limit alcohol consumption to no more than 2 drinks per day in men and one drink for women and people who are lighter in weight.

Complications

If hypertension is not addressed, it can lead to difficulties in the various organs of the body.

Heart failure is a serious condition. When blood pressure rises, the heart pumps blood faster than usual until the heart muscle weakens from overwork.

Myocardial infarction is a type of heart attack. Myocardial infarction can be caused by a lack of oxygen due to blood vessel constriction.

Vision impairment. Ineffective peripheral perfusion has an influence on the eye, producing vision issues due to a lack of oxygen.

Renal failure is a serious condition. Because of the restricted blood arteries, oxygen and nutrients could not reach the renal system.

Findings from the Assessment and Diagnostic Process

The evaluation of a hypertensive patient must be detailed and thorough. There are various diagnostic tests that can be used to confirm a hypertension diagnosis.

Assessment

1. Examine the patient’s medical history.
2. As needed, do a physical examination.
3. The retinas are checked to see if any organ damage has occurred.
4. In addition, laboratory tests are performed to determine whether or not the target organ has been damaged.

Diagnostic Tests

• Urinalysis is performed to check the concentration of sodium in the urine though the specific gravity.
• Blood chemistry (e.g. analysis of sodium, potassium, creatinine, fasting glucose, and total and high density lipoprotein cholesterol levels). These tests are done to determine the level of sodium and fat in the body.
• 12-lead ECG. ECG needs to be performed to rule presence of cardiovascular damage.
• Echocardiography. Echocardiography assesses the presence of left ventricular hypertrophy.
• Creatinine clearance. Creatinine clearance is performed to check for the level of BUN and creatinine that can determine if there is renal damage or not.
• Renin level. Renin level should be assessed to determine how RAAS is coping.
• Hemoglobin/hematocrit: Not diagnostic but assesses relationship of cells to fluid volume (viscosity) and may indicate risk factors such as hypercoagulability, anemia.
• Blood urea nitrogen (BUN)/creatinine: Provides information about renal perfusion/function.
• Glucose: Hyperglycemia (diabetes mellitus is a precipitator of hypertension) may result from elevated catecholamine levels (increases hypertension).
• Serum potassium: Hypokalemia may indicate the presence of primary aldosteronism (cause) or be a side effect of diuretic ­therapy.
• Serum calcium: Imbalance may contribute to hypertension.
• Lipid panel (total lipids, high-density lipoprotein [HDL], low-density lipoprotein [LDL], cholesterol, triglycerides, phospholipids): Elevated level may indicate predisposition for/presence of atheromatous plaques.
• Thyroid studies: Hyperthyroidism may lead or contribute to vasoconstriction and hypertension.
• Serum/urine aldosterone level: May be done to assess for primary aldosteronism (cause).
• Urinalysis: May show blood, protein, or white blood cells; or glucose suggests renal dysfunction and/or presence of diabetes.
• Creatinine clearance: May be reduced, reflecting renal damage.
• Urine vanillylmandelic acid (VMA) (catecholamine metabolite): Elevation may indicate presence of pheochromocytoma (cause); 24-hour urine VMA may be done for assessment of pheochromocytoma if hypertension is intermittent.
• Uric acid: Hyperuricemia has been implicated as a risk factor for the development of hypertension.
• Renin: Elevated in renovascular and malignant hypertension, salt-wasting disorders.
• Urine steroids: Elevation may indicate hyperadrenalism, pheochromocytoma, pituitary dysfunction, Cushing’s syndrome.
• Intravenous pyelogram (IVP): May identify cause of secondary hypertension, e.g., renal parenchymal disease, renal/ureteral ­calculi.
• Kidney and renography nuclear scan: Evaluates renal status (TOD).
• Excretory urography: May reveal renal atrophy, indicating chronic renal disease.
• Chest x-ray: May demonstrate obstructing calcification in valve areas; deposits in and/or notching of aorta; cardiac enlargement.
• Computed tomography (CT) scan: Assesses for cerebral tumor, CVA, or encephalopathy or to rule out pheochromocytoma.
• Electrocardiogram (ECG): May demonstrate enlarged heart, strain patterns, conduction disturbances. Note: Broad, notched P wave is one of the earliest signs of hypertensive heart disease.

Nursing Assessment

The blood pressure must be carefully monitored at frequent and regularly planned intervals as part of the nursing assessment.

Blood pressure is measured to test the effectiveness of antihypertensive drugs and to detect changes in blood pressure in patients who are taking them.

To assess for signs and symptoms of target organ damage, a thorough medical history should be collected.

The apical and peripheral pulses should be monitored for rate, rhythm, and character.

Nursing Care Plans

The goals of hypertension nursing care planning include reducing or regulating blood pressure, adhering to the therapeutic regimen, making lifestyle changes, and avoiding consequences.

Nursing diagnoses for hypertension nursing care plans are shown below:

• Risk for Decreased Cardiac Output
• Decreased Activity Tolerance
• Acute Pain
• Overweight

Risk for Decreased Cardiac Output

The product of cardiac output and peripheral resistance is blood pressure. An increase in cardiac output (heart rate multiplied by stroke volume) or an increase in peripheral resistance, or both, can cause hypertension.

Diagnosis

• Risk for Decreased Cardiac Output
• The following are some more nursing diagnoses:
• Cardiovascular Function Impairment is a risk.
• Cardiac Output Is Decreased
• Cardiac Tissue Perfusion is at Risk

Risk Factors:

The following are the most common risk factors for reduced cardiac output as a result of hypertension in the nursing diagnosis:

• Vasoconstriction and a rise in vascular resistance
• Ischemia of the heart muscle.
• Myocardial damage
• Hypertrophy/rigidity of the heart’s ventricles

Goals and desired outcomes

The following are some of the most typical expected results of decreased cardiac output caused by hypertension:

• Patient will engage in exercises that minimize blood pressure and cardiac workload.
• The patient will keep his or her blood pressure in a range that is comfortable for him or her.
• The patient’s heart rate and rhythm will be stable and within normal limits.
• The patient will take part in stress-relieving exercises (stress management, balanced activities and rest plan).

Nursing Assessment and Rationale

Here are the nursing assessments for the nursing diagnosis risk for decreased cardiac output secondary to hypertension.

1. Review clients at risk as noted in Related Factors and individuals with conditions that stress the heart. Persons with acute or chronic conditions may compromise circulation and place excessive demands on the heart.

2. 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).

3. 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. Severe hypertension is classified in adults as a diastolic pressure elevation of 110 mmHg; progressive diastolic readings above 120 mmHg are considered first accelerated, then malignant (very severe). Systolic hypertension is also an established risk factor for cerebrovascular disease and ischemic heart disease when elevated diastolic pressure. See updated guidelines for classifying hypertension above.

4. Note presence, 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 effects of vasoconstriction (increased systemic vascular resistance [SVR]) and venous congestion.

5. Auscultate heart tones and breath sounds.

S₄ heart sound is common in severely hypertensive patients because of atrial hypertrophy (increased atrial volume and pressure). Development of S3 indicates ventricular hypertrophy and impaired functioning. The presence of crackles, wheezes may indicate pulmonary congestion secondary to developing or chronic heart failure.

6. 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.

7. Note dependent and general edema.

May indicate heart failure, renal or vascular impairment.

8. 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.

Nursing Interventions and Rationales

1. Provide calm, restful surroundings, minimize environmental activity and noise. Limit the number of visitors and length of stay.

It helps lessen sympathetic stimulation; promotes relaxation.

2. Maintain activity restrictions (bedrest or chair rest); schedule uninterrupted rest periods; assist patient with self-care activities as needed.

Lessens physical stress and tension that affect blood pressure and the course of hypertension.

3. Provide comfort measures (back and neck massage, the elevation of head).

Decreases discomfort and may reduce sympathetic stimulation.

4. Instruct in relaxation techniques, guided imagery, distractions.

Can reduce stressful stimuli, produce a calming effect, thereby reducing BP.

5. Monitor response to medications to control blood pressure.

Response to drug therapy (usually consisting of several drugs, including diuretics, angiotensin-converting enzyme [ACE] inhibitors, vascular smooth muscle relaxants, beta and calcium channel blockers) is dependent on both the individual and as the synergistic effects of the drugs. Because of side effects, drug interactions, and patient’s motivation for taking antihypertensive medication, it is important to use the smallest number and lowest dosage of medications.

7. Implement dietary sodium, fat, and cholesterol restrictions as indicated.

These restrictions can help manage fluid retention and, with the associated hypertensive response, decrease myocardial workload.

8. Prepare for surgery when indicated.

When hypertension is due to pheochromocytoma, removal of the tumor will correct the condition.

Decreased Activity Tolerance

Another nursing diagnosis for hypertension is Decreased Activity Tolerance, which frequently occurs due to alterations in cardiac output and side effects of antihypertensive medications.

Related Factors

The following are the common related factors for the nursing diagnosis activity intolerance:

• Generalized weakness
• Sedentary lifestyle
• Imbalance between oxygen supply and demand

Defining Characteristics

The common assessment cues could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.

• Verbal report of fatigue or weakness
• Abnormal heart rate or BP response to activity
• Exertional discomfort or dyspnea
• Electrocardiogram (ECG) changes reflecting ischemia; dysrhythmias

Desired Outcomes

Common goals and outcomes for activity intolerance:

• Patient will participate in necessary/desired activities.
• Patient will use identified techniques to enhance activity tolerance.
• Patient will report a measurable increase in activity tolerance.
• Patient will demonstrate a decrease in physiological signs of intolerance.
• Nursing Assessments and Rationales

The following are nursing assessments to address activity intolerance related to generalized weakness.

1. Note the presence of factors contributing to fatigue (age, frail, acute or chronic illness, heart failure, hypothyroidism, cancer, and cancer therapies).

Fatigue affects both the client’s actual and perceived ability to participate in activities.

2. Evaluate the client’s actual and perceived limitations or degree of deficit in light of usual status.

Provides comparative baseline and provides information about needed education and interventions regarding the quality of life.

3. Assess the patient’s response to activity.

Noting pulse rate more than 20 beats per min faster than resting rate; marked increase in BP during and after activity (systolic pressure increase of 40 mm Hg or diastolic pressure increase of 20 mm Hg); dyspnea or chest pain; excessive fatigue and weakness; diaphoresis; dizziness or syncope. The stated parameters help assess physiological responses to the stress of activity and, if present, are indicators of overexertion.

4. Assess emotional and psychological factors affecting the current situation.

Stress or depression may be increasing the effects of an illness, or depression might be the result of being forced into inactivity.

Nursing Interventions and Rationales

In this section are therapeutic nursing interventions to address activity intolerance nursing diagnosis.

1. 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).

Energy-saving techniques reduce energy expenditure, thereby assisting in the equalization of oxygen supply and demand.

2. Encourage progressive activity and self-care when tolerated. Assist as needed.

Gradual activity progression prevents a sudden increase in cardiac workload. Providing assistance only as needed encourages independence in performing activities.

Acute Pain

Elevation in resting blood pressure means a progressive reduction in sensitivity to acute pain, which could result in a tendency to restore arousal levels in the presence of painful stimuli.

Related Factors

Common related factors for acute pain nursing diagnosis:

Increased cerebral vascular pressure

Defining Characteristics

The common assessment cues could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.

• Verbal reports of throbbing pain located in suboccipital region, present on awakening and disappearing spontaneously after being up and about
• Reluctance to move head, rubbing head, avoidance of bright lights and noise, wrinkled brow, clenched fists
• Changes in appetite
• Reports of stiffness of neck, dizziness, blurred vision, nausea, and vomiting

Desired Outcomes

Goals and expected outcomes for acute pain nursing diagnosis:

• Patient will report relief of pain/discomfort.
• Patient will verbalize methods that provide relief.
• Patient will follow prescribed pharmacological regimen.
• Patient will demonstrate use of relaxation skills and diversional activities, as indicated, for individual situation.

Nursing Assessment and Rationales

The following are nursing assessments to address acute pain for this hypertension nursing care plan.

1. Note the client’s attitude toward pain and use of pain medications, including any history of substance abuse.

To assess etiology or precipitating contributory factors.

2. Determine specifics of pain (location, characteristics, intensity (0–10 scale), onset, and duration). Note nonverbal cues.

Facilitates diagnosis of problem and initiation of appropriate therapy. Helpful in evaluating the effectiveness of therapy.

Nursing Interventions and Rationales

Here are the therapeutic nursing interventions for this hypertension nursing diagnosis to address acute pain.

1. Encourage and maintain bed rest during the acute phase. Minimizes stimulation and promotes relaxation.

2. 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.

Measures that reduce cerebral vascular pressure and slow or block sympathetic response effectively relieve headaches and associated complications.

3. Eliminate or minimize vasoconstricting activities that may aggravate headache (straining at stool, prolonged coughing, bending over). Activities that increase vasoconstriction accentuate the headache in the presence of increased cerebral vascular pressure.

4. Assist patient with ambulation as needed. Dizziness and blurred vision frequently are associated with vascular headaches. The patient may also experience episodes of postural hypotension, causing weakness when ambulating.

5. Provide liquids, soft foods, frequent mouth care if nosebleeds occur, or nasal packing has been done to stop bleeding.

Promotes general comfort. Nasal packing may interfere with swallowing or require mouth breathing, leading to stagnation of oral secretions and drying of mucous membranes.

6. Administer medications as indicated:

Analgesics; Antianxiety agents: lorazepam (Ativan), alprazolam (Xanax), diazepam (Valium).

Reduce or control pain and decrease stimulation of the sympathetic nervous system. May aid in the reduction of tension and discomfort that is intensified by stress.

Overweight

Excess weight or being overweight is an added risk in causing hypertension. Studies suggest that weight gain may pathophysiologically contribute to blood pressure elevation.

Related Factors

The following are the common related factors for the nursing diagnosis of Overweight:

• Excessive intake in relation to metabolic need
• Sedentary activity level
• Cultural preferences

Defining Characteristics

The common assessment cues could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.

• Adult BMI greater than 25kg/m2
• Triceps skinfold more than 15 mm in men and 25 mm in women (maximum for age and sex)
• Reported or observed dysfunctional eating patterns
• Sedentary lifestyle

Desired Outcomes

Common goals and expected outcomes for Overweight nursing diagnosis:

• Patient will identify correlation between hypertension and obesity.
• Patient will demonstrate change in eating patterns (e.g., food choices, quantity) to attain desirable body weight with optimal maintenance of health.
• Patient will initiate/maintain individually appropriate exercise program.

Nursing Assessment and Rationales

Here are the nursing assessments for this nursing diagnosis.

1. Assess risk or presence of conditions associated with obesity

Obesity is an added risk with high blood pressure because of the disproportion between fixed aortic capacity and increased cardiac output associated with increased body mass. Many studies have shown that weight loss is frequently associated with a decrease in blood pressure.

2. Assess the meaning and significance of food in the patient’s life.

The patient’s attitude towards food implicitly determines their choices between healthy and unhealthy foods.

3. Assess patient understanding of the direct relationship between hypertension and obesity.

Weight reduction may obviate the need for drug therapy or decrease the medication needed to control BP. Dysfunctional eating habits contribute to atherosclerosis and obesity, which predispose to hypertension – ultimately complications such as stroke, kidney disease, and heart failure.

3. Determine the patient’s desire to lose weight.

Readiness and motivation to change for weight reduction is an important part of treatment for behavior change. The individual should be ready to lose weight, or the program will most likely not succeed.

4. Assess the patient’s current nutritional status by using a food diary.

Insightful to examine the usual foods eaten and the patient’s pattern of eating. Self-monitoring apps are also useful and convenient.

5. Review usual daily caloric intake and dietary choices.

Identifies current strengths and weaknesses in the dietary program—aids in determining the individual need for adjustment and teaching.

Nursing Interventions and Rationales

In this section are therapeutic nursing interventions for this nursing diagnosis.

1. Establish a realistic weight-reduction plan with the patient, such as 1 lb weight loss per wk.

Reducing caloric intake by 500 calories daily theoretically yields a weight loss of 1 lb per wk. Therefore, a slow weight reduction indicates fat loss with muscle-sparing and generally reflects a change in eating habits.

2. Encourage the patient to maintain a diary of food intake, including when and where eating takes place and the circumstances and feelings around which the food was eaten.

Provides a database for both the adequacy of nutrients eaten and the emotional conditions of eating. It helps focus attention on factors that the patient has control over or can change.

3. Discuss the necessity for decreased caloric intake and limited fats, salt, and sugar as indicated.

Excessive salt intake expands the intravascular fluid volume and may damage kidneys, which can further aggravate hypertension. Restriction on salt intake and lowering intake of saturated fats and cholesterol helps in reducing body weight.

4. Instruct and assist in appropriate food selections, such as a diet rich in fruits, vegetables, and low-fat dairy foods referred to as the DASH Dietary Approaches to Stop Hypertension) diet and avoiding foods high in saturated fat (butter, cheese, eggs, ice cream, meat) and cholesterol (fatty meat, egg yolks, whole dairy products, shrimp, organ meats).

Avoiding foods high in saturated fat and cholesterol is important in preventing progressing atherogenesis. Moderation and use of low-fat products in place of total abstinence from certain food items may prevent a sense of deprivation and enhance cooperation with the dietary regimen. In conjunction with exercise, weight loss, and limits on salt intake, the DASH diet may reduce or even eliminate the need for drug therapy.

5. Recommend patient to eat a well-balanced, healthy breakfast every morning. Skipping breakfast will likely cause the patient to overeat during the evening.