Nursing Diagnosis for Hypertension

Hypertension refers to a state where a person’s blood pressure is 140/90mmHg or higher than the normal blood pressure of 120/80mmHg. There are several levels of hypertension categorized into prehypertension120-139/80-89, stage 1 hypertension: 140-159/90-99 and stage 2 hypertension: 160+/100+. The condition is dangerous to the human body, it makes the heart work beyond the normal rate which can result in a stroke, hardening of the arteries and heart failure (Ioannidis, 2018).

The primary causes of hypertension include sympathetic nervous system activation, renin-angiotensin-aldosterone and theory vasopressor. Secondary hypertension is caused by the presence of high blood pressure and associated with oral contraceptives, renal insufficiency and Reno vascular diseases .Other disorders causing secondary hypertension include metabolic disorders, parenchymal renal disorders and CNS ailments. Some of the risk factors associated with hypertension include: obese, smoking, family history of hypertension, old age, sleep apnea, stress, consumption of alcoholic and kidney diseases (Navar, 2016).

Signs and Symptoms

• Patients experience blurred vision
• Chest pains.
• Patients can have blood in the urine.
• One has problems breathing.
• One experiences irregular heartbeat.
• One has a severe headache.
• Patients can have dizziness, fatigue, and nosebleed.

Nursing diagnosis for hypertension

1. Risk for decreased cardiac output

NANDA defines risk for decreased cardiac output as inadequate blood that has been pumped by the heart in order to meet the metabolic requirements that are on demand by the body. It is evidenced by decreased cardiac output.

Outcomes/goals for decreased cardiac output

• Patient must show stable cardiac rate and rhythm.
• One must maintain an acceptable blood pressure of 120/80mmmHg.
• Patient must participate in activities that lower cardiac load and blood pressure.

Interventions

• Nurse must check the laboratory data for blood cell count, cardiac markers and electrolytes to determine what could be increasing the blood pressure.
• Nurses must monitor the blood pressure on the arms and thighs.
• Nurses must observe the patients skin color, monitor the heart rhythm and breathing sounds.
• Nurses must ensure that patient reduces sodium intake and possibly administer medication if situation arises.

2. Acute pain

NANDA defines acute pain as an emotional experience combined with an unpleasant sensory feeling that can occur from an actual tissue damage on the body (Kurucová, 2018). The experience moves from a slow onset to a mild intensity and a finally a severe intensity.

Acute pain in a case of hypertension is evidenced by a persistent throb in the head and sleepiness, patient reports not sleeping and changes appetite. Others can have nausea, vomiting, and blurred vision and nick stiffness.

Outcomes /goals

Patient must report that they do not suffer from a headache and must appear pain free or comfortable.

Interventions

• Nurses must determine the intensity of the pain, locate the point and duration of the pain.
• Nurses must look into the patient history with drug abuse and attitude on pain.
• One must be encouraged to rest during severe pain.
• Patients must not move around.
• Nurses can recommend relief techniques such as applying cloths, backrubs and neck.

3. Activity intolerance

NANDA defines activity intolerance as the inadequate psychological energy to endure and complete the normal daily activities. It is evidenced by one feeling tiredness or fatigue, abnormal heart when engaging in activity, dyspnea and changes in the dysrhythmias (Guedes, 2013).

Goals/Outcomes

• Patient must be able to participate in desired activities.
• One must be able to use different techniques to boost activity tolerance.
• Patients must demonstrate a measurable or standard tolerance activity
• Patient must demonstrate decreased signs of intolerance.

Interventions

• Nurses must examine the contributing factors to fatigue such as illness and age.
• Nurses must evaluate the degree of activity intolerance and the time it occurs.
• One must monitor how a patient responds to various activities such as chest pain, dizziness, fatigue and heart rate.
• Nurses must introduce patient to energy conserving techniques such as sitting and placing shower chairs in their bathrooms.
• Examine contributing emotional factors that boost activity intolerance.
• Nurses must encourage patients to self-care.

4. Ineffective coping

NANDA defines ineffective coping as the ability to have valid appraisal of environmental stressors, poor choices in practice response and inability to use accessible resources. It is evidenced by a patient inability to cope with normal activities and asks for help .Patients exhibit anxiety, depression, worry and irritability. Others can have destructive behaviors evidenced by lack of appetite and overreacting.

Goals/Outcomes

• Patient must be able to cope and verbalize what is available.
• One must be able to identify stressful environments and avoid them.
• Patient must show signs of coping or effective skills to deal with situations.

Interventions

• Nurses must determine the areas that the patient is unable to cope with.
• Nurses must assess the ability of the patient to cope with existing skills.
• Nurses must help in identifying stressors in patient’s life.
• One must encourage the patient to participate and contribute in the care plan

5. Imbalanced body requirements /nutrients

NANDA defines imbalanced body requirements as the intake of human nutrients that are in excess of metabolic needs. It is evidenced by a patient’s weight being abnormal in comparison to their frame and height. Patient’s exhibit dysfunctional eating patterns that can be reported or observed by the nurse.

Goals /Outcomes

• Patient must comprehend the relationship of hypertension with obesity.
• Patient must engage in correct exercise programs.
• One must change the eating patterns and consider healthier foods

Interventions

• Nurses must assess the patient’s comprehension of obesity and hypertension.
• Nurses must evaluate and determine the need for caloric intake.
• One must determine the desire of the patient to lose weight.
• Nurses must encourage patients to adopt an appropriate exercise plan

6. Knowledge deficit

NANDA defines knowledge deficit as the lack of or insufficiency of cognitive information in relation to as specific topic. This is evidenced by verbalization of the issue, patient requires the application of information and is unable to understand the information. Patient fails to follow the instructions and appears to be upset on the given information.

Goals/Outcomes

• Patient must be able to use the management information given for treatment.
• Patient must be able to use the drug appropriately and side effects.

Interventions

• Nurses must determine what the patient can comprehend about the information.
• Nurses must maximum on using blood pressure rather than normal BP.
• One must discuss with the patient on the importance of losing weight.
• Appropriate intake of calories and making use of balanced diets.
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References

Guedes, N. G. (2013). Review of nursing diagnosis sedentary lifestyle in individuals with hypertension: conceptual analysis. Rev Esc Enferm USP, 47(3), 734-41.

Ioannidis, J. P. (2018). Diagnosis and treatment of hypertension in the 2017 ACC/AHA guidelines and in the real world. Jama, 319(2), 115-116.

Kurucová, R. Ž. (2018). CLINICAL VALIDATION OF NURSING DIAGNOSIS OF ACUTE PAIN. Central European Journal of Nursing and Midwifery, 9(1), 781-790.

Navar, A. M. (2016). Assessing cardiovascular risk to guide hypertension diagnosis and treatment. JAMA cardiology, 1(8), 864-871.