hypertension nursing care plan

Hypertension is one of the most commonly diagnosed cardiovascular diseases, affecting millions of people globally. While it is quite common and treatments are easier to access, untreated hypertension may lead to the development of more serious illnesses such as strokes and other coronary artery diseases.

Nurses caring for patients with hypertension must therefore be able to assess thoroughly in order for them to be able to come up with relevant nursing diagnoses.

These diagnoses, in turn, would aid in the development of effective nursing care plans which can be tailor-fit to the needs of patients. Moreover, once patients are diagnosed with the illness, the need to accurately list nursing diagnoses and care plans according to their priorities is needed. There are actual and risk diagnoses that may be made based on assessment findings. An actual diagnosis is characterized by the presence of signs or symptoms gathered by the nurse during assessment or reported by the patient. This means that the health problem is already happening as a consequence of the diagnosis. A risk diagnosis is a health problem that may occur if the contributing factors are not addressed properly or its progression is not prevented. These do not normally have presenting symptoms.

There are a number of nursing diagnoses and patient care needs that can be identified in assessing a patient with hypertension. One of the most common among these needs is to provide patients with adequate knowledge or to help them develop an understanding of what the disease is all about and its signs and symptoms. Other nursing diagnoses may include:

  • Risk for Decreased Cardiac Output
  • Pain/Acute Pain
  • Activity Intolerance
  • Ineffective Individual Coping/Ineffective Coping
  • Nutritional Imbalance: Less than body requirements/more than body requirements
  • Deficient Knowledge

Hypertension Nursing Care Plan

Assessment of the presence of these problems would mean that the nurse would need to evaluate all verbalization from the patient, observe both verbal and non-verbal cues and correlate these with physical examination and/or other pertinent patient data. Moreover, since hypertension is a chronic condition that requires maintenance medication intake, there is also a need to consider this when planning for care.

Below are sample nursing care plans for the problems identified above.

Risk for Decreased Cardiac Output

Risk for decreased cardiac output related to inadequate oxygenated blood pumped by the heart to meet metabolic demands.

Note: “evidenced by” is not usually applicable for a risk diagnosis since the presence of signs and symptoms already makes the nursing problem an actual diagnosis.

Desired Outcomes

After nursing interventions, the patient is expected to (choose what is related to the identified risk):

  • Exhibit stability in the cardiac rate and rhythm
  • Maintain blood pressure within an acceptable/stable range (the range can be indicated if there is enough information from patient assessment)
  • Engage in interventions to help decrease cardiac load and blood pressure
Nursing Action Rationale
Assess vital signs, focusing on blood pressure and pulses and record. Blood pressure and pulse rates are good indicators of cardiac volume and cardiac output. Decreased cardiac output and irregularities in blood pressure may also indicate complications brought about by hypertension.
Thoroughly check the patient’s laboratory results such as blood cell counts, ABGs, electrolytes and cardiac marker studies. Cardiac output may be affected by conditions other than hypertension. Thoroughly checking laboratory data would help in planning better care for the patient.
Check blood pressure readings on arms and thighs and record. Comparing blood pressure readings from these two sites would help determine the presence of decreased cardiac output, if any, and its severity.
Help the patient to plan alternate periods of rest and activity. This helps to conserve energy, improve overall tissue perfusion and reduce cardiac demands.
Advise the patient to limit intake of food high in sodium and cholesterol. To help manage and maintain blood pressure within an acceptable range.
If the patient is smoking, advise the patient to stop. Cessation of smoking helps in managing blood pressure by relaxing the vessel walls.
Encourage patient to be vigilant in the intake of his maintenance medications. Maintenance medications for hypertension helps manage blood pressure, improving cardiac output and ensuring adequate tissue perfusion

Pain/Acute Pain

Acute pain related to potential tissue damage secondary to decreased oxygen tissue perfusion due to hypertension as evidenced by (include assessment findings related to pain such as, but not limited to:

  • Verbalization of pain (include range on a scale of 1-10, 1 meaning no pain and 10 indicating excruciating pain)
  • Increased vital signs (blood pressure, heart rate, pulses, respirations)
  • Guarding motion on the affected part
  • Irritability
  • Changes in appetite
  • In some cases, nausea and/or vomiting; dizziness and changes in visual acuity

Desired Outcomes

After nursing interventions, the patient is expected to:

  • Report a reduction in pain perception
  • Report that the pain has completely dissipated
  • Verbalize knowledge of non-pharmacologic interventions to relieve pain
Nursing Action Rationale
Assess patient’s report of pain, noting the characteristics of pain. Include the PQRST of pain (P=precipitating factor; Q=quality of verbal description, R= radiation or spread to other parts of the body, S= severity and T=time). Several indicators of pain perception needs to be carefully assessed to help the nurse better understand pain and plan for effective management
Observe the patient’s mood and demeanor during assessment, noting for both verbal and non-verbal cues to pain. Non-verbal cues to pain include guarding movement, facial grimace, dilation of pupils, increased respirations and others. This helps the nurse place the pain perception of the patient into context.
Check medication history and determine if the patient has indications of substance abuse. Patients who have a history of substance abuse may have a tolerance to certain pain medications or may need a different type of drug to manage their pain.
Provide patient non-pharmacologic pain management techniques such as backrubs, use of cool cloths to the forehead and allowing the patient to assume a position of comfort. These measures help the patient relax and reduce overall pain perception.
Provide diversionary activities to help manage pain such as guided imagery, use of music, meditation. Allows the patient to focus his attention other than the pain. These activities may also help enhance his mood and response to other measures.
Administer pain medication, as ordered. Medications help block pain perception by the patient, thereby reducing, if not eliminating, its presence.

Activity Intolerance

Activity intolerance related to insufficient energy to complete activities of daily living secondary to hypertension as evidenced by:

  • Reports of weakness or fatigue
  • Changes in heart rate related to physical exertion or activity
  • Exertional dyspnea
  • Changes in the EKG readings
  • Feelings of lightheadedness or dizziness associated with activities

Desired Outcomes

After nursing interventions, the patient is expected to:

  • Be able to perform activities of daily living independently
  • Participate in self-care activities within level of tolerance
  • Report increase in physical tolerance
Nursing Action Rationale
Note the factors that may contribute to the presence of fatigue (age, overall physical health, stage of illness). Patients’ ability to perform physical activities depends on several factors. It is best for the nurse to determine whether the activity intolerance is secondary only to the illness or other factors to help in planning care.
Observe the patient when performing physical activities, noting when intolerance occurs and how severe it affects the ability of the patient to perform activities of daily living. Knowing what activities cause the patient fatigue and how it affects his abilities to perform ADLs is helpful in coming up with a medium to the long-term care plan to help address the problem.
Monitor vital signs before, during and after activities. Changes in the vital signs are good indicators of the response of the patient to interventions and increasing physical tolerance.
Teach the patient different ways of performing tasks such as the use of chairs during showers, carts to push/pull things, use of mechanical lifts, etc. Using these types of equipment and/or techniques helps conserve energy and allows the patients to perform ADLs while reducing fatigue.
Allow the patient to perform simple tasks before progressing to more complex ones while ensuring that these are done within the level of tolerance. This helps increase the confidence of the patient to perform ADLs while also helping the body to slowly increase tolerance.
Encourage the patient to continuously perform activities within the level of tolerance, increasing intensity gradually. To help him sustain an optimum level of functioning while maintaining safety.

Sample Hypertension Nursing Care Plan

Nursing Diagnosis: Risk for decreased cardiac output related to increased vascular vasoconstriction

Nursing DiagnosisPatient OutcomesNursing InterventionsNursing InterventionsNursing Interventions
Risk for decreased cardiac output related to increased vascular vasoconstriction

Assessment:
Subjective Data: “I do not really feel well, right now. My blood pressure is always high and I feel light headed when I suddenly move.” as claimed by patient.


Objective Data:
-Pale in color
-Skin cool and moist to touch
-Jugular vein can be easily seen and bounding upon palpation
-Verbalized light headedness on sudden change of position
-Easy fatigability and occasional dyspnic occurrences upon exertion
-Blood pressure ranging from 140/90 to 150/100 mmHg, BP as of 6:00 A.M. 04/17/12 is 150/90 mmHg
-Pulse rate of 110 beats per minute as of 6:00 A.M. 04/17/12
-Capillary refill of 2-3 seconds

Outcome Identification:

The patient will participate in activities that reduce cardiac workload by 04/18/12.

The patient will maintain blood pressure within acceptable range by 04/19/12.

The patient will demonstrate stable cardiac rhythm and rate within patient’s normal range by 04/19/12.
Independent:
1. Monitor blood pressure periodically. Measure both arms three times; 3-5 mins apart while patient is at rest for initial evaluation.
2. Note presence of, quality of central and peripheral pulses.
3. Auscultate heart tones and breath sounds
4. Observe skin color, moisture, temperature and capillary refill time.
5. Note independent or general edema
6. Provide a calm environment; minimizing noise; limiting visitors and length of stay.
7. Maintain activity restrictions (bed rest) and assist patient with self- care activities.
8. Provide comfort measures, i.e. elevation of head
9. Encourage relaxation techniques like guided imagery and distractions
10. Monitor response to medications to control blood pressure
Depedent
11. Administer medications like diuretics, alpha and beta antagonists, calcium channel blockers, and vasodilators.
Collaborative
12. Instruct and implement to patient dietary restrictions in sodium, fat and cholesterol
1. Bounding carotid, jugular, radial, femoral pulses may be observed/ palpated. Pulses in the leg may be diminished, implicating effects of vasoconstriction and venous congestion.
2. S3 and S4 heart sounds may indicate atrial and venous hypertrophy and impaired functioning.
3. Presence of adventitious breath sounds may indicate pulmonary congestion secondary to developing heart failure.
4. Presence of pallor; cool and moist skin and delayed capillary refill may be due to peripheral vasoconstriction or decreased cardiac output.
5. It may indicate heart failure, vascular or renal impairment.
6. Promotes relaxation.
7. It reduces physical stress and stimuli that affect the blood pressure.
8. Decreases discomfort and may reduce sympathetic stimulation
9. It helps reduce stressful stimuli, thereby decreases blood pressure.
10. Response to drug is dependent on both the individual and the synergistic effect of the drug. It is also important to check for any untoward signs and symptoms of the medications.
11. These medications should be medically prescribed by the physician and dose and timing of medications should be followed. Checking BP prior to giving of medications is always a must to prevent hypotension.
12. This restrictions help manage fluid retention and decrease myocardial workload.
Please refer to the Patient Outcomes tab

References

  1. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. Philadelphia: F.A. Davis.
  2. Carpenito, L. (2016). Handbook of Nursing Diagnosis (15th ed.).
  3. Herdman, T., & Kamitsuru, S. (2018). NANDA International, Inc. nursing diagnoses (11th ed.).
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