HYPERTENSION PRELIMINARY REPORT
Made By :
Name : Tia Amanda
Class : Psik 3 a
Dosen Pengampuh : Romiko,S.Kep,.Ns,MNS
PROGRAM STUDI ILMU KEPERAWATAN INSITUT ILMU
KESEHTAN DAN TEKNOLOGI MUHAMMADIYAH PALEMBANG
TAHUN AJARAN 2021/2022
A.The meaning of hypertension
Hypertension occurs when blood pressure is more than 140/90 mmHg.
Hypertension is a condition where there is an abnormal and continuous increase
in blood pressure on several blood pressure checks caused by one or more risk
factors that do not work properly in maintaining normal blood pressure.
Definition of Hypertension is high blood pressureisan abnormal increase in
blood pressure in the arteries continuously over a period. This occurs when the
arterioles constrict. Arteriole constriction makes it difficult for blood to flow
and increases the pressure against the artery walls. Hypertension increases the
workload of the heart and arteries which, ifcontinued, can and arteries which,
ifcontinued, cancausedamagetotheheartandbloodvessels. Hypertension is also
defined as systolic bloo dpressure > 140 mmHgand/ordiastolicbloodpressure >
90 mmHg (Udjianti, 2013).
Hypertension is a symptom of increased blood pressure which then affects
other organs, such as stroke for the brain or coronary heart disease for the
heart’s blood vessels and heart muscle. This disease isoneofthe main problems
in publichealth in Indonesia andtheworld. Itisestimatedthatabout 80% of the
increase in cases of hypertension, especially occur in developing countries by
2025; from a total of 639 millioncases in 2000. This number is estimated to
increase to 1.15 billioncases in 2025. This prediction is based on the number of
people with hypertension and the current population growth .
B).Etiologi
Of all cases of hypertension 90% are primary hypertension. Several factors
are thought to beassociated with the developmen to fprimary hypertension as
follows.
a).Genetic individuals who have a family history of hypertension are at high
risk for getting this disease.
b).Gender an dage
Menaged 35-50 years and postmenopausal women are high for hypertension.
c).Diet
Consumption of a diet high in salt or fat is directly associated with the
developmen to fhypertension.
d).Weight (obesity).
e). bodyweight> 25% above ideal isassociatedwithdevelopinghypertension
f).Lifestyle
Smoking and alcohol consumption can increase blood pressure.
The etiology of secondary hypertension is generally known, here are some
conditions that cause secondary hypertension :
a).Use of hormonal contraceptives
Contraceptive drugs containing estrogen can cause hypertension through a
renin-aldosterone-mediated volume expansion mechanism. With
discontinuation of contraceptive drugs, blood pressure returns to normal within
a few months.
b).Renal parenchymal and vascular disease
It is a major cause of secondary hypertension. Renovascular hypertension is
associated with narrowing of one or more renal arteries in a client with
hypertension caused by atherosclerosis or fibrous dysplasia (abnormal growth
of fibrous tissue). Renal parenchymal disease is associated with infection,
inflammation and changes in kidney structure and function.
c).Endocrine disorders
Dysfunction of the adrenal medulla or adrenal cortex can cause secondary
hypertension. Adrenal-medited hypertension is caused by primary excess of
aldosterone, cortisol and catecholamines. In primary aldosteronism, excess
aldosterone causes hypertension and hypokaemia.
d).Coartation of the aorta (narrowing of the aorta)
It is a congenital aortic narrowing that may occur to some degree in the thoracic
or abdominal aorta. Narrowing blocks blood flow through the aortic arch and
results in increased blood flow above the constricted area.
e). Pregnancy
The increase in blood pressure during pregnancy is influenced by the hormone
estrogen in the body. During pregnancy, the level of the hormone estrogen in
the body decreases significantly. This turns out to usually cause damaged
endothelial cells and eventually lead to the appearance of plaque in blood
vessels. The presence of this plaque will inhibit blood circulation and ultimately
trigger high blood pressure
f).Smoke
Smoking can cause an increase in blood pressure because it makes blood
pressure rise immediately after the first puff, increasing the systolic blood
pressure level by 4 millimeters of mercury (mmHg). The nicotine in cigarettes
triggers nerves to release chemicals that can constrict blood vessels and increase
blood pressure.
C).Hypertension Classification
Blood pressure measurement can be done using a mercury
sphygmomanometer or with a digital sphygmomanometer. The results of these
measurements are systolic and diastolic pressures that can be used to determine
hypertension or not. There are several classifications of hypertension in the
measurement results. The classification of hypertension according to WHO is as
follows:
Klasifikasi Sistolik(mmHg) Diastolik(mmHg)
Normal <130 <85
Normal 130-139 85-89
Mild hypertension 140-159 90-99
Stadium 1
Moderate hypertension 160-179 100-109
Stadium 2
Severe hypertension 180-209 110-119
Stadium 3
Very severe hypertension 210 120
Stadium 4
D).Clinical Manifestations
Signs and Symptoms of Hypertension are :
1.Complains of headache, dizziness
2.Weak, tired
3.Out of breath
4.Nervous
5.Nauseous
6.Gag
E).Pathophysiology
The mechanisms that control the constriction and relaxation of blood vessels
are located in the vasomotor center, in the medulla in the brain. From this
vasomotor center begins the sympathetic nerves, which continue downward to
the spinal cord and abdomen. Stimulation of the vasomotor center is delivered
in the form of impulses that travel downward through the sympathetic nervous
system to the sympathetic ganglia. At this point, preganglionic neurons release
acetylcholine, which stimulates postganglionic nerve fibers to the blood vessels,
where the release of norepinephrine causes vascular constriction. Various
factors such as anxiety and fear can affect the response of blood vessels to
vasoconstrictive stimuli. Individuals with hypertension are very sensitive to
norepinephrine, although it is not clear why this occurs.
At the same time, the sympathetic system stimulates blood vessels in response
to emotional stimuli. The adrenal glands are also stimulated, resulting in
additional vasoconstrictive activity. The adrenal medulla secretes epinephrine,
which causes vasoconstriction. The adrenal cortex secretes cortisol and other
steroids, which can amplify the vasoconstrictor response of blood vessels.
Vasoconstriction results in decreased blood flow to the kidneys, resulting in the
release of renin. Renin stimulates the formation of angiotensin 1 which is then
converted to angiotensin 2, when it is a potent vasoconstrictor, which in turn
stimulates aldosterone secretion by the adrenal cortex. This hormone causes
sodium and water retention in the renal tubules, causing an increase in
intravascular volume. All of these factors tend to lead to a state of hypertension
(Price).
F).Complications
Complications of hypertension according to Triyanto (2014) are:
a.Heart disease
Complications include myocardial infarction, angina pectoris, and heart failure
b.Kidney
The occurrence of kidney failure is due to progressive damage due to high
pressure in the glomerular capillaries of the kidney. Damage to the glomerular
membrane, protein will come out through the urine so that the plasma colloid
osmotic pressure is reduced and causes edema
c.Brain
Complications in the form of stroke and ischemic attack. Stroke can occur in
chronic hypertension when the arteries that supply the brain are hypertrophied
and thickened so that blood flow to the affected area is reduced.
d.eye
Complications include retinal bleeding, visual disturbances, and blindness.
e.damage to arteries
If hypertension is not controlled, there can be damage and narrowing of the
arteries or what is often referred to as atherosclerosis and atherosclerosis
(hardening of the arteries).
G).Supporting checks
Supporting examination according to (Nur arif and Kusuma, 2015)
a.Laboratory Examination
1.Hb/Ht: to assess the relationship of cells to fluid volume (viscosity) and can
indicate risk factors such as hypocoagulability, anemia.
2.BUN / creatinine: provides information about perfusion / kidney function.
3.Glucose: Hyperglycemia (DM is a trigger for hypertension) can be caused by
the release of ketocholamines.
4.Urinalysis: blood, protein, glucose, suggests kidney dysfunction and DM.
b.CT scan: Assess the presence of cerebral tumors, encephalopathy
c.ECG: can show stretch patterns, where broad, elevated P waves are one of the
early signs of hypertensive heart disease.
d.IUP: identify causes of hypertension such as: Kidney stones, kidney repair
e.Chest photo: showing destruction of classification in the valve area, heart
enlargement.
H).Medical management
According to Triyatno (2014) the management of hypertension is divided into
two, namely non-pharmacological and pharmacological.
a. Non-pharmacological therapy is therapy without the use of drugs, non-
pharmacological therapy includes modifying a lifestyle which includes
managing stress and anxiety is the first step that must be done. Non-
pharmacological treatment is to create a relaxed state, reduce stress and reduce
anxiety. Non-pharmacological therapy is given to all hypertensive patients with
the aim of lowering blood pressure and controlling risk factors and other
diseases.
b.Pharmacological therapy
Pharmacological therapy is using medicinal compounds that in their work affect
blood pressure in hypertensive patients such as: angiotensin receptor blockers
(ARBs), beta blockers, calcium channels and others. Management of
hypertension and duration of treatment is considered complex because blood
pressure tends to be unstable.
I).Basic Concepts of Hypertension Nursing
Assessment
a.Identity
Name, age, religion, gender, date of entry and person in charge.
b.Medical history
a).Past medical history
Has the client ever had very severe pain?
b).Current medical history
Some things that must be disclosed in each symptom are headaches, fatigue,
heavy shoulders.
c.Family health history
Has your family ever had the same disease?
d.Activity / rest
1.Symptoms: fatigue, tiredness, shortness of breath, monotonous lifestyle.
2.Signs: increased heart rate, changes in heart rhythm, and tachypnea.
e.Circulation
1. Symptoms: history of disease, atherosclerosis, coronary heart disease, and
cerebrovascular disease. There were also episodes of palpitations.
2.Signs: An increase in BP (serial measurement of blood pressure) is required to
establish the diagnosis. Postural hypertension may be related to the drug
regimen.
f.Ego Integrity
1. Symptoms: personality history, anxiety, multiple stress factors (financial
relationships, work-related)
2. Signs: mood swings, restlessness, continuous constriction of attention,
exploding cries, tense facial muscles, sighing breathing, increased speech
patterns.
g.Elimination
Symptoms: current or renal impairment (such as obstruction or past history of
kidney disease).
h.Food/liquid
Symptoms: preferred foods can include foods high in salt, high in fat, high in
cholesterol (such as fried foods, cheese, eggs), black sugar, and high calorie
content, nausea, vomiting and changes in body weight increase / decrease,
history of diuretic drug use
i.Neurosensory
Symptoms: complaints of dizziness, throbbing, suboccipital headache (occurs
upon awakening and disappears spontaneously after a few hours, visual
disturbances (diplobia, blurred vision, epistaxis)
j.Pain / discomfort
Symptoms: Angina (coronary artery disease/heart involvement), severe occipital
headache, as before.
k.Respiration
1. Symptoms: dyspnea related to activity or work. Tachypnea, orthopnea,
dyspnea, cough with or without sputum formation, history of smoking.
2.Signs: respiratory distress or use of accessory respiratory muscles, additional
breath sounds (crackles / wheezing), cyanosis
J).Security
Symptoms: impaired coordination / gait, postural hypotension.
2.Health function pattern
1.Patterns of perception and management of healthy living
Describe the perception, maintenance, and treatment of health
2.Nutrition pattern
Describe nutritional intake, fluid and electrolyte balance, appetite, diet, diet,
difficulty swallowing, nausea/vomiting, and health foods
3.Elimination pattern
Explain the pattern of excretory function, bladder, defecation, presence or
absence of defecation problems, nutritional problems, and use of catheters.
4.Sleep and rest patterns
Describes sleep patterns, rest, and perception of energy, amount of sleep during
the day and night, sleep problems, and insomnia
5.Activity and rest patterns
Describe patterns of exercise, activity, respiratory function, and circulation.
History of heart disease, rate, rhythm, and depth of breathing
6.Relationship patterns and roles
Describe and know the relationship and role of the client towards family
members and the community where they live, work, homelessness, and
financial problems.
7.Sensory and cognitive patterns
Explaining sensory and cognitive perception, sensory perception patterns
include the assessment of sight, hearing, feeling, and smell. Cataract clients can
find symptoms of peripheral vision disorders, difficulty focusing work by
feeling in a dark room. While the signs are brownish or milky white in the
pupil, increased tears
8.Patterns of perception and self-concept
Describe attitudes about oneself and perceptions of self-concept abilities. Self-
concept describes a picture of self-esteem, role, self-identity. Humans as an
open system of bio-psycho-socio-cultural-spiritual beings, anxiety, fear, and the
impact of illness. Assessment of depression level using Back Depression
Inventory Table
9.Sexual and reproductive patterns
Describes satisfaction/problems with sexuality.
10.Pattern of mechanisms/stress coping and coping Describe the ability to deal
with stress
11.Values and belief patterns
Describing and explaining patterns, values, beliefs, including spiritual
K).Nursing diagnoses
According to NANDA NIC – NOC (2016).
a) Decreased cardiac output related to increased afterload, vasoconstriction and
myocardial ischemia.
b) Acute pain associated with increased cerebral vascular pressure and
ischemia.
c) Activity intolerance related to weakness, imbalance of oxygen supply and
demand
Nursing intervention elimination pattern
L).Intervensi
Nursing Goal and outcome criteria Intervesi
diagnosis
Risk for NOC NIC
decreased After nursing care is 1.Evalute
cardiac output expected result criteria : presence(intensity,location,
related to Vital signs in normal rage ( Duration)
increased blood 2.Note the presence of cardiac
afterload, pressure,respiration)can dysrhythmias
vasoconstrictio tolerate activity,no asctes 3.Note any signs and
n and there was no fatigue. No loss symptoms of decreased
myocardial of consciusness cardiac output
ischemia 4.Monitor cardiovasclular
status
5.Monitor respiratory status
for sings of heart failure
6.Monitor the abdomen as an
indecator of decreased
perfusion
7.Monitor fluid balance
8.Monitor for chages in blood
pressure
9.Monitor the
patient’response to the effects
of antiarrhythmic drugs
10.set exercise and rest
periods to avoid fatigue
11.monitor patient activity
tolerance
12. monitor for
dyspnea,fatigue,tachypnea,an
d orthopnea
13.advise to reduce stress by
playing and worshiping
14.vital sign monitoring
15.monitor blood
presure,pulse,temperature,and
breathing
16.note any fluctationsbin
blood pressure
17.monitor vs patient time
lying down or sitting or
standing
18.auscultate blood pressure
in both arms and compare
19.monitor blood
pressure,respiratory
rate,during and after activity
20.monitor the quality of the
pulse
21.monitor respiratorybrate
and rhythm
22.monitor abnormal
breathing patterns
23.monitor skin
temperature,color and
moisture
24.monitor for cushing’s triad
(widening pulse
pressure,bradycardia,increase
d systolic
25.identifty causes of vital
sign changes
Acute pain NOC NIC
related with After nursing care is 1.Comprehensive pain
iccreased expected result criteria : assessment,including
cerebral 1.clien is able to controal charactwristic
vascular pain,able to use non location,duration,frecipitating
pressure pharmacologicalmtechniques factors
to reduce pain,seek help) 2.environmental controls that
2.resports that pain is can afffect pain such as room
reduced by using pain temperature,lighting and noise
management 3.teach about non
3.able to recognize pain pharmacological techniques
recognize such as warm compresses and
pain(scale,intensity,frequenc deep bath relaxtion
y and signs of pain) 4.give analges to reduce pain
4.says comfort after pain
subsides
Intoleransi NOC NIC
aktivitas b/d After nursig care is expected 1.collaboration with medical
weakness result criteria rehabilitation personnel in
1.capable do daily activities planning the personnel in
2.vital signs within normal planning the righ therapy
limits program
2.help the to identifty acivites
that can be done
3.help to get tools
4.help the patient to develop
