Nursing Care Plans

6 Hypertension Nursing Care Plans

Nursing care planning goals for a client with hypertension includes adherence to the
therapeutic regimen, lifestyle modifications, and prevention of complications are the focus of
the nursing care for a patient with hypertension.
Hypertension is the term used to describe high blood pressure. Hypertension is repeatedly
elevated blood pressure exceeding 140 over 90 mmHg. It is categorized as primary or
essential (approximately 90% of all cases) or secondary, which occurs as a result of an
identifiable, sometimes correctable pathological condition, such as renal disease or primary
aldosteronism.
Here are six (6) nursing diagnosis for hypertension nursing care plans:
1. Risk for Decreased Cardiac Output

Decreased Cardiac Output: Inadequate blood pumped by the heart to meet metabolic
demands of the body.
Nursing Diagnosis

o - Cardiac Output, risk for decreased

Risk factors may include

o - Increased vascular resistance, vasoconstriction

o - Myocardial ischemia
o - Ventricular hypertrophy/rigidity

Possibly evidenced by

o Not applicable. Existence of signs and symptoms establishes an actual nursing diagnosis.

Desired Outcomes

o - Participate in activities that reduce BP/cardiac workload.

o - Maintain BP within individually acceptable range.
o - Demonstrate stable cardiac rhythm and rate within patient’s normal range.
o - Participate in activities that will prevent stress (stress management, balanced activities
and rest plan).
 Nursing Interventions Rationale

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

Check laboratory data (cardiac markers, complete

blood cell count, electrolytes, ABGs, blood urea
To identify contributing factors
nitrogen and creatinine, cardiac enzymes, and
cultures, such as blood, wound or secretions).

Comparison of pressures provides a more complete

picture of vascular involvement or scope of problem.
Monitor and record BP. Measure in both arms and Severe hypertension is classified in the adult as a
thighs three times, 3–5 min apart while patient is diastolic pressure elevation to 110 mmHg;
at rest, then sitting, then standing for initial progressive diastolic readings above 120 mmHg are
evaluation. Use correct cuff size and accurate considered first accelerated, then malignant (very
technique. severe). Systolic hypertension also is an established
risk factor for cerebrovascular disease and ischemic
heart disease, when diastolic pressure is elevated.

Bounding carotid, jugular, radial, and femoral pulses

may be observed and palpated. Pulses in the legs
Note presence, quality of central and peripheral
and feet may be diminished, reflecting effects of
pulses.
vasoconstriction (increased systemic vascular
resistance [SVR]) and venous congestion.

S4 heart sound is common in severely hypertensive

patients because of the presence of atrial
hypertrophy (increased atrial volume and pressure).
Auscultate heart tones and breath sounds. Development of S3 indicates ventricular hypertrophy
and impaired functioning. Presence of crackles,
wheezes may indicate pulmonary congestion
secondary to developing or chronic heart failure.

Presence of pallor; cool, moist skin; and delayed

Observe skin color, moisture, temperature, and capillary refill time may be due to peripheral
capillary refill time. vasoconstriction or reflect cardiac decompensation
and decreased output.

May indicate heart failure, renal or vascular

Note dependent and general edema.
impairment.

Evaluate client reports or evidence of extreme To assess for signs of poor ventricular function or
fatigue, intolerance for activity, sudden or impending cardiac failure.
progressive weight gain, swelling of extremities,
 Nursing Interventions Rationale

and progressive shortness of breath.

Provide calm, restful surroundings, minimize

Helps lessen sympathetic stimulation; promotes
environmental activity and noise. Limit the
relaxation.
number of visitors and length of stay.

Maintain activity restrictions (bedrest or chair

Lessens physical stress and tension that affect blood
rest); schedule periods of uninterrupted rest;
pressure and the course of hypertension.
assist patient with self-care activities as needed.

Provide comfort measures (back and neck Decreases discomfort and may reduce sympathetic
massage, elevation of head). stimulation.

Instruct in relaxation techniques, guided imagery, Can reduce stressful stimuli, produce calming effect,
distractions. thereby reducing BP.

Response to drug therapy (usually consisting of

several drugs, including diuretics, angiotensin-
converting enzyme [ACE] inhibitors, vascular smooth
muscle relaxants, beta and calcium channel
Monitor response to medications to control blood blockers) is dependent on both the individual as well
pressure. 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.

Administer medications as indicated:

Diuretics are considered first-line medications for

Thiazide diuretics: chlorothiazide (Diuril); uncomplicated stage I or II hypertension and may be
hydrochlorothiazide (Esidrix/HydroDIURIL); used alone or in association with other drugs (such
bendroflumethiazide (Naturetin); indapamide as beta-blockers) to reduce BP in patients with
(Lozol); metolazone (Diulo); quinethazone relatively normal renal function. These diuretics
(Hydromox); potentiate the effects of other antihypertensive
agents as well, by limiting fluid retention, and may
reduce the incidence of strokes and heart failure.
Loop diuretics: furosemide (Lasix); ethacrynic acid These drugs produce marked diuresis by inhibiting
(Edecrin); bumetanide (Bumex), torsemide resorption of sodium and chloride and are effective
(Demadex); antihypertensives, especially in patients who are
resistant to thiazides or have renal impairment.
 Nursing Interventions Rationale

Potassium-sparing diuretics: spironolactone

(Aldactone); triamterene (Dyrenium); amiloride May be given in combination with a thiazide diuretic
(Midamor); to minimize potassium loss.

Beta-Blockers may be ordered instead of diuretics

for patients with ischemic heart disease; obese
patients with cardiogenic hypertension; and patients
with concurrent supraventricular arrhythmias,
angina, or hypertensive cardiomyopathy. Specific
Alpha, beta, or centrally acting adrenergic actions of these drugs vary, but they generally
antagonists: doxazosin (Cardura); propranolol reduce BP through the combined effect of
(Inderal); acebutolol (Sectral); metoprolol decreased total peripheral resistance, reduced
(Lopressor), labetalol (Normodyne); atenolol
cardiac output, inhibited sympathetic activity, and
(Tenormin); nadolol (Corgard), carvedilol (Coreg);
suppression of renin release. Note: Patients with
methyldopa (Aldomet); clonidine (Catapres);
prazosin (Minipress); terazosin (Hytrin); pindolol diabetes should use Corgard and Visken with caution
(Visken); because they can prolong and mask the
hypoglycemic effects of insulin. The elderly may
require smaller doses because of the potential for
bradycardia and hypotension. African-American
patients tend to be less responsive to beta-blockers
in general and may require increased dosage or use
of another drug (monotherapy with a diuretic).
May be necessary to treat severe hypertension
Calcium channel antagonists: nifedipine when a combination of a diuretic and a sympathetic
(Procardia); verapamil (Calan); diltiazem
inhibitor does not sufficiently control BP.
(Cardizem); amlodipine (Norvasc); isradipine
Vasodilation of healthy cardiac vasculature and
(DynaCirc); nicardipine (Cardene);
increased coronary blood flow are secondary
benefits of vasodilator therapy.
Adrenergic neuron blockers: guanadrel (Hylorel);
Reduce arterial and venous constriction activity at
guanethidine (Ismelin); reserpine (Serpalan);
the sympathetic nerve endings.

Direct-acting oral vasodilators:hydralazine

Action is to relax vascular smooth muscle, thereby
(Apresoline); minoxidil (Loniten);
reducing vascular resistance.

Direct-acting parenteral vasodilators: diazoxide

(Hyperstat), nitroprusside (Nitropress); labetalol These are given intravenously for management of
(Normodyne); hypertensive emergencies.

Angiotensin-converting enzyme (ACE) The use of an additional sympathetic inhibitor may

inhibitors: captopril (Capoten); enalapril be required for its cumulative effect when other
(Vasotec); lisinopril (Zestril); fosinopril (Monopril); measures have failed to control BP or when
ramipril (Altace). congestive heart failure (CHF) or diabetes is present.
 Nursing Interventions Rationale

Angiotensin II blockers:valsartan (Diovan),

guanethidine (Ismelin).

These restrictions can help manage fluid retention

Implement dietary sodium, fat, and cholesterol
and, with associated hypertensive response,
restrictions as indicated.
decrease myocardial workload.

When hypertension is due to pheochromocytoma,

Prepare for surgery when indicated.
removal of the tumor will correct condition.

2. Activity Intolerance

Activity Intolerance: Insufficient physiologic or physiological energy to endure or complete

required or desired activity.
Nursing Diagnosis

o - Activity intolerance

May be related to

o - Generalized weakness
o - Sedentary lifestyle
o - Imbalance between oxygen supply and demand

Possibly evidenced by

o - Verbal report of fatigue or weakness

o - Abnormal heart rate or BP response to activity
o - Exertional discomfort or dyspnea
o - Electrocardiogram (ECG) changes reflecting ischemia; dysrhythmias

Desired Outcomes

o - Participate in necessary/desired activities.

o - Use identified techniques to enhance activity tolerance.
o - Report a measurable increase in activity tolerance.
o - Demonstrate a decrease in physiological signs of intolerance.

Nursing Interventions Rationale

Note presence of factors contributing to fatigue

Fatigue affects both the client’s actual and perceived
(age, frail, acute or chronic illness, heart failure,
ability to participate in activities.
hypothyroidism, cancer and cancer therapies).
 Nursing Interventions Rationale

Provides comparative baseline and provides

Evaluate client’s actual and perceived limitations
information about needed education and
or degree of deficit in light of usual status.
interventions regarding quality of life.

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 The stated parameters are helpful in assessing
after activity (systolic pressure increase of 40 mm physiological responses to the stress of activity and,
Hg or diastolic pressure increase of 20 mm Hg); if present, are indicators of overexertion.
dyspnea or chest pain; excessive fatigue and
weakness; diaphoresis; dizziness or syncope.

Instruct patient in energy-conserving techniques

Energy-saving techniques reduce the energy
(using chair when showering, sitting to brush
expenditure, thereby assisting in equalization of
teeth or comb hair, carrying out activities at a
oxygen supply and demand.
slower pace).

Gradual activity progression prevents a sudden

Encourage progressive activity and self-care when increase in cardiac workload. Providing assistance
tolerated. Provide assistance as needed. only as needed encourages independence in
performing activities.

Stress or depression may be increasing the effects of

Assess emotional and psychological factors
an illness, or depression might be the result of being
affecting the current situation.
forced into inactivity.

3. Acute Pain

Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential
tissue damage or described in terms of such damage; sudden or slow onset of any intensity
from mild to severe with anticipated or predictable end and a duration of <6 months.
Nursing Diagnosis

o - Pain, acute, headache

May be related to

o - Increased cerebral vascular pressure

Possibly evidenced by

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

Desired Outcomes

o - Report pain/discomfort is relieved/controlled.

o - Verbalize methods that provide relief.
o - Follow prescribed pharmacological regimen.
o - Demonstrate use of relaxation skills and diversional activities, as indicated, for individual
situation.

Nursing Interventions Rationale

Note client’s attitude toward pain and use of pain

To assess etiology or precipitating contributory
medications, including any history of substance
factors.
abuse.

Determine specifics of pain (location, Facilitates diagnosis of problem and initiation of

characteristics, intensity (0–10 scale), onset and appropriate therapy. Helpful in evaluating
duration). Note nonverbal cues. effectiveness of therapy.

Use pain rating scale appropriate for age and

condition.

Encourage and maintain bed rest during acute

Minimizes stimulation and promotes relaxation.
phase.

Provide or recommend nonpharmacological

Measures that reduce cerebral vascular pressure
measures for relief of headache such as cool cloth
and that slow or block sympathetic response are
to forehead; back and neck rubs; quiet, dimly lit
effective in relieving headache and associated
room; relaxation techniques (guided imagery,
complications.
distraction); and diversional activities.

Eliminate or minimize vasoconstricting activities Activities that increase vasoconstriction accentuate

that may aggravate headache (straining at stool, the headache in the presence of increased cerebral
prolonged coughing, bending over). vascular pressure.

Dizziness and blurred vision frequently are

associated with vascular headache. Patient may also
Assist patient with ambulation as needed.
experience episodes of postural hypotension,
causing weakness when ambulating.

Provide liquids, soft foods, frequent mouth care if Promotes general comfort. Nasal packing may
nosebleeds occur or nasal packing has been done interfere with swallowing or require mouth
to stop bleeding. breathing, leading to stagnation of oral secretions
 Nursing Interventions Rationale

and drying of mucous membranes.

Administer medications as indicated:

Reduce or control pain and decrease stimulation of

Analgesics; Antianxiety agents: lorazepam the sympathetic nervous system.May aid in the
(Ativan), alprazolam (Xanax), diazepam (Valium). reduction of tension and discomfort that is
intensified by stress.

4. Ineffective Coping

Ineffective Coping: Inability to form a valid appraisal of the stressors, inadequate choices
of practiced responses, and/or inability to use available resources.
Nursing Diagnosis

o - Coping, ineffective

May be related to

o - Situational/maturational crisis; multiple life changes

o - Inadequate relaxation; little or no exercise, work overload
o - Inadequate support systems
o - Poor nutrition
o - Unmet expectations; unrealistic perceptions
o - Inadequate coping methods
o - Gender differences in coping strategies

Possibly evidenced by

o - Verbalization of inability to cope or ask for help

o - Inability to meet role expectations/basic needs or problem-solve
o - Destructive behavior toward self; overeating, lack of appetite; excessive smoking/drinking,
proneness to alcohol abuse
o - Chronic fatigue/insomnia; muscular tension; frequent head/neck aches;
o - chronic worry, irritability, anxiety, emotional tension, depression

Desired Outcomes

o - Identify ineffective coping behaviors and consequences.

o - Verbalize awareness of own coping abilities/strengths.
o - Identify potential stressful situations and steps to avoid/modify them.
o - Demonstrate the use of effective coping skills/methods.
 Nursing Interventions Rationale

Determine individual stressors (family, social,

work environment, life changes, or healthcare To evaluate degree of impairment.
management).

Evaluate ability to understand events, provide

To evaluate degree of impairment.
realistic appraisal of situation.

Assess effectiveness of coping strategies by Adaptive mechanisms are necessary to appropriately

observing behaviors (ability to verbalize feelings alter one’s lifestyle, deal with the chronicity of
and concerns, willingness to participate in the hypertension, and integrate prescribed therapies
treatment plan). into daily living.

Note reports of sleep disturbances, increasing

Manifestations of maladaptive coping mechanisms
fatigue, impaired concentration, irritability,
may be indicators of repressed anger and have been
decreased tolerance of headache, inability to
found to be major determinants of diastolic BP.
cope or problem-solve.

Assist patient to identify specific stressors and Recognition of stressors is the first step in altering
possible strategies for coping with them. one’s response to the stressor.

Involvement provides patient with an ongoing sense

Include patient in planning of care, and encourage
of control, improves coping skills, and can enhance
maximum participation in treatment plan.
cooperation with therapeutic regimen.

Focuses patient’s attention on reality of present

Encourage patient to evaluate life priorities and situation relative to patient’s view of what is wanted.
goals. Ask questions such as “Is what you are Strong work ethic, need for “control,” and outward
doing getting you what you want?” focus may have led to lack of attention to personal
needs.

Assist patient to identify and begin planning for Necessary changes should be realistically prioritized
necessary lifestyle changes. Assist to adjust, so patient can avoid being overwhelmed and feeling
rather than abandon, personal/family goals. powerless.

Help client to substitute positive thoughts for

negative ones such as ” I can do this; I am in To provide meeting psychological needs
charge of myself.”

5. Imbalanced Nutrition: More Than Body Requirements

Imbalanced Nutrition: More Than Body Requirements: Intake of nutrients that exceeds
metabolic needs
Nursing Diagnosis

o - Nutrition: imbalanced, more than body requirements

 May be related to

o - Excessive intake in relation to metabolic need

o - Sedentary activity level
o - Cultural preferences

Possibly evidenced by

o - Weight 10%–20% more than ideal for height and frame

o - Triceps skinfold more than 15 mm in men and 25 mm in women (maximum for age and
sex)
o - Reported or observed dysfunctional eating patterns

Desired Outcomes

o - Identify correlation between hypertension and obesity.

o - Demonstrate change in eating patterns (e.g., food choices, quantity) to attain desirable
body weight with optimal maintenance of health.
o - Initiate/maintain individually appropriate exercise program.

Nursing Interventions Rationale

Obesity is an added risk with high blood pressure

Assess risk or presence of conditions associated because of the disproportion between fixed aortic
with obesity capacity and increased cardiac output associated
with increased body mass.

Reduction in weight may obviate the need for drug

therapy or decrease the amount of medication
Assess patient understanding of direct needed for control of BP.Faulty eating habits
relationship between hypertension and obesity. contribute to atherosclerosis and obesity, which
predispose to hypertension and subsequent
complications (stroke, kidney disease, heart failure).

Excessive salt intake expands the intravascular fluid

Discuss necessity for decreased caloric intake and
volume and may damage kidneys, which can further
limited intake of fats, salt, and sugar as indicated.
aggravate hypertension.

Motivation for weight reduction is internal. The

Determine patient’s desire to lose weight. individual must want to lose weight, or the program
most likely will not succeed.

Identifies current strengths and weaknesses in

Review usual daily caloric intake and dietary
dietary program. Aids in determining individual need
choices.
for adjustment and teaching.

Establish a realistic weight reduction plan with Reducing caloric intake by 500 calories daily
 Nursing Interventions Rationale

theoretically yields a weight loss of 1 lb per wk. Slow

reduction in weight is therefore indicative of fat loss
the patient such as 1 lb weight loss per wk.
with muscle sparing and generally reflects a change
in eating habits.

Encourage patient to maintain a diary of food Provides a database for both the adequacy of
intake, including when and where eating takes nutrients eaten and the emotional conditions of
place and the circumstances and feelings around eating. Helps focus attention on factors that patient
which the food was eaten. has control over or can change.

Avoiding foods high in saturated fat and cholesterol

Instruct and assist in appropriate food selections,
is important in preventing progressing atherogenesis.
such as a diet rich in fruits, vegetables, and low-
Moderation and use of low-fat products in place of
fat dairy foods referred to as the DASH Dietary
total abstinence from certain food items may
Approaches to Stop Hypertension) diet and
prevent sense of deprivation and enhance
avoiding foods high in saturated fat (butter,
cooperation with dietary regimen. The DASH diet, in
cheese, eggs, ice cream, meat) and cholesterol
conjunction with exercise, weight loss, and limits on
(fatty meat, egg yolks, whole dairy products,
salt intake, may reduce or even eliminate the need
shrimp, organ meats).
for drug therapy.

Can provide additional counseling and assistance

Refer to dietitian as indicated.
with meeting individual dietary needs.

6. Deficient Knowledge

Deficient Knowledge: Absence or deficiency of cognitive information related to specific

topic.
Nursing Diagnosis

o - Knowledge, deficient [Learning Need] regarding condition, treatment plan, self-care and
discharge needs

May be related to

o - Lack of knowledge/recall
o - Information misinterpretation
o - Cognitive limitation
o - Denial of diagnosis

Possibly evidenced by

o - Verbalization of the problem

o - Request for information
o - Statement of misconception
o - Inaccurate follow-through of instructions; inadequate performance of procedures
o - Inappropriate or exaggerated behaviors, e.g., hostile, agitated, apathetic

Desired Outcomes

o - Verbalize understanding of disease process and treatment regimen.

o - Identify drug side effects and possible complications that necessitate medical attention.
o - Maintain BP within individually acceptable parameters.
o - Describe reasons for therapeutic actions/treatment regimen.

Nursing Interventions Rationale

Misconceptions and denial of the diagnosis because

of long-standing feelings of well-being may interfere
with patient and SO willingness to learn about
Assess readiness and blocks to learning. Include
disease, progression, and prognosis. If patient does
significant other (SO).
not accept the reality of a life-threatening condition
requiring continuing treatment, lifestyle and
behavioral changes will not be initiated or sustained.

Provides basis for understanding elevations of BP,

Define and state the limits of desired BP. Explain and clarifies frequently used medical terminology.
hypertension and its effects on the heart, blood Understanding that high BP can exist without
vessels, kidneys, and brain. symptoms is central to enabling patient to continue
treatment, even when feeling well.

Because treatment for hypertension is lifelong,

Avoid saying “normal” BP, and use the term “well-
conveying the idea of “control” helps patient
controlled” to describe patient’s BP within desired
understand the need for continued treatment and
limits.
medication.

Assist patient in identifying modifiable risk factors

(obesity; diet high in sodium, saturated fats, and
These risk factors have been shown to contribute to
cholesterol; sedentary lifestyle; smoking; alcohol
hypertension and cardiovascular and renal disease.
intake of more than 2 oz per day on a regular
basis; stressful lifestyle).

Changing “comfortable or usual” behavior patterns

Problem-solve with patient to identify ways in
can be very difficult and stressful. Support, guidance,
which appropriate lifestyle changes can be made
and empathy can enhance patient’s success in
to reduce modifiable risk factors.
accomplishing these tasks.

Nicotine increases catecholamine discharge,

Discuss importance of eliminating smoking, and
resulting in increased heart rate, BP,
assist patient in formulating a plan to quit
vasoconstriction, and myocardial workload, and
smoking.
reduces tissue oxygenation.
 Nursing Interventions Rationale

Lack of cooperation is a common reason for failure

of antihypertensive therapy. Therefore, ongoing
Reinforce the importance of adhering to evaluation for patient cooperation is critical to
treatment regimen and keeping follow-up successful treatment. Compliance usually improves
appointments. when patient understands causative factors and
consequences of inadequate intervention and health
maintenance.

Monitoring BP at home is reassuring to patient

Instruct and demonstrate technique of BP self- because it provides visual and positive
monitoring. Evaluate patient’s hearing, visual reinforcement for efforts in following the medical
acuity, manual dexterity, and coordination. regimen and promotes early detection of deleterious
changes.

Individualizing medication schedule to fit patient’s

Help patient develop a simple, convenient
personal habits and needs may facilitate cooperation
schedule for taking medications.
with long-term regimen.

Adequate information and understanding that side

Explain prescribed medications along with their
effects (mood changes, initial weight gain, dry
rationale, dosage, expected and adverse side
mouth) are common and often subside with time can
effects, and idiosyncrasies
enhance cooperation with treatment plan.

Diuretics: Take daily doses (or larger dose) in the

Scheduling minimizes nighttime urination.
early morning;

Primary indicator of effectiveness of diuretic

Weigh self on a regular schedule and record;
therapy.

The combined vasodilating effect of alcohol and the

Avoid or limit alcohol intake; volume-depleting effect of a diuretic greatly increase
the risk of orthostatic hypotension.

Dehydration can develop rapidly if intake is poor and

Notify physician if unable to tolerate food or fluid;
patient continues to take a diuretic.

Because patients often cannot feel the difference the

medication is making in blood pressure, it is critical
Antihypertensives: Take prescribed dose on a
that there is understanding about the medications’
regular schedule; avoid skipping, altering, or
working and side effects. For example, abruptly
making up doses; and do not discontinue without
discontinuing a drug may cause rebound
notifying the healthcare provider. Review
hypertension leading to severe complications, or
potential side effects and/or drug interactions;
medication may need to be altered to reduce
adverse effects.
 Nursing Interventions Rationale

Rise slowly from a lying to standing position,

Measures reduce severity of orthostatic hypotension
sitting for a few minutes before standing. Sleep
associated with the use of vasodilators and diuretics.
with the head slightly elevated.

Decreases peripheral venous pooling that may be

Suggest frequent position changes, leg exercises
potentiated by vasodilators and prolonged
when lying down.
sitting/standing.

Recommend avoiding hot baths, steam rooms,

Prevents vasodilation with potential for dangerous
and saunas, especially with concomitant use of
side effects of syncope and hypotension.
alcoholic beverages.

Precaution is important in preventing potentially

Instruct patient to consult healthcare provider
dangerous drug interactions. Any drug that contains
before taking other prescription or over-the-
a sympathetic nervous stimulant may increase BP or
counter (OTC) medications.
counteract antihypertensive effects.

Instruct patient about increasing intake of foods/ Diuretics can deplete potassium levels. Dietary
fluids high in potassium (oranges, bananas, figs, replacement is more palatable than drug
dates, tomatoes, potatoes, raisins, apricots, supplements and may be all that is needed to
Gatorade, and fruit juices and foods/ fluids high in correct deficit. Some studies show that 400 mg of
calcium such as low-fat milk, yogurt, or calcium calcium per day can lower systolic and diastolic BP.
supplements, as indicated). Correcting mineral deficiencies can also affect BP.

Review signs and symptoms requiring notification

of healthcare provider (headache present on
awakening that does not abate; sudden and
continued increase of BP; chest pain, shortness of
breath; irregular or increased pulse rate;
Early detection of developing complications,
significant weight gain (2 lb per day or 5 lb per
decreased effectiveness of drug regimen or adverse
wk) or peripheral and abdominal swelling; visual
reactions to it allows for timely intervention.
disturbances; frequent, uncontrollable
nosebleeds; depression or emotional lability;
severe dizziness or episodes of fainting; muscle
weakness or cramping; nausea/ vomiting;
excessive thirst.

Excess saturated fats, cholesterol, sodium, alcohol,

and calories have been defined as nutritional risks in
Explain rationale for prescribed dietary regimen
hypertension. A diet low in fat and high in
(usually a diet low in sodium, saturated fat, and
polyunsaturated fat reduces BP, possibly through
cholesterol).
prostaglandin balance in both normotensive and
hypertensive people.
 Nursing Interventions Rationale

Help patient identify sources of sodium intake

(table salt, salty snacks, processed meats and
cheeses, sauerkraut, sauces, canned soups and Two years on a moderate low-salt diet may be
vegetables, baking soda, baking powder, sufficient to control mild hypertension or reduce the
monosodium glutamate). Stress the importance amount of medication required.
of reading ingredient labels of foods and OTC
drugs.

Encourage patient to establish an individual

Besides helping to lower BP, aerobic activity aids in
exercise program incorporating aerobic exercise
toning the cardiovascular system. Isometric exercise
(walking, swimming) within patient’s capabilities.
can increase serum catecholamine levels, further
Stress the importance of avoiding isometric
elevating BP.
activity.

Demonstrate application of ice pack to the back Nasal capillaries may rupture as a result of excessive
of the neck and pressure over the distal third of vascular pressure. Cold and pressure constrict
nose, and recommend that patient lean the head capillaries to slow or halt bleeding. Leaning forward
forward, if nosebleed occurs. reduces the amount of blood that is swallowed.

Community resources such as the American Heart

Association, “coronary clubs,” stop smoking clinics,
Provide information regarding community
alcohol (drug) rehabilitation, weight loss programs,
resources, and support patient in making lifestyle
stress management classes, and counseling services
changes. Initiate referrals as indicated.
may be helpful in patient’s efforts to initiate and
maintain lifestyle changes.

7. Other Nursing Care Plans

Other possible hypertension nursing care plans:

83. Activity intolerance: frequently occurs as a result of alterations in cardiac output

and side effects of medication.
84. Nutrition: imbalanced, more than body requirements: obesity is often present
and a factor in blood pressure control.
85. Therapeutic Regimen: ineffective management: result of the complexity of the
therapeutic regimen, required lifestyle changes, side effects of medication, and
frequent feelings of general well-being (“I’m not really sick”).
86. Sexuality Patterns, ineffective: interference in sexual functioning may occur
because of activity intolerance and side effects of medication.
87. Family Coping: readiness for enhanced:opportunity exists for family members to
support patient while reducing risk factors for themselves and improving quality of life
for family as a whole.

References and Sources : nurseslabs.com