Your patient’s BP is 172/102 — do you know what to do? A hypertension nursing care plan guides nurses to address high blood pressure, mitigate complications, and promote patient safety. There are many nursing interventions you could implement for patients with hypertension, but depending on the patient, one might be more appropriate than another. This article will uncover more about nursing management of hypertension.
What Is Hypertension?
Arteries are like long tubes, distributing blood throughout the body. Blood pressure is the force that the blood exerts on the walls of these vessels, and when that pressure is too high, it can damage arteries and the organs they pump blood to. This is called hypertension.
About 30% of adults in the United States have chronic hypertension, the strongest risk factor for cardiovascular disease. Between 1–2% of the population will have a hypertensive crisis in their lifetime. This means that blood pressure levels rise to the point where organs become acutely damaged: Fluid can build in the lungs, parts of the heart may lose blood flow, and neurological emergencies can result. What can nurses do to ensure the best outcomes for their patients?
The nursing process includes assessment, diagnosis, planning, intervention, and evaluation. Let’s explore potential nursing diagnoses that correspond with hypertension, as well as nursing care plans you can use to help your patients.
Where Are Nurses Likely to Implement a Hypertension Nursing Care Plan?
The following specialties are likely to see patients with hypertension:
- Emergency department (ED or ER)
- Cardiac nursing
- Neurological
- Intensive care (ICU)
- Outpatient medicine
- Community health
- Maternal care (OBGYN)
Nursing Diagnosis and Care Plan for Hypertension
Hypertension is any elevation in blood pressure greater than 120/80. High blood pressure exerts stress on arteries and the organs they carry blood to. Hypertension may be chronic or acute, with acute emergencies more common amongst patients with long-standing high blood pressure.
The most obvious sign of hypertension is an elevated blood pressure reading, but this isn’t always the best indicator. Patients with chronic hypertension may be able to tolerate higher pressures without complications, while those with a lower baseline can show signs of a hypertensive emergency with much lower pressures in comparison.
So, what other symptoms or data may indicate hypertension? Associated patient problems may include the following:
- Anxiety
- Dizziness
- Chest pain
- Headache
- Blurred vision
- Shortness of breath (dyspnea)
- Sense of doom
Hypertension can be an acute emergency that warrants a call to the rapid response team. If a patient’s level of consciousness is altered, they are unresponsive, or their blood pressure remains over 200/100 despite treatment, seek help.
Nursing Diagnoses for Patients with Hypertension
Hypertension is a medical diagnosis, not a NANDA-approved nursing diagnosis. This means that, while your patient may have hypertension, the nursing care plan you select will apply to a nursing diagnosis, such as:
Decreased cardiac output: The amount of blood that the heart pumps per minute is reduced because the ventricles are fighting against high pressure in the arteries, or afterload. In cases of severe or prolonged cardiac output, the heart cannot pump enough blood to supply the body. Nursing interventions for decreased cardiac output may include:
- Administering medications that improve heart function.
- Promoting safe physical activity.
- Educating patients on lifestyle changes to reduce cardiac workload.
Risk for decreased renal function: Over time, hypertension puts pressure on the delicate blood vessels in the kidneys, causing them to narrow and lessen blood flow. This damage limits the kidney’s ability to filter wastes and fluid and can cause retention. The retained fluid can then lead to a further increase in blood pressure — a dangerous cycle. Nursing interventions for decreased renal function may include:
- Administering antihypertensive medications.
- Educating the patient on measures to reduce blood pressure.
- Monitoring kidney function labs.
- Monitoring intake and output.
Activity intolerance: Due to decreased cardiac output, patients with chronic hypertension may get tired more quickly. Yet moderate physical activity is a core component in managing hypertension, even for patients whose hypertension has been treatment-resistant. Nursing interventions for activity tolerance include:
- Monitoring vital signs before and after physical activity.
- Encouraging healthy physical activity.
- Educating on safety measures during times of exertion.
- Providing mobility assistance.
Ineffective health maintenance: Researchers estimate that nearly 38% of patients with hypertension experience issues with maintaining healthy habits. There are many potential reasons for this: Patients may not understand the seriousness of their hypertension, they may not be able to afford their medications, or they may not have the time or energy for exercise. Nursing interventions for ineffective health maintenance include:
- Providing patient and family education.
- Completing medication reconciliation.
- Scheduling follow-up appointments.
Nursing Care Plan for Hypertension: Additional Interventions to Consider
What are the main goals for any hypertension care plan? Nursing interventions focus on bringing blood pressure down, investigating the causes of high blood pressure, and educating patients on treatment and management. See the additional hypertension nursing care plan interventions below:
- Performing frequent blood pressure monitoring
- Assessing the electrocardiogram (ECG)
- Administering antihypertensive medications as prescribed
- Auscultating the heart for a murmur and the lungs for crackles and rales (indicating fluid)
- Checking for edema on extremities
- Establishing large-bore IV access
- Checking labs for renal function and electrolytes
- Encouraging rest and a quiet environment
- Educating the patient on stress reduction and management
- Educating the patient on healthy eating, a low-salt diet, exercise, and medications
- Limiting fluid intake for patients with heart failure
Example of a Nursing Care Plan for Hypertension
Nurse Evan is working on a med-surg unit caring for a 73-year-old patient named Jennifer, who had hip replacement surgery five days ago. During the previous several shifts, Jennifer’s blood pressure has hovered between 90/60 and 110/76. This morning, Jennifer is reporting a new headache and pain in her hip, and her blood pressure is 124/86.
Evan implements the following steps of the nursing process:
- Assessment: Evan assesses Jennifer’s surgical site and finds no change. Her pain rating is 7/10. When he reviews her chart, Evan finds that the order for her scheduled post-surgical pain medication has run out, and she has not had any pain medication since yesterday.
- Diagnosis: Acute pain related to surgical site healing, as evidenced by patient pain report and blood pressure elevation.
- Plan: Administer as-needed pain medication and reposition for comfort, with a goal pain rating of 3/10 within the hour. Document blood pressure changes in the chart, and reassess in an hour.
- Intervention: Evan carries out the plan above and charts interventions.
- Evaluation: An hour later, Jennifer reports her pain as 4/10, and her blood pressure is 116/72.
Nursing Care Plan for Hypertension in Pregnancy
Pregnancy-related hypertension is a particularly dangerous form of high blood pressure. Preeclampsia is an elevation in blood pressure after the 20th week of pregnancy, while eclampsia is a worsening blood pressure that can lead to coma, seizures, and death. What nursing diagnoses might be appropriate for these patients?
- Decreased cardiac output
- Risk for injuries to the patient and fetus
- Fluid volume excess
- Risk for impaired liver/kidney function
- Fear related to health status
So, which nursing intervention is appropriate for a patient with hypertension during pregnancy? Nursing interventions focus on decreasing distress and mitigating blood pressure, including:
- Frequently monitoring vital signs.
- Implementing fetal cardiac monitoring
- Administering prescribed antihypertensive medications.
- Monitoring labs for signs of organ dysfunction.
- Providing mobility assistance.
- Promoting positive coping measures.
- Providing emotional support.
- Offering patient education.
- Notifying the provider of labs and vitals findings outside of defined parameters.
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