{ "name": "Hypertension", "slug": "hypertension", "url": "https://nursingplex.com/care-plans/hypertension", "category": "Cardiac", "summary": "Sustained high blood pressure; lifestyle modification, adherence support and end-organ monitoring.", "nursing_diagnoses": [ "Risk for decreased cardiac output", "Deficient knowledge", "Ineffective health maintenance" ], "overview": [ "Hypertension is a sustained elevation of arterial pressure, defined in most adult guidelines as a systolic reading of 130 mmHg or higher or a diastolic reading of 80 mmHg or higher on at least two separate occasions. Roughly nine out of ten cases are primary (essential) hypertension with no single identifiable cause, arising instead from a mix of genetics, excess sodium, obesity, insulin resistance, inactivity, alcohol, chronic stress and aging vessels. Secondary hypertension follows an identifiable trigger such as renal artery stenosis, chronic kidney disease, pheochromocytoma, Cushing syndrome, coarctation of the aorta, oral contraceptives or sleep apnea.", "The danger is silent. Most patients feel nothing until an organ is already injured, which is why hypertension is called the silent killer and why adherence, not symptom relief, is the nursing focus. Persistent pressure thickens the left ventricle, accelerates atherosclerosis and damages the small vessels of the kidney, retina and brain. The predictable end-organ consequences are left ventricular hypertrophy and heart failure, myocardial infarction, stroke, hypertensive nephropathy and retinopathy.", "A hypertensive crisis is a reading above roughly 180/120 mmHg. Without evidence of acute organ injury it is urgency, managed with oral agents over hours. With signs such as chest pain, neurologic change, blurred vision, dyspnea or a rising creatinine it is an emergency, managed in a monitored setting with titrated IV agents — and pressure is lowered gradually, because dropping it too fast causes cerebral, coronary and renal hypoperfusion." ], "key_facts": [ { "label": "Measurement technique", "text": "Seated five minutes, back supported, feet flat, arm at heart level, correct cuff size, no caffeine or smoking for 30 minutes. A cuff that is too small falsely raises the reading." }, { "label": "Lifestyle first line", "text": "DASH eating pattern, sodium under about 2,300 mg (ideally 1,500 mg), weight loss, 150 minutes of aerobic activity weekly, alcohol limits and smoking cessation." }, { "label": "ACE inhibitor hallmark", "text": "A persistent dry cough from bradykinin; switch to an ARB. Watch for hyperkalemia and angioedema." }, { "label": "Diuretic caution", "text": "Thiazide and loop diuretics waste potassium; potassium-sparing agents and ACE inhibitors or ARBs retain it. Dose in the morning to avoid nocturia." }, { "label": "Crisis rule", "text": "Lower mean arterial pressure by no more than about 25 percent in the first hour to protect cerebral perfusion." } ], "nursing_priorities": [ "Confirm elevated pressures with accurate, repeated technique in both arms.", "Screen for end-organ damage: heart, brain, kidneys, retina, peripheral vessels.", "Support medication adherence and troubleshoot side effects that drive patients to stop.", "Coach realistic lifestyle change rather than issuing broad orders to eat better.", "Prevent orthostatic falls during the first weeks of therapy and after dose changes.", "Recognize hypertensive urgency versus emergency and escalate appropriately." ], "assessment": { "subjective": [ "Usually asymptomatic — many patients deny any complaint", "Early morning occipital headache, dizziness or lightheadedness", "Blurred vision, epistaxis, tinnitus or palpitations", "Exertional fatigue, chest tightness or shortness of breath", "Reports of missed doses, cost concerns, or side effects such as cough, fatigue or sexual dysfunction" ], "objective": [ "Systolic 130 mmHg or higher, diastolic 80 mmHg or higher on repeated measurement", "Blood pressure difference greater than 10 mmHg between arms", "Orthostatic drop on standing, especially after a dose change", "S4 gallop, displaced apical impulse or left ventricular hypertrophy on ECG or echo", "Carotid, renal or abdominal bruits; diminished peripheral pulses", "Retinal arteriolar narrowing, hemorrhages or papilledema on fundoscopic exam", "Rising serum creatinine and BUN, proteinuria or microalbuminuria", "Elevated LDL, triglycerides, fasting glucose or A1C; BMI above 25" ], "related_factors": [ "Increased systemic vascular resistance and arterial stiffness", "Sodium and water retention with renin-angiotensin-aldosterone activation", "Obesity, sedentary lifestyle, high-sodium diet and excess alcohol", "Chronic stress and sympathetic overactivity; obstructive sleep apnea", "Deficient knowledge of a symptom-free chronic disease", "Complex or costly regimens and unpleasant medication side effects" ] }, "goals": [ "Blood pressure reaches the individualized target — commonly below 130/80 mmHg — within the ordered timeframe.", "The patient states the purpose, timing and key side effects of every prescribed antihypertensive before discharge.", "The patient demonstrates accurate home blood pressure measurement and keeps a log.", "The patient names three personal lifestyle changes and commits to a specific weekly plan.", "No injury from orthostatic hypotension occurs during the admission.", "No signs of end-organ injury develop over the follow-up period." ], "interventions": [ { "title": "Measure and trend blood pressure accurately", "points": [ "Take pressure in both arms initially and use the higher-reading arm for all future measurements; a wide difference may signal arterial disease.", "Standardize conditions — rested, seated, supported, correct cuff — because technique errors produce more false readings than physiology does.", "Check lying, sitting and standing pressures when therapy starts or changes, and hold the dose and notify the provider for a symptomatic drop.", "Record readings as a trend rather than isolated numbers; treatment decisions depend on the pattern." ] }, { "title": "Manage antihypertensive therapy", "points": [ "Give medications at consistent times and explain that pressure returns to baseline within days of stopping — the drug controls, it does not cure.", "Teach the expected side effects of each class: dry cough with ACE inhibitors, fatigue and masked hypoglycemia with beta blockers, ankle edema and constipation with calcium channel blockers, nocturia and cramps with diuretics.", "Never stop a beta blocker abruptly; rebound tachycardia, hypertension and angina can follow.", "Review every over-the-counter product — NSAIDs, decongestants, herbal stimulants and licorice all raise pressure or blunt therapy.", "Assess honestly for cost, complexity and sexual side effects; these are the most common unspoken reasons patients quit." ] }, { "title": "Prevent injury from hypotension and dizziness", "points": [ "Teach the patient to rise in stages: sit at the edge of the bed, dangle the legs, then stand with support.", "Warn that hot showers, hot tubs, alcohol, prolonged standing and dehydration all deepen the drop.", "Keep the bed low, the path clear and the call light within reach for inpatients started on new agents." ] }, { "title": "Coach nutrition and weight", "points": [ "Introduce the DASH pattern concretely — more vegetables, fruit, whole grains, low-fat dairy, nuts and lean protein; less red meat, sweets and saturated fat.", "Teach label reading for sodium and name the true sources: canned soup, deli meat, cheese, condiments, restaurant and fast food, not the salt shaker.", "Suggest herbs, citrus and vinegar as flavor substitutes, and caution against potassium-based salt substitutes for patients on ACE inhibitors, ARBs or potassium-sparing diuretics.", "Set a realistic weight target — even a 5 to 10 percent loss produces a measurable pressure drop.", "Limit alcohol to no more than two drinks daily for men and one for women." ] }, { "title": "Build activity and stress management", "points": [ "Encourage about 150 minutes weekly of moderate aerobic activity, built up gradually and cleared by the provider.", "Advise against heavy isometric lifting and Valsalva straining, which spike pressure sharply.", "Teach paced breathing, progressive muscle relaxation or brief mindfulness, and screen for sleep apnea in patients who snore, are obese or wake unrefreshed.", "Refer for smoking cessation; nicotine causes immediate vasoconstriction and multiplies cardiovascular risk." ] }, { "title": "Monitor for crisis and organ damage", "points": [ "Report severe headache, chest pain, dyspnea, blurred vision, epistaxis that will not stop, confusion or new weakness immediately.", "During a hypertensive emergency keep the patient on continuous monitoring, titrate IV agents to the ordered mean arterial pressure target, and avoid abrupt normalization.", "Track creatinine, BUN, electrolytes and urine protein for renal injury, and support annual eye exams." ] } ], "patient_teaching": [ "Take the medication every day even when you feel perfectly well — hypertension usually has no symptoms.", "Measure your pressure at home at the same times daily, record the numbers, and bring the log to every visit.", "Never stop or skip doses because you feel fine or ran out; call for a refill before that happens.", "Cut sodium by cooking at home and reading labels rather than only avoiding the salt shaker.", "Move most days, aim for gradual weight loss, limit alcohol and stop smoking.", "Rise slowly from lying or sitting to avoid dizziness and falls.", "Check with the pharmacist before any over-the-counter cold medicine, NSAID or supplement.", "Seek emergency care for a reading above 180/120 with chest pain, severe headache, vision change, trouble breathing or weakness on one side." ] }