Your nursing care planning guide that includes 6 nursing diagnosis for hypertension (HTN). Get to know the common nursing diagnosis for hypertension, nursing assessment, nursing interventions and rationale, including teaching and goals.
What is 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.
Classifications of Hypertension
The American College of Cardiology and American Heart Association published new guidelines (as of 2018) and ways to categorize blood pressure.
- Normal: Less than 120/80 mmHg;
- Elevated: Systolic between 120-129 and diastolic less than 80;
- Stage 1: Systolic between 130-139 and diastolic 80-89
- Stage 2: Systolic 140 or higher and diastolic at 90 or higher.
- Hypertensive Crisis: Higher than 180 for systolic and diastolic higher than 120.
Nursing care planning goals for hypertension includes focus on lowering or controlling blood pressure, adherence to the therapeutic regimen, lifestyle modifications, and prevention of complications.
Here are six (6) nursing diagnosis for hypertension nursing care plans:
- Risk for Decreased Cardiac Output
- Activity Intolerance
- Acute Pain
- Ineffective Coping
- Imbalanced Nutrition: More Than Body Requirements
- Deficient Knowledge
- Other Nursing Care Plans
Common related factors for acute pain nursing diagnosis:
- Increased cerebral vascular pressure
The common assessment cues that could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.
- Verbal reports of throbbing pain located in suboccipital region, present on awakening and disappearing spontaneously after being up and about
- Reluctance to move head, rubbing head, avoidance of bright lights and noise, wrinkled brow, clenched fists
- Changes in appetite
- Reports of stiffness of neck, dizziness, blurred vision, nausea, and vomiting
Goals and expected outcomes for acute pain nursing diagnosis:
- Patient will report relief of pain/discomfort.
- Patient will verbalize methods that provide relief.
- Patient will follow prescribed pharmacological regimen.
- Patient will demonstrate use of relaxation skills and diversional activities, as indicated, for individual situation.
Nursing Interventions and Rationale
Here are the nursing interventions for this hypertension nursing care plans.
|Note client’s attitude toward pain and use of pain medications, including any history of substance abuse.||To assess etiology or precipitating contributory factors.|
|Determine specifics of pain (location, characteristics, intensity (0–10 scale), onset and duration). Note nonverbal cues.||Facilitates diagnosis of problem and initiation of appropriate therapy. Helpful in evaluating effectiveness of therapy.|
|Encourage and maintain bed rest during acute phase.||Minimizes stimulation and promotes relaxation.|
|Provide or recommend non pharmacological measures for relief of headache such as cool cloth to forehead; back and neck rubs; quiet, dimly lit room; relaxation techniques (guided imagery, distraction); and diversional activities.||Measures that reduce cerebral vascular pressure and that slow or block sympathetic response are effective in relieving headache and associated complications.|
|Eliminate or minimize vasoconstricting activities that may aggravate headache (straining at stool, prolonged coughing, bending over).||Activities that increase vasoconstriction accentuate the headache in the presence of increased cerebral vascular pressure.|
|Assist patient with ambulation as needed.||Dizziness and blurred vision frequently are associated with vascular headache. Patient may also experience episodes of postural hypotension, causing weakness when ambulating.|
|Provide liquids, soft foods, frequent mouth care if nosebleeds occur or nasal packing has been done to stop bleeding.||Promotes general comfort. Nasal packing may interfere with swallowing or require mouth breathing, leading to stagnation of oral secretions and drying of mucous membranes.|
|Administer medications as indicated:|
|Analgesics; Antianxiety agents: lorazepam (Ativan), alprazolam (Xanax), diazepam (Valium).||Reduce or control pain and decrease stimulation of the sympathetic nervous system.May aid in the reduction of tension and discomfort that is intensified by stress.|
References and Sources
Recommended references and sources for this hypertension nursing care plan guide:
- Arbour, R. (2004). Intracranial hypertension monitoring and nursing assessment. Critical Care Nurse, 24(5), 19-32. [Link]
- Black, J. M., & Hawks, J. H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (Vol. 1). A. M. Keene (Ed.). Saunders Elsevier. [Link]
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. FA Davis. [Link]
- Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences. [Link]
- Hamilton, G. A. (2003). Measuring adherence in a hypertension clinical trial. European Journal of Cardiovascular Nursing, 2(3), 219-228. [Link]
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Cardiac Care Plans
Nursing care plans about the different diseases of the cardiovascular system:
- Angina Pectoris (Coronary Artery Disease) | 4 Care Plans
- Cardiac Arrhythmia (Digitalis Toxicity) | 3 Care Plans
- Cardiac Catheterization | 4 Care Plans
- Cardiogenic Shock | 5 Care Plans
- Congenital Heart Disease | 5 Care Plans
- Heart Failure | 16+ Care Plans
- Hypertension | 6 Care Plans
- Hypovolemic Shock | 4 Care Plans
- Myocardial Infarction | 7 Care Plans
- Pacemaker Therapy | 7 Care Plans