In this nursing care planning guide are six (6) NANDA nursing diagnosis for hypertension or high-blood pressure. Learn about the assessment, nursing interventions, teaching, and goals for hypertension nursing care plans.
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.
Nursing Care Plans
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
Patient’s understanding of the disease process, therapeutic regimen, and adherence to lifestyle changes are key in controlling hypertension. In nursing diagnosis Deficient Knowledge the nurse must emphasize the concept of controlling hypertension rather than curing it.
- Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.
The following are the common related factors for Deficient knowledge:
- Lack of knowledge/recall
- Information misinterpretation
- Cognitive limitation
- Denial of diagnosis
The common assessment cues that could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.
- Verbalization of the problem
- Request for information
- Statement of misconception
- Inaccurate follow-through of instructions; inadequate performance of procedures
- Inappropriate or exaggerated behaviors, e.g., hostile, agitated, apathetic
Common goals and expected outcomes for Deficient Knowledge nursing diagnosis:
- Patient will verbalize understanding of disease process and treatment regimen.
- Patient will identify drug side effects and possible complications that necessitate medical attention.
- Patient will maintain BP within individually acceptable parameters.
- Patient will describe reasons for therapeutic actions/treatment regimen.
Nursing Interventions and Rationale
Here are the nursing interventions for this hypertension nursing care plans.
|Assess readiness and blocks to learning. Include significant other (SO).||Misconceptions and denial of the diagnosis because of long-standing feelings of well-being may interfere with patient and SO willingness to learn about disease, progression, and prognosis. If patient does not accept the reality of a life-threatening condition requiring continuing treatment, lifestyle and behavioral changes will not be initiated or sustained.|
|Define and state the limits of desired BP. Explain hypertension and its effects on the heart, blood vessels, kidneys, and brain.||Provides basis for understanding elevations of BP, and clarifies frequently used medical terminology. Understanding that high BP can exist without symptoms is central to enabling patient to continue treatment, even when feeling well.|
|Avoid saying “normal” BP, and use the term “well-controlled” to describe patient’s BP within desired limits.||Because treatment for hypertension is lifelong, conveying the idea of “control” helps patient understand the need for continued treatment and medication.|
|Assist patient in identifying modifiable risk factors (obesity; diet high in sodium, saturated fats, and cholesterol; sedentary lifestyle; smoking; alcohol intake of more than 2 oz per day on a regular basis; stressful lifestyle).||These risk factors have been shown to contribute to hypertension and cardiovascular and renal disease.|
|Problem-solve with patient to identify ways in which appropriate lifestyle changes can be made to reduce modifiable risk factors.||Changing “comfortable or usual” behavior patterns can be very difficult and stressful. Support, guidance, and empathy can enhance patient’s success in accomplishing these tasks.|
|Discuss importance of eliminating smoking, and assist patient in formulating a plan to quit smoking.||Nicotine increases catecholamine discharge, resulting in increased heart rate, BP, vasoconstriction, and myocardial workload, and reduces tissue oxygenation.|
|Reinforce the importance of adhering to treatment regimen and keeping follow-up appointments.||Lack of cooperation is a common reason for failure of antihypertensive therapy. Therefore, ongoing evaluation for patient cooperation is critical to successful treatment. Compliance usually improves when patient understands causative factors and consequences of inadequate intervention and health maintenance.|
|Instruct and demonstrate technique of BP self-monitoring. Evaluate patient’s hearing, visual acuity, manual dexterity, and coordination.||Monitoring BP at home is reassuring to patient because it provides visual and positive reinforcement for efforts in following the medical regimen and promotes early detection of deleterious changes.|
|Help patient develop a simple, convenient schedule for taking medications.||Individualizing medication schedule to fit patient’s personal habits and needs may facilitate cooperation with long-term regimen.|
|Explain prescribed medications along with their rationale, dosage, expected and adverse side effects, and idiosyncrasies||Adequate information and understanding that side effects (mood changes, initial weight gain, dry mouth) are common and often subside with time can enhance cooperation with treatment plan.|
|Diuretics: Take daily doses (or larger dose) in the early morning;||Scheduling minimizes nighttime urination.|
|Weigh self on a regular schedule and record;||Primary indicator of effectiveness of diuretic therapy.|
|Avoid or limit alcohol intake;||The combined vasodilating effect of alcohol and the volume-depleting effect of a diuretic greatly increase the risk of orthostatic hypotension.|
|Notify physician if unable to tolerate food or fluid;||Dehydration can develop rapidly if intake is poor and patient continues to take a diuretic.|
|Antihypertensives: Take prescribed dose on a regular schedule; avoid skipping, altering, or making up doses; and do not discontinue without notifying the healthcare provider. Review potential side effects and/or drug interactions;||Because patients often cannot feel the difference the medication is making in blood pressure, it is critical that there is understanding about the medications’ working and side effects. For example, abruptly discontinuing a drug may cause rebound hypertension leading to severe complications, or medication may need to be altered to reduce adverse effects.|
|Rise slowly from a lying to standing position, sitting for a few minutes before standing. Sleep with the head slightly elevated.||Measures reduce severity of orthostatic hypotension associated with the use of vasodilators and diuretics.|
|Suggest frequent position changes, leg exercises when lying down.||Decreases peripheral venous pooling that may be potentiated by vasodilators and prolonged sitting/standing.|
|Recommend avoiding hot baths, steam rooms, and saunas, especially with concomitant use of alcoholic beverages.||Prevents vasodilation with potential for dangerous side effects of syncope and hypotension.|
|Instruct patient to consult healthcare provider before taking other prescription or over-the-counter (OTC) medications.||Precaution is important in preventing potentially dangerous drug interactions. Any drug that contains a sympathetic nervous stimulant may increase BP or counteract antihypertensive effects.|
|Instruct patient about increasing intake of foods/ fluids high in potassium (oranges, bananas, figs, dates, tomatoes, potatoes, raisins, apricots, Gatorade, and fruit juices and foods/ fluids high in calcium such as low-fat milk, yogurt, or calcium supplements, as indicated).||Diuretics can deplete potassium levels. Dietary replacement is more palatable than drug supplements and may be all that is needed to correct deficit. Some studies show that 400 mg of calcium per day can lower systolic and diastolic BP. 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; significant weight gain (2 lb per day or 5 lb per wk) or peripheral and abdominal swelling; visual disturbances; frequent, uncontrollable nosebleeds; depression or emotional lability; severe dizziness or episodes of fainting; muscle weakness or cramping; nausea/ vomiting; excessive thirst.||Early detection of developing complications, decreased effectiveness of drug regimen or adverse reactions to it allows for timely intervention.|
|Explain rationale for prescribed dietary regimen (usually a diet low in sodium, saturated fat, and cholesterol).||Excess saturated fats, cholesterol, sodium, alcohol, and calories have been defined as nutritional risks in hypertension. A diet low in fat and high in polyunsaturated fat reduces BP, possibly through prostaglandin balance in both normotensive and hypertensive people.|
|Help patient identify sources of sodium intake (table salt, salty snacks, processed meats and cheeses, sauerkraut, sauces, canned soups and vegetables, baking soda, baking powder, monosodium glutamate). Stress the importance of reading ingredient labels of foods and OTC drugs.||Two years on a moderate low-salt diet may be sufficient to control mild hypertension or reduce the amount of medication required.|
|Encourage patient to establish an individual exercise program incorporating aerobic exercise (walking, swimming) within patient’s capabilities. Stress the importance of avoiding isometric activity.||Besides helping to lower BP, aerobic activity aids in toning the cardiovascular system. Isometric exercise can increase serum catecholamine levels, further elevating BP.|
|Demonstrate application of ice pack to the back of the neck and pressure over the distal third of nose, and recommend that patient lean the head forward, if nosebleed occurs.||Nasal capillaries may rupture as a result of excessive vascular pressure. Cold and pressure constrict capillaries to slow or halt bleeding. Leaning forward reduces the amount of blood that is swallowed.|
|Provide information regarding community resources, and support patient in making lifestyle changes. Initiate referrals as indicated.||Community resources such as the American Heart Association, “coronary clubs,” stop smoking clinics, alcohol (drug) rehabilitation, weight loss programs, stress management classes, and counseling services may be helpful in patient’s efforts to initiate and maintain lifestyle changes.|
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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