6 Hypertension Nursing Care Plans

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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 due to 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 Plans

Nursing care planning goals for hypertension include lowering or controlling blood pressure, adherence to the therapeutic regimen, lifestyle modifications, and prevention of complications.

Here are six nursing diagnoses for hypertension nursing care plans

  1. Risk for Decreased Cardiac Output
  2. Decreased Activity Tolerance
  3. Acute Pain
  4. Ineffective Coping
  5. Overweight
  6. Deficient Knowledge
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Deficient Knowledge

The patient’s understanding of the disease process, therapeutic regimen, and 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. 

Nursing Diagnosis

  • Deficient Knowledge

Related Factors

The following are the common related factors for Deficient knowledge:

  • Lack of knowledge/recall
  • Information misinterpretation
  • Cognitive limitation
  • Denial of diagnosis

Defining Characteristics

The common assessment cues 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

Desired Outcomes

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 Assessment and Rationales

Here are the nursing assessments for this nursing diagnosis for hypertension:

1. 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 the patient and SO willingness to learn about the disease, progression, and prognosis. If the patient does not accept the reality of a life-threatening condition requiring continuing treatment, lifestyle and behavioral changes will not be initiated or sustained.

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Nursing Interventions and Rationales

In this section are nursing interventions to address deficient knowledge nursing diagnosis for this hypertension nursing care plan.

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

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

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

4. Problem-solve with the patient to identify ways appropriate lifestyle changes can reduce modifiable risk factors.
Changing “comfortable or usual” behavior patterns can be complicated and stressful. Support, guidance, and empathy can enhance patient’s success in accomplishing these tasks.

5. Discuss the importance of eliminating smoking, and assist the 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.

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

7. Instruct and demonstrate the technique of BP self-monitoring. Evaluate patient’s hearing, visual acuity, manual dexterity, and coordination.
Monitoring BP at home is reassuring to patients because it provides visual and positive reinforcement for following the medical regimen and promotes early deleterious changes.

8. Help patients develop a simple, convenient schedule for taking medications.
Individualizing medication schedules to fit the patient’s personal habits and needs may facilitate cooperation with the long-term regimen.

9. 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 a treatment plan.

10. Diuretics: Take daily doses (or larger doses) in the early morning.
Scheduling minimizes nighttime urination.

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11. Weigh self on a regular schedule and record;
The primary indicator of the effectiveness of diuretic therapy.

12. 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.

13. Notify physician if unable to tolerate food or fluid;
Dehydration can develop rapidly if intake is poor and the patient continues to take a diuretic.

14. Antihypertensives: Take prescribed doses regularly; 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 makes in blood pressure, it is critical to understand the medications’ working and side effects. For example, abruptly discontinuing a drug may cause rebound hypertension leading to severe complications, or medication may be altered to reduce adverse effects.

15. Rise slowly from a lying to a standing position, sitting for a few minutes before standing. Sleep with the head slightly elevated.
Measures reduce the severity of orthostatic hypotension associated with the use of vasodilators and diuretics.

16. Suggest frequent position changes, leg exercises when lying down.
Decreases peripheral venous pooling that may be potentiated by vasodilators and prolonged sitting/standing.

17. Recommend avoiding hot baths, steam rooms, and saunas, especially with the concomitant use of alcoholic beverages.
Prevents vasodilation with the potential for dangerous side effects of syncope and hypotension.

18. Instruct patient to consult a 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.

19. 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 maybe all that is needed to correct the deficit. Some studies show that 400 mg of calcium per day can lower systolic and diastolic BP. Correcting mineral deficiencies can also affect BP.

20. 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 allow for timely intervention.

21. Explain the rationale for the 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.

22. 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.

23. Encourage the patient to establish an individual exercise program incorporating aerobic exercise (walking, swimming) within the 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.

24. Demonstrate application of ice pack to the back of the neck and pressure over the distal third of the 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.

25. Provide information regarding community resources, and support the 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.

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Related nursing diagnoses you can use to craft your own nursing care plan for patients with hypertension.

  1. Ineffective Management of Therapeutic Regimen. Result of the complexity of the therapeutic regimen, required lifestyle changes, side effects of medication, and frequent feelings of general well-being.
  2. Ineffective Sexuality Patterns. Interference in sexual functioning may occur because of activity intolerance and side effects of medication.
  3. Readiness for Enhanced Family Coping. Opportunity exists for family members to support patient while reducing risk factors for themselves and improving quality of life for family as a whole.
  4. Risk for Impaired Cardiovascular Function. Obesity, inadequate physical activity, and dysfunctional diet.

References and Sources

Recommended journals, books, and other interesting materials to help you learn more about hypertension nursing care plans and nursing diagnosis:

  1. Arbour, R. (2004). Intracranial hypertension: monitoring and nursing assessmentCritical Care Nurse24(5), 19-32.
  2. Black, J. M., & Hawks, J. H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (Vol. 1). A. M. Keene (Ed.). Saunders Elsevier.
  3. Chapman, J. M., & Massey Jr, F. J. (1964). The interrelationship of serum cholesterol, hypertension, body weight, and risk of coronary disease: Results of the first ten years’ follow-up in the Los Angeles Heart Study. Journal of Chronic Diseases, 17(10), 933-949.
  4. Chummun, H. (2009). Hypertension–a contemporary approach to nursing careBritish Journal of Nursing18(13), 784-789.
  5. Cohen, J. B. (2017). Hypertension in obesity and the impact of weight loss. Current cardiology reports19(10), 1-8.
  6. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. FA Davis.
  7. Drevenhorn, E. (2006). Counselling patients with hypertension at health centres-a nursing perspective. Inst of Health and Care Sciences.
  8. Giles, T. D., Berk, B. C., Black, H. R., Cohn, J. N., Kostis, J. B., Izzo Jr, J. L., & Weber, M. A. (2005). Expanding the definition and classification of hypertensionThe Journal of Clinical Hypertension7(9), 505-512.
  9. Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences.
  10. Hamilton, G. A. (2003). Measuring adherence in a hypertension clinical trialEuropean Journal of Cardiovascular Nursing2(3), 219-228.
  11. Hong, W. H. S. (2010). Evidence-based nursing practice for health promotion in adults with hypertension: a literature reviewAsian Nursing Research4(4), 227-245.
  12. Johnson, F., & Wardle, J. (2011). The association between weight loss and engagement with a web-based food and exercise diary in a commercial weight loss programme: a retrospective analysisInternational Journal of Behavioral Nutrition and Physical Activity8(1), 1-7.
  13. Julius, S., Valentini, M., & Palatini, P. (2000). Overweight and hypertension: a 2-way street?. Hypertension35(3), 807-813.
  14. Julius, S., PASCUAL, A. V., Sannerstedt, R., & Mitchell, C. (1971). Relationship between cardiac output and peripheral resistance in borderline hypertensionCirculation43(3), 382-390.
  15. Sacco, M., Meschi, M., Regolisti, G., Detrenis, S., Bianchi, L., Bertorelli, M., … & Caiazza, A. (2013). The relationship between blood pressure and painThe journal of clinical hypertension15(8), 600-605.
  16. Sheps, D. S., Bragdon, E. E., Gray III, T. F., Ballenger, M., Usedom, J. E., & Maixner, W. (1992). Relation between systemic hypertension and pain perceptionThe American journal of cardiology70(16), F3-F5.

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Cardiac Care Plans

Nursing care plans about the different diseases of the cardiovascular system:

 

Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.

12 thoughts on “6 Hypertension Nursing Care Plans”

  1. Real i like the website as i’m a nursing student third year, i wish if could get an app from play store for Android, “Nurseslabs.com” with this materials care plans for different medical conditions to guide on caring patients according to standard and finally saving life of many patients through competence and experience.👊🙏

    Reply
  2. Hi! Its really helpful but couldn’t find any nursing interventions as assessments are not considered as an intervention!! Just a request if you could add some nursing interventions for hypertension, it’ll be great. Thank you.

    Reply
  3. I love your website and info provided. Please make an App for my phone/tablet as I am a PACE RN CM and could really use it for in the field.

    Reply
  4. I always run to you. Thank you so much.
    I’m kindly requesting you to help us with more of the nursing interventions for the different nursing diagnoses of this condition plus those of other conditions in the different care plans. May God bless you exceedingly and abundantly.

    Reply

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