Learning Center Articles

Nursing management : Hypertension

Nursing management

  • Nursing Assessment
    • Subjective Data
      • Important Health Information
        • Past health history: Known duration and past workup of high BP; cardiovascular, cerebrovascular, renal, or thyroid disease; diabetes mellitus; pituitary disorders; obesity; dyslipidemia; menopause or hormone replacement status
        • Medications: Use of any prescription or over-the-counter, illicit, or herbal drugs or products; previous use of antihypertensive drug therapy
      • Functional Health Patterns
        • Health perception–health management: Family history of hypertension or cardiovascular disease; tobacco use, alcohol use; sedentary lifestyle; health literacy; readiness for change
        • Nutritional-metabolic: Usual salt and fat intake; weight gain or loss
        • Elimination: Nocturia
        • Activity-exercise: Fatigue; dyspnea on exertion, palpitations, exertional chest pain; intermittent claudication, muscle cramps; usual pattern and type of exercise
        • Cognitive-perceptual: Dizziness; blurred vision; paresthesias
        • Sexual-reproductive: Erectile dysfunction, decreased libido
        • Coping–stress tolerance: Stressful life events
    • Objective Data
      • Cardiovascular
        • SBP consistently >140 mm Hg or DBP >90 mm Hg for patients <60 yr old or >150 mm Hg or DBP >90 mm Hg for patients >60 years old.
        • Orthostatic changes in BP and HR; bilateral BPs significantly different; abnormal heart sounds; laterally displaced apical pulse; diminished or absent peripheral pulses; carotid, renal, or femoral bruits; peripheral edema
      • Gastrointestinal
        • Obesity (BMI ≥30 kg/m2); abnormal waist-hip ratio
      • Neurologic
        • Mental status changes
    • Possible Diagnostic Findings
      • Abnormal serum electrolytes (especially potassium)
      • Increased BUN, creatinine, glucose, cholesterol, and triglyceride levels
      • Proteinuria, albuminuria, microscopic hematuria
      • Evidence of ischemic heart disease and left ventricular hypertrophy on ECG
      • Evidence of structural heart disease and left ventricular hypertrophy on echocardiogram; evidence of arteriovenous nicking, retinal hemorrhages, and papilledema on funduscopic examination
    • BP Measurement
      • Take in both arms initially
      • Proper size and placement of cuff
      • Can use forearm if needed
        • Document site
      • Assess for orthostatic hypotension
        • BP and HR supine, sitting, and standing
        • Measure within 1 to 2 minutes of position change
        • Positive if decrease of 20 mm Hg or more in SBP, decrease 10 mm Hg or more in DBP, or increased 20 beats/minute or more in heart rate