What is Hypertension?
Hypertension is defined as an intermittent or continuous elevation of systolic or diastolic blood pressure above 160/90 mmHg. It’s probably the issue most important public health in developed countries. It is the leading cause of cerebrovascular disease, heart disease and renal insufficiency. It is a common condition, often asymptomatic, readily detectable, usually easy to treat and is often fatal complications if not properly treated. Based on statistics of the Joint National Committe Report on Detection, Evaluation and Treatment of High Blood Pressure, an estimated 60 million Americans have been diagnosed with hypertension and an additional 25 million people have high infant. Fortunately the number of patients untreated or undiagnosed decreased significantly from the decades of the 1960s and 1970s through extensive educational programs implemented by private and government agencies, reaching less than 20% today. Thus, efforts to control hypertension in the population should focus on prevention, early detection and effective treatment.
Hypertension is a chronic disease, meaning that lasts a lifetime and you need drug treatment followed a diet and hygiene recommendations.
Hypertension causes an increase in the numbers of stress, Blood pressure {the force that blood exerts on the walls of blood vessels). To measure this value, we use two figures, the highest value is the maximum or systolic pressure (occurs when the heart muscle contracts and pushes blood from the ventricles to the blood vessels), the lower value is the diastolic pressure (occurs when the heart muscle relaxes and blood reenters the heart).
Which values are normal:
If we take the average of all age groups get a systolic pressure of 120 mm Hg. and a diastolic pressure of 80 mm Hg.
The World Health Organization considers that 140/90 mm Hg is the upper limit of normal. Values greater than 160/95 mm Hg are rates of hypertension.
Etiology
Primary or essential hypertension
It occurs in 90% of all cases, is the most common and their exact causes are not well known. Some mechanisms involved are:
Neural Theory
An abnormal condition in which excessive neurohumoral stimulation results in increased muscle tone.
Sympathetic nervous system activation
With increased CNS activity blood pressure can rise because renin increases through release of catecholamines or venoarterial causing constriction.
Renin-angiotensin-aldosterone
Stimulation in the production of high plasma renin levels results in the production of angiotensin I and II, both are vasoconstrictors. Angiotensin II causes constriction venoarterial, which in turn stimulates aldosterone production, causing them to retain salt and water.
Theory vasopressor
Caused by the decrease of the concentration of vasodilator substances, such as prostaglandins and quinines.
Secondary Hypertension
Presence of high blood pressure and some other related pathology. The most common disorders that cause secondary hypertension, renal insufficiency usually, renovascular disease and oral contraceptive use in women. Also parenchymal renal disorders, renal artery disease, metabolic and endocrine disorders, CNS ailments and coarctation of the aorta.
Risk Factors
Heredity and age
The statistics do not properly reflect the actual numbers, but there is evidence that approximately between 2 and 12% of young people presented at some point a high TA. This factor increases the risk of primary hypertension, if one or both parents (28-41%) were hypertensive. In the elderly, hypertension is the leading risk factor for cardiovascular disease. The prevalence rates tested in the elderly population, 20% have isolated systemic hypertension (systolic blood pressure> 160 mmHg) or mild diastolic hypertension (± 90 mmHg).
Race and sex
The presence of hypertension in black individuals Americans is 38.2% compared to 28.8% of Caucasians, and that manifests itself in a more severe and cause increased risk of organ damage located in the former. It has higher prevalence in men than in women, though the likelihood increases if they have used oral contraceptives, if family history of hypertension and obesity. Smoking, stress and high intakes of saturated fat and salt in the diet habit all increase significantly the development of hypertension in both sexes.
Pathogenesis
The multiple and complex homeostatic mechanisms involved in the maintenance of blood pressure in normal situations make its pathophysiology varied aspects to contemplate its appearance. Systemic vascular resistance (SVR) and cardiac index (heart rate x stroke volume) hemodynamic factors are determinants of blood pressure.
The high cardiac output, heart rate or high SVR, can cause hypertension box. The Wall baroreceptors of the carotid sinus and aortic arch stimulate the sympathetic nervous system and results in increased levels of adrenaline and noradrenaline. This translates to increased cardiac output (CO) and RSV. In many patients the GC remains normal while the SVR rises.
Complications
Organic lesion located
Patients with mild to moderate hypertension may remain clinically asymptomatic. However, in the medium to long term expresses the effect it has on various organs such as the heart and kidneys.
Prolonged hypertension leads to concentric cardiac hypertension due to prolonged exposure to high afterload with primary effect on the heart. Thus patients may have multiple complications:
– Hypertensive Crisis
– Coronary Artery Disease
– Cerebrovascular disease
– Kidney Disease
– Congestive Heart Failure
– Peripheral Vascular disease
– Aneurysm and aortic dissection
– Sudden death
Medical treatment
The Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressures for Drug Therapy systematized care recommended for the treatment of hypertension.
In an initial stage 0 or non pharmacological treatment indications is based on restriction and modification of dietary habits and increased physical activity through aerobic exercise that is appropriate to the age of the subject, and the removal of snuff consumption and a regular TA registration determined by the degree of elevation of the same. Sodium intake restriction can be varied between a moderate to severe restriction, the recommended amount is 2 to 4 g / day depending on the severity of the hypertension. The stage 1 starts with a low dose drug, progressively increasing or adding or substituting another in increasing doses until the desired effect controlled to maintain the TA.
hypertension Nursing diagnosis
Hypertension is often asymptomatic when present study mild to moderate and the data reported by the physical examination may be normal except for high levels of blood pressure, other important data can be:
General discomfort
Headache, fatigue, dizziness, palpitations, hypertension in severe, throbbing headache sub-occipital (may occur when getting up in the morning and goes away within a few hours), epistaxis.
Blood pressure
You must register in both arms, sitting, standing and supine; determined on at least two occasions, above 160/90 or higher.
Pulse
Tachycardia femoral delays when compared with the brachial or femoral pulse.
Precordium
Displaced apical impulse but intense tug ventricular (apical elevation)
Heart Sounds
Murmurs of carotid and femoral areas; S2 accentuated at the base; apical systolic murmur, audible S4; early diastolic murmur whistling sternal edges and right and left intercostal spaces.
Fundus
Changes can be observed in the retina: Grade I-arterial narrowing or irregularities minimum, grade II-arteriolar narrowing and irregularities in the retina marked tortuosity or focal spasm grade III-arteriolar narrowing and irregularities in the retina, marked tortuosity generalized bleeding flame-shaped in the form of exudates and cotton wool, grade IV-like grade III more presence of papilledema.
Nursing diagnoses
Subjective data
The apparent lack of patient knowledge regarding high BP and its prevention. Refers to have a lifestyle that includes factors that increase the risk of elevated BP, as a diet high in sodium, cigarette smoking and physical inactivity. Stress levels and high tension in his work or family environment, lack of supervision and control of TA and may be present additional risks such as race and family history.
In women it is important to the history of oral contraceptive use.
Blood pressure may be within the limits of the abnormality of moderate, mild or severe obesity, signs and symptoms of localized organ damage.
Lack of compliance
There is a attitude and behavior and noncompliance own information can also be found by the family or people close to the patient on the failure of their treatment regimen.
Diagnostic and laboratory tests that reveal a lack of observation of treatment data exists organ involvement, exacerbation of symptoms, not attending the established medical check.
Potential for impaired tissue perfusion
Nursing Care Plan
The care plan should focus on the achievement of the objectives to eliminate negative behaviors and risks associated with deteriorating stadium figures to more severe hypertension
Objectives
* The patient will identify behaviors directed to health care that prevent and / or control high blood pressure.
* The patient’s own responsibility demonstrate knowledge and habits that favor maintaining control of blood pressure.
* The patient will identify the reasons and / or experiences of their lack of compliance with medical treatment.
* The patient will demonstrate an increased level of knowledge about their condition, treatment and measures to reduce the risks of complications.
Implementation
Altered health maintenance
Assess lifestyle factors that increase the risk of elevated TA: Explore and identify personal, social and labor and influence to promote lifestyle changes in behavior and treatment acceptance.
Identify the lack of information in the knowledge that the patient should have about their disease: Compression of the disease and therapeutic treatment must be clear and according to their level of understanding, the misperception produces frustration, anger and abandonment treatment.
Take and record the TA, instructing the patient about the procedure and the readings obtained. Patient participation increases knowledge and fosters a sense of responsibility.
Instruct the patient on the pharmacology indicated, reviewing the names, doses and expected side effects that you should report. This contributes to their best knowledge, ability and track long-term treatment.
Establish a health education program and encourage the patient and family to participate in it. Active participation will allow the patient and family make decisions correctly and timely in self care.
Provide information about the actions that will help change negative behaviors regarding health care, such as: weight loss, snuff consumption, exercise, and stress support groups, help books, smoking cessation clinics, methods and fitness centers, classes for relaxation and stress reduction, visualization and deep breathing, etc.
Lack of compliance
Assess whether treatment failure is due to denial or lack of knowledge. It may be that the patient has no trouble understanding everything related to your condition, but the lack of compliance is due to other personal factors that create conflict.
Assess other factors that affect their ability to carry out treatment, such as: Economy, age, culture, work.
Review and develop a profile of individual behaviors that may increase the risk of cardiac complications and / or renal, detailing the concepts clearly to eliminate errors in the perception of their disease status. This provides the certainty that the disease can be controlled effectively and achieve positive results in reducing risk of complications.
Gaps in knowledge
Instruct the patient and family about hypertension, factors contributing to the increase of blood pressure, which can identify and avoid the effect of high BP on heart, kidneys and brain.
Explain the procedures for taking and recording of TA, interpretation of results and the steps you can take to the significant changes.
Explain the dietary management, emphasizing the restrictions on sodium, calories and fat according to medical indications. Stress the importance of restricting the consumption of alcohol.
Report on the importance of weight control and the benefit of losing kilos in a controlled manner.
Explain the effect of consumption of snuff in the body and refer, if necessary, to a support group to quit smoking.
Explain the importance of practicing the exercise on a regular basis and the effect it has on the regulation of BP.
Describe and report on drug treatment, including name, indication, dosage and side effects of all medications the patient is taking.
Evaluation
The TA is within controlled limits: figures TA within 140/80, has disappeared headache, dizziness, etc.. And lab results were reported within normal limits.
The patient demonstrates knowledge and commitment to control their own TA: In forma taking their medications correctly, checked weight loss has stopped using snuff and participate in physical activities. And demonstrates refers holding frequent self-monitoring of its TA.
The patient complies with the treatment plan: Is compliance and persistence in changing their lifestyle and acceptance of treatment.
The level of knowledge has increased their disease: expresses a high level of understanding of the development of the disease and associated risk factors for treatment failure. Demonstrates that it has achieved significant changes in your lifestyle that promote positive development of their disease.
To sum it up, nanda Nursing diagnosis list for hypertension, demands proper care and focused attention. Hypertension is a symptom in which the cardiac activity in the human being comes down significantly. In other words, it is state of high blood pressure, which can result into to some hazardous health effects like heart failure, stroke, extreme headaches, dizziness, problem in breathing normally, severe chest pains and heart attack; it is one of the most dangerous and fatal kind of symptom that requires careful analysis and cure, any kind of negligence in this matter can also result in loss of life. To cure this symptom let’s first understand the causes that increases the risk of this medical condition in any person. In human body, normal blood pressure that is required for proper functioning of the heart is measured below 120/80; the person with such a reading is free from any risk of hypertension. The blood pressure reading anywhere between 120/80 to 139/89 requires immediate attention, it is still not the stage of hypertension, but any failure to react at this stage can result into further consequences and once the measurement of blood pressure goes past 140 the medical condition becomes serious, some main causes for this condition are:
Causes those results in to Fatal Conditions of Hypertension:
• This cause is commonly observed in people who are addicted to smoking
• Over eating, resulting into over-weight and obesity can also result into the condition of hypertension.
• Stress is another common constituent of this cause.
• Some people with age also get confronted to this medical condition.
• Few people get these symptoms genetically from their family members.
• Addiction to alcohol can also result in this condition.
A part from this there is few more conditions that can result into this cause, the most imperative and the preventive step to control any effect of hypertension on the body is to cure it before it stems up. By proper Nursing diagnosis for hypertension the blood pressure can be brought down its normal level and with proper care and regular check-ups that blood pressure can be maintained throughout. Most people who suffer this symptom is because of their lack of knowledge, many people don’t realize that their blood pressure has gone above normal reading and they require an immediate medical attention from a good health care center. Complete understanding and Nursing diagnosis for hypertension will only happen if the person understands that the symptoms like headaches, chest pain and dizziness can be the result of this condition that requires an immediate medical check-up. Let’s understand how these conditions can be successfully combated and cured.
Measure to reduce and control the impact of Hypertension:
• Knowing and acting; people must make their regular and scheduled visit to the doctors. They must take regular reading of their blood pressure so that it can be prevented and cured down at an early stage itself.
• Introducing proper diet; intake of vegetables, fruits and fluids will increase the strength of digestive system, keeping check on obesity thereby preventing any symptom of hypertension.
• Regular exercise keeps body fit, healthy and is good for the blood pressure.
• Reduce the use of salt in food; salt during increased blood pressure can act like poison that can worsen the condition, so special check has to be regulated on its use.
• Habits like smoking and drinking must be considerably reduced; they are the main cause of this disease and must be kept under proper check.
Normal blood pressure helps a person to enjoy healthy and active lifestyle, therefore they must never underestimate the potential threat of conditions like hypertension and must try to prevent it and in case they do get into such situation, than they must immediately seek medical guidance for successful nursing diagnosis for hypertension.