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NURSING CARE PLAN
 ASSESSMENT              DIAGNOSIS        INFERENCE              PLANNING           INTERVENTION               RATIONALE           EVALUATION
                                                                                  INDEPENDENT:
SUBJECTIVE:              โ™ฆ Risk for     โ™ฆ High blood           โ™ฆ After 8 hours    โ™ฆ Define and state the     โ™ฆ Provides basis    โ™ฆ After 8 hours of
                           prone          pressure (HBP)         of nursing          limits of desired BP.     for                 nursing
โ€œBakit kaya                behavior       or hypertension        interventions,      Explain                   understanding       interventions,
madalas ako                related to     means high             the patient         hypertension and its      elevations of BP,   the patient was
mahilo?โ€ (Why do I         lack of        pressure               will verbalize      effect on the heart,      and clarifies       able to
always feel dizzy?) as     knowledge      (tension) in the       understanding       blood vessels,            misconceptions      verbalize
verbalized by the          about the      arteries. Arteries     of the disease      kidney, and brain.        and also            understanding
patient.                   disease        are vessels that       process and                                   understanding       of the disease
                                          carry blood from       treatment                                     that high BP can    process and
OBJECTIVE:                                the pumping            regimen.                                      exist without       treatment
                                          heart to all the                                                     symptom or even     regimen.
โ™ฆ Request for                             tissues and                                                          when feeling
  information.                            organs of the                                                        well.
โ™ฆ Agitated                                body. High
  behavior                                blood pressure                          โ™ฆ Assist the patient in    โ™ฆ These risk
โ™ฆ Inaccurate                              does not mean                             identifying                factors have
  follow through                          excessive                                 modifiable risk            been shown to
  of instructions.                        emotional                                 factors like diet high     contribute to
โ™ฆ V/S taken as                            tension,                                  in sodium, saturated       hypertension.
  follows:                                although                                  fats and cholesterol.
                                          emotional
    T: 37.2                               tension and                             โ™ฆ Reinforce the            โ™ฆ Lack of
    P: 84                                 stress can                                importance of              cooperation is
    R: 18                                 temporarily                               adhering to                common reason
    BP: 180/110                           increase blood                            treatment regimen          for failure of
                                          pressure.                                 and keeping follow         antihypertensive
                                          Normal blood                              up appointments.           therapy.
                                          pressure is
                                          below 120/80;                           โ™ฆ Suggest frequent         โ™ฆ Decreases
                                          blood pressure                            position changes,          peripheral
                                          between 120/80                            leg exercises when         venous pooling
                                          and 139/89 is                             lying down.                that may be
                                          called "pre-                                                         potentiated by
                                          hypertension",                                                       vasodilators and
and a blood                                      prolonged sitting
pressure of                                      or standing.
140/90 or above      โ™ฆ Help patient identify   โ™ฆ Two years on
is considered          sources of sodium         moderate low
high. An               intake.                   salt diet may be
elevation of the                                 sufficient to
systolic and/or                                  control mild
diastolic blood                                  hypertension.
pressure
increases the        โ™ฆ Encourage patient       โ™ฆ Caffeine is a
risk of                to decrease or            cardiac stimulant
developing             eliminate caffeine        and may
heart (cardiac)        like in tea, coffee,      adversely affect
disease, kidney        cola and chocolates.      cardiac function.
(renal) disease,
hardening of the
arteries             โ™ฆ Stress importance of    โ™ฆ Alternating rest
(atherosclerosis       accomplishing daily       and activity
or                     rest periods.             increases
arteriosclerosis),                               tolerance to
eye damage,                                      activity
and stroke                                       progression.
(brain damage).
These                COLLABORATIVE:
complications of     โ™ฆ Provide information     โ™ฆ Community
hypertension            regarding                resources like
are often               community                health centers
referred to as          resources, and           programs and
end-organ               support patients in      check ups are
damage                  making lifestyle         helpful in
because                 changes.                 controlling
damage to                                        hypertension.
these organs is
the end result of
chronic (long
duration) high
blood pressure.

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Nursing care plan hypertension

  • 1. NURSING CARE PLAN ASSESSMENT DIAGNOSIS INFERENCE PLANNING INTERVENTION RATIONALE EVALUATION INDEPENDENT: SUBJECTIVE: โ™ฆ Risk for โ™ฆ High blood โ™ฆ After 8 hours โ™ฆ Define and state the โ™ฆ Provides basis โ™ฆ After 8 hours of prone pressure (HBP) of nursing limits of desired BP. for nursing โ€œBakit kaya behavior or hypertension interventions, Explain understanding interventions, madalas ako related to means high the patient hypertension and its elevations of BP, the patient was mahilo?โ€ (Why do I lack of pressure will verbalize effect on the heart, and clarifies able to always feel dizzy?) as knowledge (tension) in the understanding blood vessels, misconceptions verbalize verbalized by the about the arteries. Arteries of the disease kidney, and brain. and also understanding patient. disease are vessels that process and understanding of the disease carry blood from treatment that high BP can process and OBJECTIVE: the pumping regimen. exist without treatment heart to all the symptom or even regimen. โ™ฆ Request for tissues and when feeling information. organs of the well. โ™ฆ Agitated body. High behavior blood pressure โ™ฆ Assist the patient in โ™ฆ These risk โ™ฆ Inaccurate does not mean identifying factors have follow through excessive modifiable risk been shown to of instructions. emotional factors like diet high contribute to โ™ฆ V/S taken as tension, in sodium, saturated hypertension. follows: although fats and cholesterol. emotional T: 37.2 tension and โ™ฆ Reinforce the โ™ฆ Lack of P: 84 stress can importance of cooperation is R: 18 temporarily adhering to common reason BP: 180/110 increase blood treatment regimen for failure of pressure. and keeping follow antihypertensive Normal blood up appointments. therapy. pressure is below 120/80; โ™ฆ Suggest frequent โ™ฆ Decreases blood pressure position changes, peripheral between 120/80 leg exercises when venous pooling and 139/89 is lying down. that may be called "pre- potentiated by hypertension", vasodilators and
  • 2. and a blood prolonged sitting pressure of or standing. 140/90 or above โ™ฆ Help patient identify โ™ฆ Two years on is considered sources of sodium moderate low high. An intake. salt diet may be elevation of the sufficient to systolic and/or control mild diastolic blood hypertension. pressure increases the โ™ฆ Encourage patient โ™ฆ Caffeine is a risk of to decrease or cardiac stimulant developing eliminate caffeine and may heart (cardiac) like in tea, coffee, adversely affect disease, kidney cola and chocolates. cardiac function. (renal) disease, hardening of the arteries โ™ฆ Stress importance of โ™ฆ Alternating rest (atherosclerosis accomplishing daily and activity or rest periods. increases arteriosclerosis), tolerance to eye damage, activity and stroke progression. (brain damage). These COLLABORATIVE: complications of โ™ฆ Provide information โ™ฆ Community hypertension regarding resources like are often community health centers referred to as resources, and programs and end-organ support patients in check ups are damage making lifestyle helpful in because changes. controlling damage to hypertension. these organs is the end result of chronic (long duration) high blood pressure.