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Linda S. Williams / Paula D. Hopper
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Chapter 22
Nursing Care of Patients with
Hypertension

Hypertension Incidence
 2005–2006:
 29% U.S. Adults > 18 Years of Age
 Increases with Age
 Non-Hispanic Blacks: 41%
 Non-Hispanic Whites: 28%
 Mexican Americans: 22%

Safety: Clean Stethoscope
 Contaminated with Bacteria, Even MRSA
 Clean at Start of Shift
 Clean Between Every Patient Use
 Clean with Each Hand Hygiene
 Use Ethanol-based Cleanser or Isopropyl
Alcohol Pads

Taking Blood Pressure (BP)
 Use Calibrated Instrument
 Have Patient Sit Quietly for 5 Minutes in Chair
(Not Exam Table) with Feet on Floor, Arm
Supported at Heart Level
 Use Cuff Bladder Encircling at Least 80% of Arm
 Take Two BP Measurements (Wait In-between)
 Tell Patient BP Reading

Hypertension
 Normal BP is Below 120/80 mm Hg
 Average of Two or More Readings on
Different Dates
 Highest Reading Determines Category

Classification of Hypertension
Systolic Diastolic
 Pre-hypertension 120–139 or 80–89 mm Hg
 Stage 1 Hypertension 140–159 or 90–99 mm Hg
 Stage 2 Hypertension >160 or >100 mm Hg

Follow-Up Care
 Normal BP: 2 Years
 Pre-hypertension: 1 Year
 Stage 1 Hypertension: 2 Months
 Stage 2 Hypertension: 1 Month
 >180/110 mm Hg: Immediate Treatment

Blood Pressure
 Pressure Exerted by Blood on Walls
of Blood Vessels
 Determined by Cardiac Output, Peripheral
Vascular Resistance, Vessel Stretch, Blood
Viscosity, Blood Volume

Pathophysiology
 Primary Hypertension
 Unknown Cause
 Secondary Hypertension
 Known Cause
 Isolated Systolic Hypertension
 SBP >140 mm Hg

Hypertension
Signs/Symptoms
 None
 “Silent Killer”
 Rare
 Headache, Bloody Nose, Anxiety, Dyspnea
 Target Organ Disease
 Damage to Blood Vessels of Heart, Kidney,
Brain, Eyes

Diagnosis of Hypertension
 History
 Signs and Symptoms
 Kidney or Heart Disease
 Medications
 Blood Pressure Readings
 Home Blood Pressure Measurements

Diagnostic Tests
 ECG
 Blood Glucose
 Hematocrit
 Potassium
 Calcium
 Lipoprotein, Cholesterol, Triglyceride

Hypertension Risk Factors
 Nonmodifiable: Unable to be Changed
 Modifiable: Changeable

Nonmodifiable Risk Factors
 Family History of Hypertension
 Age
 Ethnicity
 Diabetes Mellitus

Modifiable Risk Factors
 Weight
 Diet
 DASH
 Limit Sodium
 Limit Caffeine
 Alcohol Use
 Exercise
 Smoking
 Stress Management
 Adequate Sleep

Hypertension Treatment
 No/Low Risk Hypertensive
 Lifestyle Changes
 BP >140/90 mm Hg Over 6 Months
 Goal of Treatment
 <140/90 mm Hg
 <130/80 mm Hg Diabetes/Kidney Disease/
Proteinuria

Hypertension Treatment (cont’d)
 Lifestyle Changes
and
 Antihypertensive Medications
 Initial Therapy: Thiazide-type Diuretics
 Combination Medications

Medications for Hypertension
 Diuretics
 Alpha Blockers
 Beta Blockers
 Calcium Channel Blockers

Medications for Hypertension
(cont’d)
 Angiotensin-converting Enzyme Inhibitors
 Central Agents
 Peripheral Agents
 Vasodilators
 Aspirin 100 mg at Bedtime

Complications of
Hypertension
 Atherosclerosis
 Coronary Artery Disease
 Myocardial Infarction
 Left Ventricular Hypertrophy
 Stroke
 Kidney/Eye Damage

Hypertensive Emergency
 SBP >180 mm Hg Systolic
 DBP >120 mm Hg Systolic
 Risk for/Progression for Target Organ
Dysfunction
 Immediate Gradual Reduction of BP to
Protect Target Organs
 Treatment: Nitroprusside (Nipride) IV

Hypertensive Urgency
 Severe BP Elevation Without Target Organ
Dysfunction Progression
 Severe Headaches, Nosebleeds,
Shortness of Breath, and Severe Anxiety
 Oral Medication

Nursing Process
 Deficient Knowledge
 Ineffective Therapeutic Regimen
Management

Patient Education
 Lifelong BP Control
 Self-care Measures
 Prescribed Medical Regimen

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