Hypertension is very common disease, known as the "silent Killer".A primary health Nurse role in the care of hypertension patient is much higher than in an acute care... assist them to lead a healthy life and identifying the disease process and complications.... etc... etc...

2. By. Ms Shanta Peter

3. NURSING INTERVENTIONS
Objective
Focuses on lowering and controlling BP
without adverse effects and
without undue cost

4. Patient attitude to treatment & medicine is
influenced by:
» Cultural difference
»Beliefs
»Previous experience with Health Care
system
We have to………..
• Build Trust
• Identify the attitude
• Good communication with patient and family

5. Promoting home &
community based care
• Teaching patient self care
• Therapeutic regimen is responsibility of pt----
but we collaborate the education – goals,
and social support to achieve control of BP
• Involve family members in education
programs – they support patient effort to
control HBP

6. Health Teaching.. ………….you must Know
• The family and patient
• Environment
• Lifestyle- patient & family..
• Consumption factors --- smoking… alcohol
• Occupational factors
• Exercise– Leisure activities (TV , Comp) sedentary ,
obesity, Diseases
• Food habits
• Other behaviors
• Self assessment of BP

7. Supply written information on – medications –
expected effects – and side effects
• Side effects – reportable – how to manage
• Rebound hypertension--- if suddenly
stopped –
• Beta blockers – sexual dysfunction
• Measure their BP at home –Monitoring B.P,
maintaining chart
• Encourage their own care – increase in BP if
not taken medicine

8. Teach patient to ..
• Adhere treatment regimen – by
implementing lifestyle changes –
& taking medications in time
• Regular follow up ,monitor BP
• Identify and treat any complications

9. Increasing knowledge
• Understand disease process – lifestyle changes , medications
can control HTn.
• Emphasis on concept of controlling – rather than curing
• Encourage to consult dietician – plan for weight loss – less Na,
fat --- more fruits & vegies --- (1st 2-3 mths taste bad)
• Regular physical activity – regular exercise regimen
• Avoid Tobacco —that it will increase the risk higher
• Support groups – smoking—weight loss –stress reduction

10. Continue care----Follow-up………..
• Important – disease process should be assessed –
and treat
• Physical exam is mandatory at each visit ………..
• Find out all potential problems … -- specially
medication related problems ---
(..postural/orthostatic hypo tension – dizziness or
light headiness'.. )
• Reinforce – compliance with self care
(Non compliance is a main problem --- in lifetime mgt )
(50% discontinue medications in 1 yr BP control is
achieved only by 27%

11. • Greater sense of BP control--- achieve
compliance with self care – that is self monitoring
BP –diet-- medications etc…
(They get immediate feed back )
• Lifestyle modifications. /taking regular
medications – (achieve by much effort )
• Some people effort is unreasonable
• They are asymptomatic without medications –
but may have side effects of medications
• Continue education-- regular reminder follow up
Need encouragement to accept the regimen and
adhere to treatment plan

12. Potential problems
Monitoring / Managing
• Symptoms – of progressing HBP –detect early
involving target systems– so that treatment
can be initiated
• Assess all body systems – when come for
follow up……… especially eyes—
Blurred vision- spots in front of eyes.. diminished
visual acuity
• Heart , Nervous system, kidneys -assess and
exam – additional diagnostic assessments also
should be done
Medications maybe changed based on these.

13. EVALUATION Expected outcomes
1. Maintain adequate tissue perfusion:
• BP maintain at less than 140/90 – with
medications and lifestyle modifications
• Has no symptoms of angina palpitations, or vision
changes
• Stable BUN & S. Crea. levels
• Peripheral pulses are
palpable

14. 2.Complies with self care program
• Adheres to dietary regimen as directed –
low cal, low Na, fat – increased vegetables fruits
• Regular exercise
• Takes medications as instructed and report undue
actions
• Measure BP regularly
• Abstains from Tobacco – alcohol
• Keeps follow-up appointments

15. 3. Has no complications
• Report no changes in vision
• No retinal damage – vision treating
• Maintains – Pulse rate – rhythm—resp. rate –
normal
• No dyspnea or edema
• Maintains urine output consistent with intake
• Renal function / all profiles in normal range
• No speech- motor- sensory deficits
• No head ache- dizziness, weakness, changes in gait
or falls

16. Client Education
Family & Care taker

17. Patient /Family Education
• Importance of compliance with treatment
• Disease process- symptoms not develop until major
organs involve
• Initiate a regular exercise program- avoid – weight
lifting & isometric exercise—Develop the exercise
gradually
• Encourage to express about stress—identify ways to
reduce stress—Teach relaxation techniques in daily
activities
• Checking and Monitor BP – diary for BP
• Lifelong medication and need to follow-up treatment
• Dietary restrictions – Na, Fat, Calories cholesterol-
shop and prepare low Na diet, (list of food)

18. …Pt/family education….
• Select food – reading labels – for Na ,MSG –
• Ways to cook- bake- grill- roast - avoid salt- add in
cooked food.
• Avoid canned food – use fresh – vegies & fruits.
• Actions- side effects--- contact physician-- do not
stop scheduling medications - avoid OTC
medicines.
• Importance of follow up care.

19. DASH Diet…
Dietary Approach to Stop Hypertension

20. DASH……………….Less……SALT …Sodium
• Less salt…..( 1tsp (5ml) /day …
• Limit salt in cooking and none at table
• Avoid salty food
• Choose fresh/frozen foods
• Avoid canned foods
• Check the label for -- Sodium…
• Use other seasoning – herbs… spices … lemon juice
• Choosing correct food
while eating out

21. Easy ways to start.. DASH diet
• Determination
• Change gradually
• Add food of your taste ---- Add fruits and
vegies
• Reduce fat foods
• Limit meat

22. Common foods to avoid –
while on low sodium diet
• Any pre salted – canned foods, meat, snacks
• Foods preserved by sodium addition
• Soups , bouillon and gravies
• Condiment and sauces
• Cheese, butter, and cheese spreads
• Seasoning prepared with salt,
garlic/onion salt
• Frozen fish, pizza or sausage products
Herbs and spices to substitute salt.. as like
…………Lemon…………….

23. Teaching ………
• Explain the consequences and risk of non
compliances ---- and the benefit of compliance
• Refer/introduce to support group
• Encourage the family to become involved with
treatment regimen –especially lifestyle
modifications
• Teach them to check BP , weight – weekly and
keep record
• Praise the patient ( family) for compliance of
treatment

24. Adequate EXERCISE….

25. Behavior modification program—
• Identify the behavior to be changed with patient’s
approval
• Make it written like a contract – goal oriented – Be
sure it is realistic, measurable, positively stated,
and timed with deadline
• Let patient and nurse- family sign the contract –
give a copy to them
• Make sure the follow up occurs on the stated date-
renegotiation is done if necessary
• Identify the reward for patient if the behavior is
achieved

26. Finally … Expected Outcome….
Goal achieved ………
• Maintain BP less than 140/90 with
medications and lifestyle modifications
• Complies with self care program
• Has no complications

27. High BP lead to STROKE .
Warning signs ……(AHA)
a) Sudden numbness/weakness of face,
arm, leg especially on one side of the body
b) Sudden confusion, trouble speaking or
understanding
c)Sudden trouble seeing in one or both eyes
d) Sudden trouble walking, dizziness, loss of balance
or coordination
e) Sudden severe head ache with no known cause
Not all have the same sign