Hypertension Nursing Managment

By Jamie Brinton, RN

Hypertension is often referred to as the silent killer because there are frequently no symptoms associated with it, but it can lead to stroke, heart failure and heart attack. As nurses we help our patients decrease their risk of hypertension and manage hypertension through screening and education.

The first responsibilities of nurses for managing patients hypertension is to understand the disease itself. Primary hypertension is hypertension that has no identifiable cause, such as kidney failure or pregnancy. Most people who suffer from hypertension are suffering from primary hypertension. Even though there is not identifiable cause, there are several factors that may contribute to primary hypertension.

Hypertension occurs when the systemic vascular resistance is too high. Systemic vascular resistance, or SVR, is the amount the heart must work against to push the blood from the heart to the arteries.

Now that we understand the physiology of high blood pressure, we can look at what factors cause a high SVR. Obesity, stress, smoking, and caffiene use can lead to the release of epinephrine. Epinephrine increases the resistance, which in turn leads to an increased blood pressure. Obesity can also activate the renin-angiotension-aldosterone system. Angiotension II, is a potent vasoconstrictor, which also increases the resistance and therefore blood pressure. Genetics are a major risk factor for hypertension. It is believed that genetics effects angiotension and this increased hormone leads to the increased resistance in the body. Salt can cause an increased volume in the vascular system. This increase puts pressure on the ventricles making it harder to move the blood from the heart to the body. (Chummun, 2009)

As nurses we would not expect all of our patients to fully understand the causes of hypertension. However, it is important for nurses to understand the causes of the disease in order to fully answer patients questions.

The next step in managing hypertension for our patient's is education. Once a lifestyle assessment has been made, we can begin teaching. I would begin with telling patients at risk for hypertension the reasons it needs to be addressed. Hypertension can lead to other serious conditions such as heart failure, heart attacks and stroke. Furthermore, hypertension is associated with symptoms that effect quality of life such as fatigue, head aches, dizziness, sob, tinnitus, blurred vision, confusion and irregular heart beat. (Chummun,2009)

Next I would address their individual risk factors. Those who have a BMI greater than 25 can begin with weight loss. Programs such as weight watchers and seatle sutton promote portion control and making choices with lean protein, high in fiber and whole grains. I would give them a copy of a the updated food pyramid. Furthermore, teach them to look for food products that are approved by the American Heart Association. I know that at Jewel, they have heart tags next to price tags on items approved by the AHA. Increased physical activity will help patients loose weight, reduce stress, and lower cholesterol. All of these will help decrease their risk of hypertension. I would recommend inactive patients to set small achievable goals at first and gradually increase their activity as it become a permanat part of their lifestyle. As mentioned before excessive alcohol and caffiene intake can increase epinephrine levels and therefore increase blood pressure. Teach patients to limit these items and make sure they understand the effects of these on blood pressure. Stress is a part of life, but stress reduction is essential to prevent hypertension. Teach your patients stress reducing activities such as exercise, meditation, increased social support, aromatherapy, massage, baths and decreased worrying. Tell patients to put themselves on their to do list. Daily activities for stress reduction should be as important as work, school, and family.

Finally, it is important to make sure that patients know that by modifying the risk factors and taking an active role in the management of hypertension, shows a marked decrease in morbidity and mortality.

References:

Chummun, H. (2009). Hypertension - a contemporary approach to nursing care. British Journal of Nursing (BJN), 18(13), 784-789

NOTE: This blog post reflects the work of Jamie Brinton, RN with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.