DecreasedCardiacOutput

NURSINGDIAGNOSIS:CardiacOutput,riskfordecreased DecreasedCardiacOutputHypertensionNursingCarePlans Riskfactorsmayinclude Increasedvascularresistance,vasoconstriction Myocardialischemia Ventricularhypertrophy/rigidity

Possiblyevidencedby [Notapplicablepresenceofsignsandsymptomsestablishesanactualdiagnosis.]

DesiredOutcomes ParticipateinactivitiesthatreduceBP/cardiacworkload. MaintainBPwithinindividuallyacceptablerange. Demonstratestablecardiacrhythmandratewithinpatientsnormalrange. RATIONALES

NURSING INTERVENTIONS MonitorBP.Measurein botharms/thighsthree times,35minapart whilepatientisatrest, thensitting,then standingforinitial evaluation.Usecorrect cuffsizeandaccurate technique.

Comparisonofpressuresprovidesamorecompletepictureof vascularinvolvement/scopeofproblem.Severehypertensionis classifiedintheadultasadiastolicpressureelevationto110mm Hgprogressivediastolicreadingsabove120mmHgare consideredfirstaccelerated,thenmalignant(verysevere). Systolichypertensionalsoisanestablishedriskfactorfor cerebrovasculardiseaseandischemicheartdisease,when diastolicpressureiselevated.

Notepresence,qualityof Boundingcarotid,jugular,radial,andfemoralpulsesmaybe centralandperipheral pulses. observed/palpated.Pulsesinthelegs/feetmaybediminished, reflectingeffectsofvasoconstriction(increasedsystemicvascular resistance[SVR])andvenouscongestion. Auscultatehearttones andbreathsounds. S4heartsoundiscommoninseverelyhypertensivepatients becauseofthepresenceofatrialhypertrophy(increasedatrial volume/pressure).DevelopmentofS3indicatesventricular hypertrophyandimpairedfunctioning.Presenceofcrackles, wheezesmayindicatepulmonarycongestionsecondaryto developingorchronicheartfailure. Observeskincolor, moisture,temperature, andcapillaryrefilltime. Presenceofpallorcool,moistskinanddelayedcapillaryrefill timemaybeduetoperipheralvasoconstrictionorreflectcardiac decompensation/decreasedoutput.

Notedependent/general Mayindicateheartfailure,renalorvascularimpairment. edema. Providecalm,restful surroundings,minimize environmentalactivity/ noise.Limitthenumber ofvisitorsandlengthof stay. Maintainactivity restrictions,e.g., bedrest/chairrest scheduleperiodsof uninterruptedrestassist patientwithselfcare activitiesasneeded. Providecomfort measures,e.g.,back Decreasesdiscomfortandmayreducesympatheticstimulation. Reducesphysicalstressandtensionthataffectbloodpressure andthecourseofhypertension. Helpsreducesympatheticstimulationpromotesrelaxation.

andneckmassage, elevationofhead. Instructinrelaxation techniques,guided imagery,distractions. Monitorresponseto medicationstocontrol bloodpressure. Responsetodrugtherapy(usuallyconsistingofseveraldrugs, includingdiuretics,angiotensinconvertingenzyme[ACE] inhibitors,vascularsmoothmusclerelaxants,betaandcalcium channelblockers)isdependentonboththeindividualaswellas thesynergisticeffectsofthedrugs.Becauseofsideeffects,drug interactions,andpatientsmotivationfortakingantihypertensive medication,itisimportanttousethesmallestnumberandlowest dosageofmedications. Administermedications asindicated: Thiazidediuretics,e.g., chlorothiazide(Diuril) hydrochlorothiazide (Esidrix/HydroDIURIL) bendroflumethiazide (Naturetin)indapamide (Lozol)metolazone (Diulo)quinethazone (Hydromox) Loopdiuretics,e.g., furosemide(Lasix) ethacrynicacid (Edecrin)bumetanide (Bumex),torsemide (Demadex) Thesedrugsproducemarkeddiuresisbyinhibitingresorptionof sodiumandchlorideandareeffectiveantihypertensives, especiallyinpatientswhoareresistanttothiazidesorhaverenal impairment. Diureticsareconsideredfirstlinemedicationsforuncomplicated stageIorIIhypertensionandmaybeusedaloneorinassociation withotherdrugs(suchasbetablockers)toreduceBPinpatients withrelativelynormalrenalfunction.Thesediureticspotentiatethe effectsofotherantihypertensiveagentsaswell,bylimitingfluid retention,andmayreducetheincidenceofstrokesandheart failure. Canreducestressfulstimuli,producecalmingeffect,thereby reducingBP.

Potassiumsparing diuretics,e.g., spironolactone (Aldactone)triamterene (Dyrenium)amiloride (Midamor) Alpha,beta,orcentrally actingadrenergic antagonists,e.g., doxazosin(Cardura) propranolol(Inderal) acebutolol(Sectral) metoprolol(Lopressor), labetalol(Normodyne) atenolol(Tenormin) nadolol(Corgard), carvedilol(Coreg) methyldopa(Aldomet) clonidine(Catapres) prazosin(Minipress) terazosin(Hytrin) pindolol(Visken) Calciumchannel antagonists,e.g., nifedipine(Procardia) verapamil(Calan) diltiazem(Cardizem) amlodipine(Norvasc) isradipine(DynaCirc) nicardipine(Cardene) Adrenergicneuron blockers:guanadrel

Maybegivenincombinationwithathiazidediuretictominimize potassiumloss.

BetaBlockersmaybeorderedinsteadofdiureticsforpatients withischemicheartdiseaseobesepatientswithcardiogenic hypertensionandpatientswithconcurrentsupraventricular arrhythmias,angina,orhypertensivecardiomyopathy.Specific actionsofthesedrugsvary,buttheygenerallyreduceBPthrough thecombinedeffectofdecreasedtotalperipheralresistance, reducedcardiacoutput,inhibitedsympatheticactivity,and suppressionofreninrelease.Note:Patientswithdiabetesshould useCorgardandViskenwithcautionbecausetheycanprolong andmaskthehypoglycemiceffectsofinsulin.Theelderlymay requiresmallerdosesbecauseofthepotentialforbradycardiaand hypotension.AfricanAmericanpatientstendtobelessresponsive tobetablockersingeneralandmayrequireincreaseddosageor useofanotherdrug,e.g.,monotherapywithadiuretic.

Maybenecessarytotreatseverehypertensionwhena combinationofadiureticandasympatheticinhibitordoesnot sufficientlycontrolBP.Vasodilationofhealthycardiacvasculature andincreasedcoronarybloodflowaresecondarybenefitsof vasodilatortherapy.

Reducearterialandvenousconstrictionactivityatthesympathetic nerveendings.

(Hylorel)guanethidine (Ismelin)reserpine (Serpalan) Directactingoral (Apresoline)minoxidil (Loniten) Directactingparenteral vasodilators:diazoxide (Hyperstat),nitroprusside (Nitropress)labetalol (Normodyne) Angiotensinconverting Theuseofanadditionalsympatheticinhibitormayberequiredfor Thesearegivenintravenouslyformanagementofhypertensive emergencies. Actionistorelaxvascularsmoothmuscle,therebyreducing

vasodilators:hydralazine vascularresistance.

enzyme(ACE)inhibitors, itscumulativeeffectwhenothermeasureshavefailedtocontrol e.g.,captopril(Capoten) BPorwhencongestiveheartfailure(CHF)ordiabetesispresent. enalapril(Vasotec) lisinopril(Zestril) fosinopril(Monopril) ramipril(Altace). AngiotensinIIblockers, e.g.,valsartan(Diovan), guanethidine(Ismelin). Implementdietary sodium,fat,and cholesterolrestrictions asindicated. Prepareforsurgery whenindicated. Whenhypertensionisduetopheochromocytoma,removalofthe tumorwillcorrectcondition. Theserestrictionscanhelpmanagefluidretentionand,with associatedhypertensiveresponse,decreasemyocardial workload.

ActivityIntolerance
NURSINGDIAGNOSIS:Activityintolerance ActivityIntoleranceHypertensionNursingCarePlans Mayberelatedto Generalizedweakness Imbalancebetweenoxygensupplyanddemand

Possiblyevidencedby Verbalreportoffatigueorweakness AbnormalheartrateorBPresponsetoactivity Exertionaldiscomfortordyspnea Electrocardiogram(ECG)changesreflectingischemiadysrhythmias

DesiredOutcomes Participateinnecessary/desiredactivities. Reportameasurableincreaseinactivitytolerance. Demonstrateadecreaseinphysiologicalsignsofintolerance. NursingInterventions Assessthepatientsresponsetoactivity,notingpulserate morethan20beats/minfasterthanrestingratemarked increaseinBPduring/afteractivity(systolicpressure increaseof40mmHgordiastolicpressureincreaseof20 mmHg)dyspneaorchestpainexcessivefatigueand weaknessdiaphoresisdizzinessorsyncope. Rationale Thestatedparametersare helpfulinassessing physiologicalresponsestothe stressofactivityand,if present,areindicatorsof overexertion.

Instructpatientinenergyconservingtechniques,e.g.,using chairwhenshowering,sittingtobrushteethorcombhair, carryingoutactivitiesataslowerpace.

Energysavingtechniques reducetheenergy expenditure,therebyassisting inequalizationofoxygen supplyanddemand.

Encourageprogressiveactivity/selfcarewhentolerated. Provideassistanceasneeded.

Gradualactivityprogression preventsasuddenincreasein cardiacworkload.Providing assistanceonlyasneeded encouragesindependencein performingactivities.

AcutePain
NURSINGDIAGNOSIS:Pain,acute,headache Mayberelatedto Increasedcerebralvascularpressure

Possiblyevidencedby Reportsofthrobbingpainlocatedinsuboccipitalregion,presentonawakeningand disappearingspontaneouslyafterbeingupandabout Reluctancetomovehead,rubbinghead,avoidanceofbrightlightsandnoise, wrinkledbrow,clenchedfists Reportsofstiffnessofneck,dizziness,blurredvision,nausea,andvomiting

DesiredOutcomes Reportpain/discomfortisrelieved/controlled. Verbalizemethodsthatproviderelief. Followprescribedpharmacologicalregimen.

NursingInterventions Determinespecificsofpain,e.g.,location, characteristics,intensity(010scale),onset/ duration.Notenonverbalcues. Encourage/maintainbedrestduringacutephase.

Rationale Facilitatesdiagnosisofproblemand initiationofappropriatetherapy.Helpful inevaluatingeffectivenessoftherapy. Minimizesstimulation/promotes relaxation.

Provide/recommendnonpharmacological measuresforreliefofheadache,e.g.,coolclothto relaxationtechniques(guidedimagery,distraction) anddiversionalactivities.

Measuresthatreducecerebralvascular pressureandthatslow/block relievingheadacheandassociated complications.

foreheadbackandneckrubsquiet,dimlylitroom sympatheticresponseareeffectivein

Eliminate/minimizevasoconstrictingactivitiesthat Activitiesthatincreasevasoconstriction mayaggravateheadache,e.g.,strainingatstool, prolongedcoughing,bendingover. accentuatetheheadacheinthe presenceofincreasedcerebralvascular pressure. Assistpatientwithambulationasneeded. Dizzinessandblurredvisionfrequently areassociatedwithvascularheadache. Patientmayalsoexperienceepisodesof posturalhypotension,causingweakness whenambulating. Provideliquids,softfoods,frequentmouthcareif tostopbleeding. Promotesgeneralcomfort.Nasal requiremouthbreathing,leadingto stagnationoforalsecretionsanddrying ofmucousmembranes. Administermedicationsasindicated:Analgesics Antianxietyagents,e.g.,lorazepam(Ativan), alprazolam(Xanax),diazepam(Valium). Reduce/controlpainanddecrease stimulationofthesympatheticnervous system.Mayaidinthereductionof

nosebleedsoccurornasalpackinghasbeendone packingmayinterferewithswallowingor

tensionanddiscomfortthatisintensified bystress.

IneffectiveCoping
NURSINGDIAGNOSIS:Coping,ineffective IneffectiveCopingHypertensionNursingCarePlans Mayberelatedto Situational/maturationalcrisismultiplelifechanges Inadequaterelaxationlittleornoexercise,workoverload Inadequatesupportsystems Poornutrition Unmetexpectationsunrealisticperceptions Inadequatecopingmethods

Possiblyevidencedby Verbalizationofinabilitytocopeoraskforhelp Inabilitytomeetroleexpectations/basicneedsorproblemsolve Destructivebehaviortowardselfovereating,lackofappetiteexcessive smoking/drinking,pronenesstoalcoholabuse Chronicfatigue/insomniamusculartensionfrequenthead/neckaches chronicworry,irritability,anxiety,emotionaltension,depression

DesiredOutcomes Identifyineffectivecopingbehaviorsandconsequences. Verbalizeawarenessofowncopingabilities/strengths. Identifypotentialstressfulsituationsandstepstoavoid/modifythem.

Demonstratetheuseofeffectivecopingskills/methods. Rationale Adaptivemechanismsarenecessaryto appropriatelyalteroneslifestyle,dealwiththe chronicityofhypertension,andintegrateprescribed therapiesintodailyliving.

NursingInterventions Assesseffectivenessofcoping strategiesbyobservingbehaviors,e.g., abilitytoverbalizefeelingsand concerns,willingnesstoparticipatein thetreatmentplan. Notereportsofsleepdisturbances, increasingfatigue,impaired concentration,irritability,decreased toleranceofheadache,inabilityto cope/problemsolve. Assistpatienttoidentifyspecific stressorsandpossiblestrategiesfor copingwiththem.

Manifestationsofmaladaptivecopingmechanisms maybeindicatorsofrepressedangerandhave beenfoundtobemajordeterminantsofdiastolic BP.

Recognitionofstressorsisthefirststepinaltering onesresponsetothestressor.

Includepatientinplanningofcare,and Involvementprovidespatientwithanongoingsense encouragemaximumparticipationin treatmentplan. Encouragepatienttoevaluatelife Iswhatyouaredoinggettingyouwhat youwant? ofcontrol,improvescopingskills,andcanenhance cooperationwiththerapeuticregimen. Focusespatientsattentiononrealityofpresent Strongworkethic,needforcontrol,andoutward focusmayhaveledtolackofattentiontopersonal needs. Assistpatienttoidentifyandbegin planningfornecessarylifestyle changes.Assisttoadjust,ratherthan abandon,personal/familygoals. Necessarychangesshouldberealistically prioritizedsopatientcanavoidbeingoverwhelmed andfeelingpowerless.

priorities/goals.Askquestionssuchas situationrelativetopatientsviewofwhatiswanted.

ImbalancedNutrition
NURSINGDIAGNOSIS:Nutrition:imbalanced,morethanbodyrequirements Mayberelatedto Excessiveintakeinrelationtometabolicneed Sedentarylifestyle Culturalpreferences

Possiblyevidencedby Weight10%20%morethanidealforheightandframe Tricepsskinfoldmorethan15mminmenand25mminwomen(maximumforage andsex) Reportedorobserveddysfunctionaleatingpatterns

DesiredOutcomes Identifycorrelationbetweenhypertensionandobesity. Demonstratechangeineatingpatterns(e.g.,foodchoices,quantity)toattain desirablebodyweightwithoptimalmaintenanceofhealth. Initiate/maintainindividuallyappropriateexerciseprogram. Rationale

NursingInterventions

Assesspatientunderstandingofdirect Obesityisanaddedriskwithhighbloodpressure relationshipbetweenhypertensionand obesity. becauseofthedisproportionbetweenfixedaortic capacityandincreasedcardiacoutputassociated withincreasedbodymass.Reductioninweightmay obviatetheneedfordrugtherapyordecreasethe amountofmedicationneededforcontrolof BP.Faultyeatinghabitscontributetoatherosclerosis andobesity,whichpredisposetohypertensionand

subsequentcomplications,e.g.,stroke,kidney disease,heartfailure. Discussnecessityfordecreased salt,andsugarasindicated. Determinepatientsdesiretolose weight. Excessivesaltintakeexpandstheintravascularfluid aggravatehypertension. Motivationforweightreductionisinternal.The individualmustwanttoloseweight,ortheprogram mostlikelywillnotsucceed. Reviewusualdailycaloricintakeand dietarychoices. Identifiescurrentstrengths/weaknessesindietary program.Aidsindeterminingindividualneedfor adjustment/teaching. Establisharealisticweightreduction planwiththepatient,e.g.,1lbweight loss/wk. Reducingcaloricintakeby500caloriesdaily theoreticallyyieldsaweightlossof1lb/wk.Slow reductioninweightisthereforeindicativeoffatloss withmusclesparingandgenerallyreflectsachange ineatinghabits. Encouragepatienttomaintainadiary offoodintake,includingwhenand whereeatingtakesplaceandthe circumstancesandfeelingsaround whichthefoodwaseaten. Instructandassistinappropriatefood Avoidingfoodshighinsaturatedfatandcholesterol selections,suchasadietrichinfruits, vegetables,andlowfatdairyfoods referredtoastheDASHDietary ApproachestoStopHypertension)diet andavoidingfoodshighinsaturatedfat (butter,cheese,eggs,icecream, meat)andcholesterol(fattymeat,egg isimportantinpreventingprogressing atherogenesis.Moderationanduseoflowfat productsinplaceoftotalabstinencefromcertain fooditemsmaypreventsenseofdeprivationand enhancecooperationwithdietaryregimen.The DASHdiet,inconjunctionwithexercise,weightloss, andlimitsonsaltintake,mayreduceoreven eliminatetheneedfordrugtherapy. Providesadatabaseforboththeadequacyof nutrientseatenandtheemotionalconditionsof eating.Helpsfocusattentiononfactorsthatpatient hascontrolover/canchange.

caloricintakeandlimitedintakeoffats, volumeandmaydamagekidneys,whichcanfurther

yolks,wholedairyproducts,shrimp, organmeats). Refertodietitianasindicated. Canprovideadditionalcounselingandassistance withmeetingindividualdietaryneeds.

KnowledgeDeficit
NURSINGDIAGNOSIS:Knowledge,deficient[LearningNeed]regardingcondition, treatmentplan,selfcareanddischargeneeds KnowledgeDeficitHypertensionNursingCarePlans Mayberelatedto Lackofknowledge/recall Informationmisinterpretation Cognitivelimitation Denialofdiagnosis

Possiblyevidencedby Verbalizationoftheproblem Requestforinformation Statementofmisconception Inaccuratefollowthroughofinstructionsinadequateperformanceofprocedures Inappropriateorexaggeratedbehaviors,e.g.,hostile,agitated,apathetic

DesiredOutcomes Verbalizeunderstandingofdiseaseprocessandtreatmentregimen. Identifydrugsideeffectsandpossiblecomplicationsthatnecessitatemedical attention. MaintainBPwithinindividuallyacceptableparameters.

Describereasonsfortherapeuticactions/treatmentregimen. RATIONALE Misconceptionsanddenialofthe diagnosisbecauseoflongstanding feelingsofwellbeingmayinterfere withpatient/SOwillingnesstolearn aboutdisease,progression,and prognosis.Ifpatientdoesnotaccept therealityofalifethreatening conditionrequiringcontinuing treatment,lifestyle/behavioral changeswillnotbeinitiated/ sustained.

NURSINGINTERVENTIONS Assessreadinessandblockstolearning.Include significantother(SO).

DefineandstatethelimitsofdesiredBP.Explain hypertensionanditseffectsontheheart,blood vessels,kidneys,andbrain.

Providesbasisforunderstanding elevationsofBP,andclarifies frequentlyusedmedicalterminology. UnderstandingthathighBPcanexist withoutsymptomsiscentralto enablingpatienttocontinuetreatment, evenwhenfeelingwell.

AvoidsayingnormalBP,andusetheterm wellcontrolledtodescribepatientsBPwithin desiredlimits.

Becausetreatmentforhypertension islifelong,conveyingtheideaof controlhelpspatientunderstandthe needforcontinuedtreatment/ medication.

Assistpatientinidentifyingmodifiableriskfactors, cholesterolsedentarylifestylesmokingalcohol intake(morethan2oz/dayonaregularbasis) stressfullifestyle.

Theseriskfactorshavebeenshown cardiovascularandrenaldisease.

e.g.,obesitydiethighinsodium,saturatedfats,and tocontributetohypertensionand

Problemsolvewithpatienttoidentifywaysinwhich modifiableriskfactors.

Changingcomfortable/usual andstressful.Support,guidance,and empathycanenhancepatients successinaccomplishingthese tasks.

appropriatelifestylechangescanbemadetoreduce behaviorpatternscanbeverydifficult

Discussimportanceofeliminatingsmoking,and assistpatientinformulatingaplantoquitsmoking.

Nicotineincreasescatecholamine discharge,resultinginincreased heartrate,BP,vasoconstriction,and myocardialworkload,andreduces tissueoxygenation.

Reinforcetheimportanceofadheringtotreatment regimenandkeepingfollowupappointments.

Lackofcooperationisacommon reasonforfailureofantihypertensive therapy.Therefore,ongoing evaluationforpatientcooperationis criticaltosuccessfultreatment. Complianceusuallyimproveswhen patientunderstandscausativefactors andconsequencesofinadequate interventionandhealthmaintenance.

InstructanddemonstratetechniqueofBP selfmonitoring.Evaluatepatientshearing,visual acuity,manualdexterity,andcoordination.

MonitoringBPathomeisreassuring topatientbecauseitprovidesvisual/ positivereinforcementforeffortsin followingthemedicalregimenand promotesearlydetectionof deleteriouschanges.

Helppatientdevelopasimple,convenientschedule Individualizingmedicationscheduleto fortakingmedications. fitpatientspersonalhabits/needs mayfacilitatecooperationwith longtermregimen.

Explainprescribedmedicationsalongwiththeir andidiosyncrasies,e.g.:

Adequateinformationand moodchanges,initialweightgain,dry mouth)arecommonandoften subsidewithtimecanenhance cooperationwithtreatmentplan.

rationale,dosage,expectedandadversesideeffects, understandingthatsideeffects(e.g.,

Diuretics:Takedailydoses(orlargerdose)inthe earlymorning Weighselfonaregularscheduleandrecord

Schedulingminimizesnighttime urination. Primaryindicatorofeffectivenessof diuretictherapy.

Avoid/limitalcoholintake

Thecombinedvasodilatingeffectof alcoholandthevolumedepleting effectofadiureticgreatlyincreasethe riskoforthostatichypotension.

Notifyphysicianifunabletotoleratefoodorfluid

Dehydrationcandeveloprapidlyif intakeispoorandpatientcontinuesto takeadiuretic.

Antihypertensives:Takeprescribeddoseonaregular Becausepatientsoftencannotfeel scheduleavoidskipping,altering,ormakingup dosesanddonotdiscontinuewithoutnotifyingthe healthcareprovider.Reviewpotentialsideeffects and/ordruginteractions thedifferencethemedicationis makinginbloodpressure,itiscritical thatthereisunderstandingaboutthe medicationsworkingandside effects.Forexample,abruptly discontinuingadrugmaycause reboundhypertensionleadingto severecomplications,ormedication mayneedtobealteredtoreduce adverseeffects.

Riseslowlyfromalyingtostandingposition,sitting forafewminutesbeforestanding.Sleepwiththe headslightlyelevated.

Measuresreduceseverityof orthostatichypotensionassociated withtheuseofvasodilatorsand diuretics.

Suggestfrequentpositionchanges,legexercises whenlyingdown.

Decreasesperipheralvenouspooling thatmaybepotentiatedby vasodilatorsandprolonged sitting/standing.

Recommendavoidinghotbaths,steamrooms,and beverages.

Preventsvasodilationwithpotential andhypotension.

saunas,especiallywithconcomitantuseofalcoholic fordangeroussideeffectsofsyncope

Instructpatienttoconsulthealthcareproviderbefore Precautionisimportantinpreventing takingotherprescriptionoroverthecounter(OTC) medications. potentiallydangerousdrug interactions.Anydrugthatcontainsa sympatheticnervousstimulantmay increaseBPorcounteract antihypertensiveeffects. Instructpatientaboutincreasingintakeoffoods/fluids Diureticscandepletepotassium highinpotassium,e.g.,oranges,bananas,figs, dates,tomatoes,potatoes,raisins,apricots, Gatorade,andfruitjuicesandfoods/fluidshighin calcium,e.g.,lowfatmilk,yogurt,orcalcium supplements,asindicated. levels.Dietaryreplacementismore palatablethandrugsupplementsand maybeallthatisneededtocorrect deficit.Somestudiesshowthat400 mgofcalcium/daycanlowersystolic anddiastolicBP.Correctingmineral deficienciescanalsoaffectBP. Reviewsigns/symptomsrequiringnotificationof healthcareprovider,e.g.,headachepresenton awakeningthatdoesnotabatesuddenand continuedincreaseofBPchestpain/shortnessof breathirregular/increasedpulseratesignificant Earlydetectionofdeveloping complications/decreased effectivenessofdrugregimenor adversereactionstoitallowsfor timelyintervention.

weightgain(2lb/dayor5lb/wk)orperipheral/ abdominalswellingvisualdisturbancesfrequent, uncontrollablenosebleedsdepression/emotional labilityseveredizzinessorepisodesoffainting muscleweakness/crampingnausea/vomiting excessivethirst. Explainrationaleforprescribeddietaryregimen (usuallyadietlowinsodium,saturatedfat,and cholesterol). Excesssaturatedfats,cholesterol, sodium,alcohol,andcalorieshave beendefinedasnutritionalrisksin hypertension.Adietlowinfatand highinpolyunsaturatedfatreduces BP,possiblythroughprostaglandin balanceinbothnormotensiveand hypertensivepeople. Helppatientidentifysourcesofsodiumintake(e.g., tablesalt,saltysnacks,processedmeatsand cheeses,sauerkraut,sauces,cannedsoupsand vegetables,bakingsoda,bakingpowder, monosodiumglutamate).Stresstheimportanceof readingingredientlabelsoffoodsandOTCdrugs. Encouragepatienttoestablishanindividualexercise BesideshelpingtolowerBP,aerobic programincorporatingaerobicexercise(walking, swimming)withinpatientscapabilities.Stressthe importanceofavoidingisometricactivity. activityaidsintoningthe cardiovascularsystem.Isometric exercisecanincreaseserum catecholaminelevels,further elevatingBP. Demonstrateapplicationoficepacktothebackof theneckandpressureoverthedistalthirdofnose, nosebleedoccurs. Nasalcapillariesmayruptureasa resultofexcessivevascularpressure. capillariestosloworhaltbleeding. Twoyearsonamoderatelowsalt dietmaybesufficienttocontrolmild hypertensionorreducetheamountof medicationrequired.

andrecommendthatpatientleantheheadforward,if Coldandpressureconstrict

Leaningforwardreducestheamount ofbloodthatisswallowed. Provideinformationregardingcommunityresources, Communityresourcessuchasthe andsupportpatientinmakinglifestylechanges. Initiatereferralsasindicated. AmericanHeartAssociation, coronaryclubs,stopsmoking clinics,alcohol(drug)rehabilitation, weightlossprograms,stress managementclasses,and counselingservicesmaybehelpfulin patientseffortstoinitiateand maintainlifestylechanges.