CHAPTER 2

REVIEW OF REVENUE

2.1 Theoretical Medical

2.1.1 Define

Hypertension or high blood pressure is an increase in systolic blood pressure of more

than 140 mmHg and diastolic blood pressure of more than 90 mmHg in two

measurements with an interval of five minutes in sufficient rest (Central Data and

Information Ministry of Health, 2013).

Hypertension is high blood pressure where systolic blood pressure is greater than 140

mmHg and diastolic pressure is more than 90 mmHg (Ardiansyah, 2012).

Hypertension is a condition where systolic blood pressure is greater than 120 mmHg

and diastolic pressure is more than 80 mmHg. Hypertension often causes changes in

blood vessels that may lead to increased blood pressure (Muttaqin, 2009).

2.1.3 Etiology
Its etiology is a lot of factors with unidentifiable factors, but some that are generally
involved with homeostatics. Blood pressure remains high and continues to rise from
time to time due to progressive and persistent improvement in peripheral arterial
resistance. The constant increase in arterial resistance is due to improper kidney
retention of salts and water or abnormalities in vessel walls (Black and Hawks, 2014).
The cause of hypertension has not yet been confirmed in more than 90% of the cases.

2.1.4 Epidemiology and Risk Factors

Primary hypertension covers more than 90% of all cases of hypertension. Less than 5
- 8% of adult hypertensive clients have secondary hypertension. Hypertension is a
result of a series of genetic and environmental factors. These risk factors are
classified as convertible and non - convertible. Education and lifestyle changes are
shown on factors that can be changed (Black and Hawks, 2014).
Risk factors that can not be changed:
1. Family history
2. Age
3. Gender
4. Ethnic
Risk factors that can be changed:
1. Diabetes
2. Stress
3. Obesity
4. Nutrition
5. Drug use

2.1.5 Clinical Manifestation

1. Headaches constantly
2. Fatigue
3. Turn around
4. Heart pounding
5. Short
6. Blurred vision or double vision
7. Nos

2.1.6 Complications
The complications that can occur in hypertensive diseases include brain blood vessel
disease such as stroke, brain hemorrhage, transient ischemic attack (TIA), heart
disease such as heart failure, angina pectoris, acute myocardial infarction (IMA),
kidney disease such as kidney failure, eyes such as retinal bleeding, retina thickening
and pupil edema.

2.1.7 Examination of Support

Follow-up examination according to FKUI of 2003 (cited in Sarif, 2012) includes
routine laboratory examinations performed before the start of the therapy to
determine the presence of organ damage and other risk factors or to seek the cause of
hypertension. Usually checked urine analysis, complete peripheral blood, blood
chemistry (potassium, sodium, creatinine, fasting blood sugar, fixed cholesterol, high
density lipoprotein (HDL), low density lipoprotein (LDL) and Electro Cardio Graphi
(ECG). including blood urea nitrogen (BUN) / creatinine (kidney function), glucose
(Diabetes Mellitus), serum potassium (increased increased aldosterone), serum
calcium, thyroid examination, urinalysis protein, sugar,

2.1.9 Management

There are two ways to treat hypertension according to FKUI in 1990 (cited in Sarif,

2012) with non pharmacological and pharmacological. Non pharmacologic ways by

weight loss in obese people, low salt and low fat diets, altering habits of life, regular

exercise and regular control of blood pressure. While by pharmacologic way is by

giving anti - hypertension drugs such as diuretics such as hydrochlorothiazide (HCT),

higroton, lasix. Beta blockers like propanolol. Alphabets such as phentolamine,

prozazine, nitroprusside, captopril. Sympatholic polymers such as hydralazine,

dizoxine. Calcium antagonists such as nifedipine (Sarif, 2012).

2.2 Theory of Pain

Pain is defined as a condition that affects a person and its existence is known if one

has experienced it. According to the International Association for Study of Pain
(IASP), pain is an unpleasant emotional experience due to actual or potential damage,

or to describe the condition of damage (Hanley, 2008).

Acute pain is a defensive mechanism that lasts less than six months. According to

NANDA (2010) acute pain is characterized by changes in heart rate, blood pressure,

respiratory, appetite, expression and behavior that exhibit pain, sleep disorders and

verbal pain reports. Someone who is experiencing painful disorders will be disturbed

by the pattern of sleep and sleep (Judha, Fauziah, and Sudarti, 2012).

P (provocat) tests are the cause of pain due to what, Q (quality) pain perceived by

patients to have different qualities, R (regional) is a painful area perceived by the

patient, S (scale) pain has a scale which vary according to the patient 's design scale,

T (time) pain occurs having its own time. This assessment method is conducted to

determine the characteristics of pain perceived by the patient (Kusuma and Nurarif,

2012). In treating pain can be done with pharmacological and non-pharmacological

therapies. Non pharmacological therapy or complementary complementary therapy

has been shown to reduce pain. There are two types of complementary therapies that

can be used to reduce pain: behavioral treatments such as relaxation exercises,

distractions, hypnotherapy, biofeedback exercises and physical therapy such as

acupuncture, Transcutaneous Electric Nerve Stmulation (TENS) (Machfoed &

Suharjanti, 2010). Distraction is a technique focusing patient attention on something

other than pain. Distractions are supposed to lower pain, decrease pain perception by

stimulating the desendens control system, resulting in less stimulation of pain

transmitted to the brain.

2.3 Pain Scale

The most subjective characteristic of pain is the scale of the pain itself. Patients

describe pain as mild, moderate or severe pain, but of course each individual will

have different assessments. Descriptive scale is a more objective measurement tool.

According to Miller (2009), one of the scales is often used to measure the pain scale,

namely: Visual Analog Scale (VAS). VAS is the most widely used method for

assessing pain. This linear scale illustrates visually the degree of pain gradually a

patient may experience. The range of pain is represented as a line length of 10 cm,

with or without mark on each centimeter. Signs at both ends of this line can be

numeric or descriptive statements.

Asuhan Keperawatan

2.4 Nursing Care

2.4.1 Nursing Assessment
Assessment is the first step of the nursing process through data collection or accurate
data acquisition for patients to find out the various problems (Aziz, 2009). The study
on hypertensive patients according to Doengoes, et al (2013) is:
1. Break activity
Symptoms: General fatigue, weakness, tiredness, short breath, lifestyle
Tags:
a. Cardiac frequency increases
b. Change of heart trauma (tachycnea)
2. Circulation
Symptoms: Atherosclerotic hypertension history, coronary heart disease / valves and
cerebrovascular disease, palpitation episodes.
Tags:
a. TD increase (serial measurements and TD increments are needed to increase the
diagnosis).
b. Postural hypotension (possibly related to the brain regimen)
c. Clear pulses from carotid, juguralist, radial
d. Tarikardia

3. Integrity of the ego

Symptoms: Personal change history, anxiety, depression.
Note: Explosion of mood, anxiety, continuous narrowing of attention, bursting tears,
empathy movements, tense facial muscles (especially around the eyes) rapid physical
movement.
4. Elimination
Symptoms: Current or past renal disorders.
5. Food / Liquids
Symptoms: Preferred foods that can include high salt foods, high fat, high cholesterol.
Tags:
a. Normal weight or obesity
b. Existence of edema (may be general or specific)
c. Glycosuria (almost 10% of hypertension is diabetic).
6. Neurosensory
Symptoms:
a. Dizziness / dizziness
b. Pulsatile, suboxipital headache (occurs when waking up and spontaneously
disappearing after several hours)
c. Episode numbness and weakness on one side of the body
d. Visual impairment
e. Epistaxic episodes
Marks: Mental status, change in orientation, speech patterns, effects, thought
processes or memory.
7. Pain / discomfort
Symptoms:
a. Pain loss occurs on the limb / claudication
b. Heavy occipital headache is like a previous one
8. Breathing
Symptoms: Dysnea related to work activity, smoking history, cough with or without
sputum
Tags:
a. Respiratory distress
b. Cyanosis
9. Security
Symptoms: Coordination / walking disorders
Tags:
a. Cardiac frequency increases
b. Change of heart trauma (tachycnea)
10. Learning / Causes
Symptoms: Family risk factors: hypertension, atherosclerosis, heart disease, diabetes
mellitus.
2.4.2 Nursing Diagnosis

According to Doengoes (2013), one of the nursing diagnoses that appears in patients

with hypertension, namely:

Acute pain associated with elevated cerebral pressure pressure is characterized by the

client reporting pulsating pain in the subococcus area.

2.4.3 Nursing Intervention

Nursing interventions for pain according to Doengoes (2013):

1. Keep up with bedtime during acute phase.

Rationale: minimize stimulation, increase relaxation

2. Provide non-pharmacological action to eliminate headaches, such as cold compress

on the forehead, back and neck massage, calm down, room lighting, relaxation and

distraction techniques.

Rationale: actions that lower cerebral vascular pressure and which slow down / block

the sympathetic response effectively in eliminating headaches and complications.

3. Eliminate / minimize vasoconstriction activity that can improve headache for

example: waking up BAB, coughing and bowing.

Rationale: activities that increase vasoconstriction cause headaches and increased

vascular pressure.

4. Help patients in ambulatory as needed

Rationale: dizziness and blurred vision are often associated with headaches.

5. Provide fluid, soft food, regular oral care when a nose bleed or nose compress to

stop bleeding.

Rationale: improve general comfort

2.4.4 Nursing Implementation

1. Maintain baring during acute phase.

2. Provide non-pharmacological action to eliminate headaches.

3. Minimize vasoconstriction activity that can improve headache.

4. Help patients in ambulatory as needed

5. Gives fluid, soft food, regular oral care when a nose bleed or nose compress to stop

bleeding.

2.4.5 Evaluation of Nursing

The goal to achieve After the implementation of nursing implementation in

hypertensive patients is expected to decrease pain / control.