Hypertension

Prepared BY: DR Shimaa Mohamed

Geriatric Nursing 2 nd year
Technical Institute Nursing
 Definition of Hypertension

Hypertension is defined as a systolic blood pressure

greater than 140 mm Hg and a diastolic pressure greater than 90 mm

Hg, based on two or more accurate measurements.

 Classification of Blood Pressure for Adults Age 18
and Older

BP Classification Systolic BP Diastolic BP

(mmHg) (mmHg)
1-Normal < 120 < 80
2-Prehypertension 120 – 139 or 80 – 89
3- Stage 1 hypertension 140 -159 or 90 – 99
4- Stage 2 hypertension ≥ 160 or ≥ 100
 Risk Factors With Hypertension
• A-Major Risk Factors
• 1- Cigarette smoking
• 2- Obesity
• 3-Diabetes mellitus
• 4- Physical inactivity
• 6- Age (older than 55 for men, 65 for women)
• 7- Family history of premature cardiovascular disease (men under age
55 or women under age 65)
 -Hypertension can be classified according to cause
as follows:

• 1-Essential (Primary) Hypertension

In the adult population with hypertension, between 90% and

95% have essential (primary) hypertension, which has no identifiable

medical cause
2- Secondary Hypertension

• Secondary hypertension is characterized by elevations in blood

pressure with a specific cause, such as:

a-Narrowing of the renal arteries

b-Hyperaldosteronism

C- Thyroid or parathyroid disease

 d-Certain medications as cold medication, decongestants, birth

control pills, illegal drugs as cocaine

e-Pregnancy
Clinical Manifestations of
Hypertension
1- most people have no signs or symptoms even if blood pressure
reach dangerously high level

2- a few people with blood pressure have headaches, shortness of

breath or nosebleeds theses symptoms aren`t specific and don`t occur
until blood pressure reached sever stage
 complications of prolonged, uncontrolled
hypertension

1-Myocardial infarction 2-Heart failure

3-Renal failure 4-Strokes

5-Impaired vision.
 Assessment and Diagnostic Methods
a-Blood pressure measurement
b-Retinal examination
c- laboratory studies for organ damage, including:
*Urinalysis
*Blood chemistry (sodium, potassium, creatinine, fasting
glucose)
d- ECG; and echocardiography to assess left ventricular hypertrophy.
Nursing Process For Patient With
Hypertension
I-Assessment
1- Assess blood pressure at frequent intervals; know baseline level.
Note changes in pressure that would require a change in medication.

2- Assess for signs and symptoms that indicate target organ damage
(eg, anginal pain; shortness of breath; alterations in speech, vision, or
balance; nosebleeds; headaches; dizziness; or nocturia).
IV- Nursing Interventions
1-Increasing Patient Knowledge
a- Emphasize the concept of controlling hypertension (with lifestyle

changes and medications) rather than curing it.

b- help to develop a plan for improving nutrient intake or for weight

loss

*The program usually consists of restricting sodium & salt intake and
fat intake, increasing intake of fruits and vegetables, and implementing
regular physical activity.
c- Advise patient to limit alcohol intake and avoid use of tobacco.

d- Recommend support groups for weight control, smoking cessation,

and stress reduction, if necessary.

2-Teaching Patients About Self-Care

a- Encourage and teach patient to measure their blood pressure at

home

b- Provide written information about the expected effects and side

effects of medications; ensure patient understands importance of
reporting side effects (and to whom) when they occur.
V- Evaluation
Expected patient outcomes may
include:
a. Maintains blood pressure at less than 140/90 mm Hg (or less than 130/80
mm Hg for people with diabetes or chronic kidney disease) with lifestyle
modifications, medications, or both

b. Demonstrates no symptoms of angina, palpitations, or vision changes

. Adheres to the dietary regimen as prescribed: reduces calorie, sodium, and

fat intake; increases fruit and vegetable intake

b. Exercises regularly
3. Has no complications
a. Reports no changes in vision
b. Exhibits no retinal damage on vision testing
c. Maintains pulse rate and rhythm and respiratory rate within normal
ranges
d. Reports no dyspnea or edema
e. Maintains urine output consistent with intake
f. Has renal function test results within normal range
g. Demonstrates no motor, speech, or sensory deficits