NAME OF THE STUDENT: SURAJ S.

VASAVE
1st YEAR M.SC NURSING
MEDICAL-SURSICAL NURSING
NAME OF THE SUPERVISOR: MISS. NAZIMA BHATTI
LECTURER
DEPARTEMENT OF MEDICAL SURGICAL NURSING
SUBJECT: MEDICAL-SURSICAL NURSING
TOPIC: HYPERTENSION
STUDENT GROUP: 1ST YEAR M.Sc. NURSING
VENUE: CLASS ROOM
DATE: 00-APRIL-2012
TIME: 45 MIN
METHODS OF TEACHING: LECTURE CUM DISCUSSION
A.V AIDS: WHITE BOARD, CHART, PALMFLETS,
GENERAL OBJECTIVE :
At the end of the presentation the group will improve knowledge, skills and attitude regarding hypertension.

SPECIFIC OBJECTIVES:
At the end of the presentation the group will able to answer.

 Define hypertension ?
 Explain the risk factors of hypertension?
 Discuss the causes of hypertension?
 Explain the sign and symptoms of hypertension?
 Discuss the diagnostic evaluation for hypertension?
 Which drugs are used to treat the hypertension ?
 Explain about the nursing management for patient with hypertension?
 Explain the health education for patient with hypertension/
S.NO TIME SPECIFIC OBJECTIVE CONTENT TEACHING A.V AIDS EVALUATION
AND
LEARNING
ACTIVITIES
1. 2min Introduction about INTRODUCTION: Lecture cum
hypertension. discussion
Hypertension(HTN) or high blood pressure,
often referred to as the “silent killer disease.
Hypertension is a major public health concern
internationally. This requires the heart to work
harder than normal to circulate blood.

2. 2min Define hypertension. DEFINITION: Lecture cum White board what do you mean
discussion by hypertension?
It is defined as a persistent elevation of the systolic
blood pressure at a level of 140 mm Hg or higher and
diastolic blood pressure at a level of 90mm Hg or
higher.
3. 3min Explain the risk factors of Lecture cum Chart What are the
hypertension. RISK FACTORS: factors responsible
discussion
NON-MODIFIABLE RISK FACTORS: for hypertension?

1. FAMILY HISTORY
There is in any person with family history of
hypertension. The genetic pre-disposition that make
certain families more susceptible to hypertension.

2. AGE:
 Primary hypertension appears between the
ages of 30 and 50 years. The incidence of
hypertension increases with age 50% to 60% of
clients older than 60 years.

3. GENDER ;
Incidence of hypertension is higher in men
than in women until about age 55 years .

MODIFIABLE RISK FACTORS:

 STRESS: Stressors such as noise, infection,

pain ,decreased oxygen supply, heat, cold ,
old age, drugs. Over time hypertension can
develop. If stress arousal becomes excessive
or prolonged, target organ dysfunction or
disease will result.

 OBESITY: Obesity especially in the upper

body(give apple shape), is associated with
subsequent development of hypertension.
People who are over weight but carry most of
the excess weight in the buttocks, hips, and
thighs (given them pear shape) are at far less
risk for development of hypertension.

 NUTRIENTS: Sodium consumption can be an

important factor in the development of
essential hypertension.

 SUBSTANCE ABUSE: Cigarette smoking, heavy

 alcohol consumption, and some illicit drug Lecture cum Pamphlets What are main the
4. 3min Discuss the causes of use all are risk factors for hypertension discussion causes for
hypertension. hypertension?
ETIOLOGY:
 Hypertension results from a complex
interaction of genes and environmental
factors..

 Medications:
o Antihistamine
o Cocain use
o Heavy metal poisons (lead, arsenic) s
o Oral contraceptives
o NSAIDs

 Some Renal disorders:

o Acute glomerulonephritis
o Chronic polynephritis
o Atherosclerosis
o Hydronephrosis

 Severe anaemia
 Neurologic disorders
o Increased intracranial pressure
5. 4min Explain the signs and Lecture cum Flash cards What are the main
o Brain tumor
symptoms of discussion signs and
 Problem with pregnancy:
hypertension symptoms for
o Pregnancy include hypertension
o Eclampsia hypertension?

SIGNS AND SYMPTOMS:

  In early stages of hypertension no signs are
noted.
 Headaches(particularly at the back of the
head and in the morning).
 vertigo
 Tinnitus(buzzing or hissing in the ears)
 Altered vision or fainting episodes.
 Occasionally, retinal changes such
hemorrhages ,exudates (fluid
accumulation),arteriolar narrowing and
cotton wool spots occurs.
 Increase blood urea nitrogen Lecture cum Chart
6. 4min Discuss the diagnostic  Alteration in vision and speech discussion Which diagnostic
evaluations for  Dizziness test use for the
hypertension.  Weakness hypertensive
 Sudden fall patient?
 Hemiplegia

DIAGNOSIS:

1. PATIENT ASSESSMENT:

HISTORY:

 Family history of hypertension, diabetes

mellitus, cardiovascular disease, renal
disease, smoking, obesity etc.
 History of any disease or trauma to target
organ.
  History of recent weight gain, exercise
activities, sodium intake, fat intake, alcohol
use, smoking.
 Psychosocial and environmental factors such
as emotional stress, cultural food practices,
etc.
 Psychosocial and environmental factors such
as emotional stress, cultural food practices,
etc.

PHYSICAL EXAMINATION:

 Physical examination should include an

accurate determination of blood pressure as
well as an elevation of target organs:
 Vital signs and weight
 Examination of the neck for distended veins,
and enlarged thyroid.
 Auscultation of the heart for increased heart
rate, dysrhythmias, murmur.

The following techniques are strongly

recommended:
 The client should be seated with the arm
bared, supported, and positioned at the heart
level. The client should not have smoked
tobacco or ingested caffeine within the
previous 30 minutes.

2. LABORATORY STUDIES:
 Studies used in the routine evaluation of
hypertension include:

 Complete blood count

 Urinalysis
 Determination of serum potassium
and
7. 5min Which drugs are used to Lecture cum Pamphlets
 sodium level
treat the hypertension. discussion Which type of
 Blood urea nitrogen
drugs used for
 Serum creatinine level
hypertensive
 Electrocardiogram
patient?
 Chest radiography

These will provide useful information in determining

the severity of vascular disease, the extent of target
organs damage, and the possible causes of
hypertension.

TREATMENT:
MEDICAL MANAGEMENT:

1. LIFE STYLE MODIFICATIONS:

o First line of treatment for hypertension is

8. 2min Explain about the identical to the recommended preventive Lecture cum Chart
nursing management for lifestyle changes, includes, dietary changes, discussion Which type of
patient with physical exercise, and weight loss. These have drugs used for
all been shown to significantly reduce blood
 hypertension. pressure in people with hypertension. If hypertensive
hypertension is high enough to justify patient?
immediate use of medications, lifestyle
changes are still recommended in
conjunction with medication.

o Regarding dietary changes, a low sodium diet

is beneficial. A long term (more than 4 weeks)
low sodium diet reducing blood pressure.

NURSING MANEGMENT:
 Assessment of dietary risk factors, weight,
physical activity level, alcohol use, tobacco
use

9. 4min  Diet modifications including DASH (Dietary Lecture cum Chart

Explain the health Approaches to Stop Hypertension) and discussion
education for patient limitations on sodium intake Which type of
with hypertension.  Weight reduction strategies dietary
 Increased exercise modifications is
 Reduce alcohol consumption amounts required for the
 Brief Tobacco Intervention hypertensive
 Nicotine replacement therapies patient?
 Stress management strategies
 Obtain medication history and provide
patient education regarding medication
 Assessment and promotion of adherence to
treatment plan.
 Follow-up and documentation of
management
HEALTH EDUCATION:

EXERCISE:
 Studies suggest that regular physical activity
may be beneficial for both prevention and
treatment of hypertension, to enable weight
loss, for functional health status, and to
diminish all-cause mortality and risk of
cardiovascular disease. In Japanese men,
duration of walk-to-work and leisure-time
physical activity was significantly associated
with a reduction in the risk for incident
hypertension.
Suggested activities for older adults:
Walking, Gardening, Bowling, Light house
work, Bicycle or walk to work. Walk to the
corner store, bank or post office, Wash the
car by hand, Take the stairs instead of the
elevator.

DIET:
 Diet modifications including DASH (Dietary
Approaches to Stop Hypertension) and
limitations on sodium intake. Advice to
develop a reasonable diet plan, according to
the daily energy requirements with
reasonable, eat more fresh vegetables, fruit,
eat or not eat animal fat, smoked products,
control the daily salt intake.
 Select foods low in salt (fresh fruits and
vegetables);
o Avoiding processed foods
o Refraining from adding salt at the
table
o Minimizing the use of salt in cooking
and
o Awareness of the salt content in food
eaten in restaurants.

MEDICATION:
 Teach the patient about the action and dose
of medication. Patient have to take regular
blood pressure medication, do not just stop
medication. The medical treatment of
hypertension is relatively long. Even normal
blood pressure should also adhere to the
medication, doctor's medical advice based on
changes in amount of drugs.

FOLLOW UP:
 The patients should follow the medical
expert’s recommendation and should alter it
unless the doctor told you so. Patient need to
go to the hospital on time for routine check
up. Patients should be encouraged to tell
their doctors about their way of living and
diet alteration.

SUMMERY:
CONCLUSION:

BIBLIOGRAPHY: