Definition

• Hypertension is better known as high blood

pressure. Limit blood pressure which can be used as
a reference to determine normal or not blood
pressure is systolic and diastolic pressure.
• Based on JNC (Joint National Committee) VII said
have hypertension if the systolic pressure is 140
mmHg or more and diastolic 90 mmHg or more
(Chobaniam, 2003).
 Sign and Symptom

• According to Price, the symptoms of hypertension

include back pain, stiff neck, difficulty sleeping,
restlessness, dizzy head, palpitations, weakness,
shortness of breath, sweating and dizziness (Price, 2005).
• Symptoms of the disease are common both in patients
with hypertension that is headache, restlessness,
palpitations, nasal bleeding, difficulty sleeping, tightness
breath, irritability, ringing in ears, buckling feels heavy,
palpitating and frequent urination at night.
 Physiology Anatomy
1. Anatomy
The cardiovascular system is a transport system
bring respiratory gas, nutrients, hormones and
other substances to and from body tissue. The
cardiovascular system is built by:
a. Heart
The heart is an organ that consists of muscles. Cardiac
muscle is a special network because it is seen from the same
shape and arrangement with latitude muscle, but the way it
works is the same as smooth muscle that is out of will us
(influenced by the autonomic nervous system).
 Physiology Anatomy
Heart shape resembles a banana heart, the upper
part is blunt (base of the heart) and is called the
cordial base. At the bottom is rather pointed the so-
called cord apex.
The location of the heart in the front of the chest
cavity (cavity anterior mediastinum), lower left side
of the mid chest cavity
The size of the heart is about the size of a right hand
and weighing approximately 250 - 300 grams.
 Physiology Anatomy

1. Heart Lining
Endocardium is the heart lining that is next to it in a
one consisting of endothelial tissue or a lender
membrane lining the endothelial cavity or the lining
membrane lining the surface heart cavity.
Myocardium is the core layer of the heart consisting
of muscles heart, this heart muscle forms muscle
bundles
 Physiology Anatomy

2. Valve Heart
In the heart there are valves - very important valves meaning in the
composition of blood circulation and movement of the human heart.
• Valcula biscuspidalis, there is between the dextra atrium with the
ventricles dextra consists of 3 valves.
• biscuspidalis vein, located between the atria sinistra with ventricles
sinistra consists of 2 valves.
• vulvar semilunaris artei pulmonalis, located between the ventricles
dextra with pulmonary arteries, where blood flows to the lungs.
• the aortic semilunar vein, located between the ventricular system
and the aorta right blood flows throughout the body.
 Physiology Anatomy
3. Blood Vessel
a. Arterial blood vessels
Artery is a type of blood vessel that comes out of the
heart which carries blood throughout the ventricle sinistra
called the aorta.
b. Capillary
Capillaries are very small blood vessels palpable from
smoothest branches of the arteries so they are not visible
except from under a microscope. Webbing capillaries in all
body tissues. Capillary then meeting one another
becomes greater blood called vein.
 Physiology Anatomy

c. Veins (veins)
Veins carry dirty blood back to the heart Some important veins:
• Superior vena cava
The return veins that enter the right atrium carry dirty blood
from head region, thorax and upper extremities.
• Vena cava inferor
Veins that return dirty blood to the heart from all organs lower
body.
• Jugular vein cava
Veins that return dirty blood from the brain to the heart.
 Pathofisiologi

The mechanism that controls the constriction and

relaxation of blood vessels located in the center of the
vasomotor, in the brain medulla. From the center of this
vasomotor begins sympathetic nerve pathway, which
continues down to the spinal cord and out of spinal cord
column sympathetic ganglia in the thorax and abdomen.
Central stimulation vasomotor delivered in the form of
impulses that move down through the system
sympathetic nerves to sympathetic ganglia.
 Pathofisiologi

At the same time the sympathetic nervous system is

stimulating blood vessels in response to emotional
stimuli, adrenal glands are also stimulated, resulting in
additional vasoconstrictive activity. The adrenal medulla
secretes epinephrine, which causes vasoconstriction. The
adrenal cortex secretes cortisol and other steroids, which
can strengthen the vasoconstrictor response of vessels
blood. Vasoconstriction which results in decreased flow
to the kidneys, causes the release of rennin.
 Pathofisiologi

Rennin stimulates the formation of angiotensin I which

is then converted becomes angiotensin II, a powerful
vasoconstrictor, which in turn stimulates Aldosterone
secretion by the adrenal cortex. This hormone causes
sodium retention and water by the renal tubules,
causing an increase in intra-vascular volume. All this
factor tends to trigger the state of hypertension for
consideration gerontology. Structural and functional
changes in the peripheral vessel system responsible for
changes in blood pressure that occur in old age.
 Complications Of
Hypertension
According to Elisabeth J Corwin, hypertension consists of
stroke, myocardial infarction, kidney failure, encephalopathy
(brain damage) and hypertension including pregnancy (PIH)
(Corwin, 2005).
1. Stroke
Stroke can occur in chronic hypertension if the arteries that
blood the brain experience hypertrophy and thicken, so that
blood flow to the affected areas is reduced. Brain arteries
that experience atherosclerosis can be weakened thereby
increasing the likelihood of anurism formation (Corwin,
2005).
 Complications Of
Hypertension
2. Myocardial infarction Infarction can occur
Myocardial infarction can occur if an atherosclerotic
coronary artery cannot supply enough oxygen to the
myocardium or if a thrombus is formed which blocks
blood flow through the vessel.
3. Fail the kidney
The mechanism of hypertension in chronic kidney
failure due to salt and water accumulation or the renin
angiotensin aldosterone system (RAA) (Chung, 1995).
hypertension (Mansjoer, 2001).
 Complications Of
Hypertension

4. Encephalopathy (brain damage)

Encephalopathy (brain damage) can occur mainly in
malignant hypertension (hypertension that increases
rapidly). Very high pressure in this disorder causes
increased capillary pressure and pushes into the
intersitium space throughout the central nervous
system. The surrounding neurons collapse which can
cause deafness, blindness and not infrequently
coma and sudden death.
 Management Of
Hypertension
• Pharmacological therapy
Age and the presence of disease are factors that will
affect the metabolism and distribution of the drug, so
it must be considered in giving antihypertensive
drugs. Drug administration should start with small
doses and then increase slowly. According to JNC VI 1
the first choice for treatment in elderly hypertensive
patients is diuretics or beta blockers. In HST, it is
recommended to use diuretics and calcium
antagonists.
 Management Of
Hypertension

Drugs that cause changes in postural blood pressure

(peripheral adrenergic blockers, alpha blockers and high-dose
diuretics) or medications that can cause cognitive dysfunction
(central α2 agonists) must be given with caution. ' Because
the elderly often find other diseases and administration of
more than one type of drug, it is necessary to consider the
interaction of drugs between antihypertensive drugs with
other drugs. Potential drugs that have antihypertensive
effects, for example: anti-psychotic drugs, especially
phenothiazines, antidepressants, especially tricyclic, L-dopa,
benzodiapezin, baclofen and alcohol.
 Management Of
Hypertension

2. Non Pharmacological Treatment

Lifestyle modification is always recommended as a
treatment for hypertension in general. Even in some
patients with mild hypertension this way can be
without drugs. The action to stop smoking, weight
control, reduce mental stress, limit consumption of
salt, alcohol, increase physical activity all of which
can reduce blood pressure and also the use of anti-
hypertensive drug doses.
 Supporting
Examination

Rountine Laboratory Examinations are Cartier out

before starting the trophy aims to determine the
presence of tisssue damage and other risk factors
off look for the cause of hypertension, ususally
examinations urinalysis, complete peripheral blood,
blood chemistry, pottasium, sodium, creatine, fas
ting, blood sugar, total cholestrol, HDL, cholesterol ,
and ECG ( Mansjoer.dkk,2001)
Patoflow
 Nursing Care
It’s known that a person tn.x is 30 years old was hospitalized with
complaints quickly tired of doing daily activities. The patient said feeling
weak and feeling uncomfortable after the move. Based on EKG results
the patient shows ischaemia, the patient skin condition is bluish in color
and the patient blood pressure condition changes >20% from the resting
condition.
Nursing Care