Hypertension For Nurses

• It is important to complete an accurate assessment/history of a patient with possible hypertension in order to determine the appropriate treatment.  
• Physical examination also serves as an important indication of diagnosing hypertension.  There are certain diagnostic labs that need to be completed with patients with hypertension in order to manage any complications.  
• Patient education regarding signs, symptoms, and management of hypertension is a must and needs to be explained to both the patient and the caregiver(s).  
  

Introduction to Hypertension

Over 75 million Americans have hypertension, contributing to increased mortality and disability rates.  

Normal blood pressure is systolic pressure lower than 120 mmHg and diastolic pressure lower than 80 mm Hg.  However, sometimes it might rise persistently or intermittently to systolic arterial blood pressure above 140 mmHg or diastolic pressure above 90 mm Hg – a condition known as hypertension.  

A blood pressure reading of systolic pressure of 120 to 139 mmHg and a diastolic pressure of 80 to 89 mmHg is considered prehypertension.  

Stage 1 hypertension is a systolic pressure of 140 to 159 mm Hg and a diastolic pressure of 90 to 99 mm Hg.  

Stage 2 hypertension is a systolic pressure of more than 160 mmHg and a diastolic pressure equal to or more than 100 mm Hg. 

Hypertension needs to be treated promptly.  Otherwise, if left untreated, it can lead to atherosclerosis which increases the workload of the heart, thereby reducing perfusion to vital organs and leading to complications such as: 

• Transient ischemic attacks 
• Strokes  
• Myocardial infarction 
• Left ventricular hypertrophy 
• Congestive heart failure 
• Renal failure 
• Damage to the small arteries of the eyes can also lead to blindness 

Assessment & History

As a nurse, a detailed patient history must be in place and the nurse needs to ensure the following points: 

• Elicit history from the patient about family history of hypertension, history of elevated blood pressure, and blood cholesterol level.  
• Ask the patient if he/she is stressed at work, at home, or because of any other reason.  
• Inquire with the patient if they have any symptoms such as malaise, fatigue, general weakness, a vague sense of discomfort, or have a history of headache, lightheadedness, dizziness, nosebleeds, ringing in the ears, or blurred vision.  Symptoms occur when the mean arterial blood pressure rises above 150 mmHg.  
• Ask the patient if they have been taking steroids, oral contraceptives, or cold medications, as these can raise blood pressure. 
• Rule out if the patient has ever experienced symptoms such as the following: 
  • loss of vision 
  • shortness of breath/chest pain 
  • confusion 
  • increased irritability 
  • seizures 
  • transient paralysis or stupor 
  • sleepiness 
  • visual disturbances 
  • severe headaches 
  • vomiting
    

Physical Examination

As a nurse, the following examinations are essential to diagnose hypertension: 

• Initially, the patient may not have any symptoms.  However, as the blood pressure increases the patient might have facial flushing.  
• Measure the blood pressure by using a correctly sized blood pressure cuff in both arms three times 3 to 5 minutes apart, while the patient is at rest in the sitting, standing, and lying positions.  
• One reading is not enough to diagnose the patient with hypertension until it is above 210/120 mmHg.  If three readings are above 140/90 mmHg, it also indicates that the patient is hypertensive.  

Hypertension Diagnostic Highlights

When a patient is diagnosed with hypertension, there are varying diagnostic labs that need to be checked in order to determine if there are any complications such as: 

• Blood urea nitrogen – to determine if hypertension has caused renal dysfunction or fluid imbalances.  
• Serum creatinine – to be aware about the renal function and if kidney damage has occurred due to elevated blood pressure.  
• Total cholesterol – to know about coronary artery disease  
• Serum triglycerides – helps in the screening and detection of coronary artery diseases and to know about hyperlipidemia.  
• EKG – if the ventricle is hypertrophied due to long-standing uncontrolled high blood pressure, it can result in EKG changes; therefore, an EKG helps one to be aware. 
  

Other tests that can be helpful in hypertension are:

• Urinalysis 
• Chest x-ray 
• Complete blood count 
• Plasma glucose 
• Hemoglobin A1C 
• Serum potassium, calcium, and uric acid 
• Plasma renin 
• Thyroid function tests 

If the patient has hypertension and exhibits abnormal neurological examination, head computed tomography or brain magnetic resonance imaging should also be done.  

Patient Education

As a nurse, you must discuss the following points with the patient and caregiver(s): 

• Hypertension – its pathophysiology and complications, the drugs prescribed, their doses, and adverse effects.  
• Review the patient’s diet and the importance of lowering sodium intake.  
• Importance of reading food labels before buying packaged products as they are rich in sodium.  
• Ask patient to wash the canned meat and vegetables with running water for at least one minute to wash away sodium content.  
• Discuss the importance of lowering the intake of saturated fats and cholesterol.  
• Encourage the patient on potassium-depleting medications to eat foods rich in potassium, such as dates and bananas, and those on potassium-sparing diuretics to avoid excessive use of potassium-rich foods.  
• Compel the patient to incorporate aerobic activity into their daily routine and reduce stress.  
• Advise the patient to record his/her blood pressure reading at least twice weekly in a journal and to bring the journal with him/her when visiting the physician. 
• Tell the patient to keep a record of the medications he/she takes and to monitor the effectiveness with the blood pressure reading.  
• Inform the patient to not take any over-the-counter vasoconstrictive or sinus medications that can increase blood pressure.  
• Ask the patient to take the blood pressure medications daily at the appropriate time to avoid the complications of hypertension.  
• Inform the patient how long-standing uncontrolled blood pressure can damage the kidneys, heart, and brain.  

The Bottom Line

Hypertension needs to be treated promptly and seriously.  In many cases, the patient may need to take hypertensive medications for a lifetime; therefore, you must counsel them. Compel them to monitor blood pressure frequently and visit the physician soon if a drug does not work well. 

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