CHAPTER 1 INTRODUCTION

1.1 Background
The cardiovascular system is a closed transport system consisting of the heart, blood
components, and blood vessels (Muttaqin, 2009). The function of the cardiovascular
system is to provide and drain the supply of oxygen and nutrients to all tissues and organs
that are required in the process of metabolism. Normally every tissue and organ of the body
will receive the bloodstream in sufficient quantities so that the tissues and organs receive
adequate nutrition. Cardiovascular System that serves as the regulatory system perform a
variety of mechanisms to respond to all the activities of the body. In certain circumstances,
more blood will flow in vital organs such as the heart and brain to maintain the circulatory
system organs.
Cardiac function that circulates blood throughout the body. This circulation process will
work well if the pumping process is going well. If pumping is not perfect, the distribution
of oxygen decreases were compensated by the heart by increasing the respiration rate. If
the compensation process occurs continuously, eventually the heart will fail to do
pemompaaan. Heart pump works through the stages called the cardiac cycle consisting of
systole and diatol (Ronny, et al., 2008).
Blood pressure is the force that is necessary so blood can reach all tissues of the human
body. Systolic blood pressure is the blood pressure when the heart menguncuo (systole).
Adapaun diastolic blood pressure is the blood pressure when the heart relaxes back
(diastole). Human blood pressure can be classified into three groups: low blood pressure
(hypotension), normal (normotensive), and high (hypertension) (Gunawan, 2001).

CHAPTER 2. BASIC CONCEPTS OF DISEASE

2.1 Definition of Hypertension
Hypertension is defined as blood pressure above normal or persistent blood pressure where
the systolic pressure above 140 mmHg and diastolic pressure above 90 mmHg. In an aging
population, hypertension is defined as systolic pressure of 160 mmHg and a diastolic
pressure of 90 mmHg. Hypertension is a major cause of heart failure, stroke, and kidney
failure. Known as the "silent killer" because people with hypertension often have no
symptoms. Half the people who suffer from hypertension are not aware of the condition.
Once the disease suffered, the patient's blood pressure should be monitored at regular
intervals because hypertension is a lifelong condition.
2.2 Etiology Hypertension
Based on the etiology of hypertension are divided into two categories, namely:
1. Essential hypertension or primary hypertension
Hypertension is hypertension is unknown peyebabnya also called idiopathic hypertension.
There are 95% of cases (Smeltzer & Bare, 2001). Many factors influence it, such as gender,
genetics,

age,

environment,

reninangiotensin

system

and

the

nervous

system

otonom.Faktor other factors, namely smoking, excessive salt intake, alcohol, obesity, stress
and lack of exercise / physical activity. (Lauralee, 2001; dalamRahmadani, 2011).
2. Secondary hypertension
Hypertension, there are about 5% of all cases of hypertension prevalence. The specific
cause is known, for example; kidney disease (acute glomerulonephritis, chronic nephritis,
diseases polyarthritis, diabetic nephropathy), endocrine diseases (hypothyroidism,
hypercalcemia, acromegaly), koarktasioaorta, hypertension in pregnancy, neurological
disorders, drugs and other substances (Lauralee, 2001; dalamRahmadani, 2011).
Primary hypertension is present in more than 90% of hypertensive patients, while the
remaining 10% are caused by secondary hypertension (Gunawan, 2001). Although primary
hypertension is not known with certainty the cause, research data have found several
factors that often lead to hypertension. These factors are as follows:

1. Heredity
From the statistical data proved that someone will be more likely to get hypertension if
parents are hypertensive.
2. Individual Characteristics
Individual characteristics that influence the onset of hypertension are:
a. Age (if the TD increases with age)
b. Gender (males higher than females)
c. Race (blacks more than whites)
In general, hypertension does not have a specific cause. Hypertension occurs in response to
increased cardiac output or increased peripheral pressure. But there are several factors that
influence the occurrence of hypertension:
1. Genetic: nerologi response to stress or disorders atautransport Na excretion.
2. Obesity, associated with high insulin levels resulting in increased blood pressure.
3. Environmental Stress.
4. The loss of tissue elasticity and arterisklerosis parents and dilation of blood vessels.
The cause of hypertension in the elderly is the change - change to:
1. The elasticity of the aortic wall decreases
2. valvular heart to thicken and become stiffer
3. The ability of the heart to pump blood decreases 1% every year after the age of 20 years
decreased blood pumping ability of the heart contractions and caused a decline in volume.
4. Loss of elasticity of blood vessels
This happens karenakurangnya effectiveness for peripheral vascular oxygenation
5. Increased peripheral vascular resistance
2.3 Pathophysiology of Hypertension
According Smeltzer & Bare (2002: 898) says that the mechanisms that control the
constriction and relaxation of blood vessels located in the vasomotor center in the medulla
oblongata in the brain which of vasomotor began the sympathetic nerves that continues
down the spinal cord and out of Kolomna cord to the sympathetic ganglia in torax and

abdomen, vasomotor center stimulation delivered in the form of an impulse that moves
downward through the sympathetic nervous system. At the point of this ganglion
preganglionic neurons release acetylcholine which stimulates post-ganglion nerve fibers to
the blood vessels, which by releasing norepinefrine lead to constriction of blood vessels.
Factors such as anxiety and fear can affect the vascular response to stimuli vasoconstrictive
which causes vasoconstriction of blood flow to the kidneys is reduced or decreased and
results produced renin, renin stimulates production of angiostensin I, which is then
converted into angiostensin II is a potent vasoconstrictor which stimulates aldosterone
secretion by the adrenal cortex hormone aldosterone which is cause retention of sodium
and water by the kidney tubules and caused an increase in intra vascular fluid volume that
causes hypertension. The occurrence of hypertension can be caused by several factors as
follows:
1. The cardiac output and peripheral resistance
Maintaining a normal blood pressure depends on the balance between cardiac output and
peripheral vascular resistance. The vast majority of patients with essential hypertension had
normal cardiac output, but increasing peripheral prisoners. Peripheral resistance is
determined not by the large arteries or capillaries, but by small arterioles, whose walls
contain smooth muscle cells. Contraction of smooth muscle cells suspected to be related to
an increase in intracellular calcium concentration (Lumbantobing, 2008). Kontriksi smooth
muscle lasts long been suspected of inducing change structurally with the blood vessel wall
thickening of the arterioles, probably mediated by angiotensin, and could lead to increased
peripheral resistance is irreversible. At a very early hypertension, peripheral resistance is
not increased and the increase in blood pressure caused by increased cardiac output, which
is associated with sympathetic overactivity. Increased prisoners Peifer happened possibility
is compensated to prevent an increase in pressure is not distributed to a network of
capillary blood vessels, which will be able to substantially disrupt cell homeostasis
(Lumbantobing, 2008).
2. The renin-angiotensin system
Renin-angiotensin system may be an endocrine system that is most important in controlling
blood pressure. Renin is secreted from renal juxtaglomerular apparatus in response to the
lack of perfusion glomerular or less intake of salt. He also released in response to

stimulation and the sympathetic nervous system (Lumbantobing, 2008). Renin is

responsible converts renin substrate (angiotensinogen) to Angiotensin II in the lungs by
angiotensin converting enzyme (ACE). Angiotensin II is a powerful vasokontriktor and
lead to increased blood pressure (Lumbantobing, 2008).
3. The autonomic nervous system
Stimulation of the autonomic nervous system can cause constriction of arterioles and
dilatation of arterioles. So the autonomic nervous system has an important role in
maintaining normal blood pressure. It also has an important role in mediating the changes
that took place briefly on the blood pressure response to stress and physical work
(Lumbantobing, 2008).
4. atrial natriuretic peptides (atrial natriuretic pept ideas / ANP)
ANP is a hormone produced by the atria of the heart in response to increased blood
volume. The effect is to increase the excretion of salt and water from the kidneys, so as a
kind of a natural diuretic. Disturbances in the system can lead to fluid retention and
hypertension (Lumbantobing, 2008).
2.4 Signs and Symptoms of Hypertension
Clinical manifestations in clients with hypertension are:
1. Increased blood pressure> 140/90 mmHg
2. Headaches
3. Epistaksis
4. Headache / Migraine
5. heaviness ditengkuk
6. It is hard to sleep
7. Eyes berkunang Firefly
8. Weak and tired
9. Advance pale
10. Low body temperature
Most patients with hypertension usually has no specific symptoms are showing a rise in
blood pressure and are only identified by examination of blood pressure alone (Kurt, 2000;

in Sari, 2011). One can assume headache, dizziness or nosebleed merupakantanda the rise
of blood pressure, but the symptoms are only a small part yangterjadi due to hypertension
(Sheps, 2005; in Sari, 2011) .A study found no association between pain kepaladengan
increased blood pressure, even some people do not feel any signs or symptoms.
Other signs and symptoms are often associated with hypertension, such as excessive
sweating, muscle cramps, frequent urination and a fast heart rate and irregular or
palpitations (Sheps, 2005; in Sari, 2011). Other symptoms that commonly occur in patients
with hypertension, dizziness, flushing, headache, bleeding from the nose of a sudden, neck
ached and others (Wiryowidagdo, 2002; in Sagala, 2010). Kushartanti (2008) mentions
hypertension symptoms that include headache, stiff nape of the neck, stiff shoulder,
numbness, nausea, weakness, back pain and shortness nafas.Menurut Smeltzer & Bare
(2001) factors affecting the symptoms of hypertension that is the damage / vascular
disorders with manifestations typical corresponding with divaskularisasi organ systems.
Symptoms of hypertension is a clinical manifestation of a disorder perceived convenience
of patients. Patients can treat a disorder symptoms of hypertension as a convenience or not
depends on several factors. According to Potter & Perry (2005) some of these factors,
namely; age, gender, culture, the meaning of pain, concern, anxiety, fatigue, previous
experiences, coping and social support for families.
2.5 Diagnostic Procedures
1. Examination Laboratory:
a. Hb or Ht: to examine the relationship of the cells to the volume of fluid (viscosity) and
may indicate risk factors such as: hipokoagulabilitas and anemia
b. BUN or creatinine: provide information about renal perfusion or function
c. Glucose: Hyperglycemia (DM is the originator of hypertension) can be caused by
spending ketokolamin levels. Hypertension is accompanied by diabetes with hypertension
or diabetes that may pose a risk to the vital organs. It is therefore necessary for the
monitoring of glucose levels in the blood
d. Urinalisa: assessing the blood, protein, glucose, showed no kidney dysfunction and the
presence of DM
2. CT Scan: to assess their cerebral tumor and encelopati

3. ECG: may show patterns of strain, exactly where and how much breadth, P wave
elevation is one of the early signs of heart disease hypertension
4. IUP: identify the causes of hypertension, such as kidney stones and kidney repair
5. Thorax Photo: destruction can show calcification of the valve area and an enlarged heart
2.6 Management of Hypertension
Management of hypertension can be done by:
1. Therapeutic nonfarmakologi
2. Pharmacological Therapy
1. Therapeutic nonfarmakologi
Adopt a healthy lifestyle for everyone is essential to prevent high blood pressure and is an
important part in the treatment of hypertension. All patients with prehypertension and
hypertension should make lifestyle changes. Changes that have been seen to lower blood
pressure can be seen in Table 4 in accordance with the recommendations of the JNC VII.
Besides lowering blood pressure in patients with hypertension, lifestyle modification can
also reduce blood pressure continued to hypertension in patients with blood pressure
prehipertensi.12 important lifestyle modification is seen to lower blood pressure is to
reduce weight for obese individuals or fat; adopting the DASH diet (Dietary Approaches to
Stop Hypertension) is rich in potassium and calcium; low-sodium diet; physical activity;
and consuming a little alcohol. In some patients with blood pressure control is quite good
with an antihypertensive drug therapy; reduce salt and weight can free patients from using
the drug. 10 easy diet program received is designed to lose weight slowly in patients who
are obese and obese limiting the influx of sodium and alcohol. This requires education to
patients, and encouragement. The following facts can be told to the patient so that the
patient understands rationality dietary intervention:
a. Hypertension is 2-3 times more common in obese people compared to people with ideal
weight
b. More than 60% of patients with hypertension are obese (overweight)
c. Weight loss, with only 10 pounds (4.5 kg) can lower blood pressure significantly in
obese people

d. Abdominal obesity is associated with metabolic syndrome, which is also a precursor of

hypertension and insulin resistance syndrome, which may progress to type 2 diabetes,
dyslipidemia, and further to cardiovascular disease.
e. Diets rich in fruits and vegetables and low in saturated fat can lower blood pressure in
individuals with hypertension.
f. Although there are patients with hypertension who are not sensitive to salt, most patients
have systolic blood pressure penurunaan with sodium restriction.
JNC VII recommends the DASH diet is a diet rich in fruits, vegetables, and dairy products
with high levels of fat redah total fat and saturated fat is reduced. Sodium recommended
<2.4 g (100 mEq) / day. Physical activity can lower blood pressure. Regular aerobic
exercise at least 30 minutes / day several days per week is ideal for most patients. Studies
show that aerobic exercise, such as jogging, swimming, walking, and using a bicycle, can
lower blood pressure.
These advantages can occur despite the absence of weight loss. Patients should consult
with a physician to determine the type of sport where the best, especially for patients with
end-organ damage. Smoking is a major independent risk factor for cardiovascular disease.
Patients with hypertension who smoke should be counseled associated with other risks that
can be caused by smoking.
2. Pharmacological Therapy
There are nine classes of antihypertensive drugs. Diuretics, beta blockers, angiotensin
converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and calcium
antagonists are considered as the main antihypertensive drugs. These drugs either alone or
in combination, must be used to treat the majority of patients with hypertension because of
evidence showing benefit with this drug class. Some of this class of drugs (eg, diuretics
and calcium antagonists) have subclass where significant difference seen in the study of the
mechanism of action, clinical use or side effects. Alpha blockers, alpha 2 agonists central
adrenergic inhibitors, and vasodilators are used as an alternative medicine in certain
patients in addition to the primary drug.
Evidence-based medicine is the treatment that is based on the best available evidence in
making decisions when choosing a medication conscious, clear, and considerate of each

patient and / or disease. The practice of evidence-based medicine for hypertension include
selecting particular by data showing a decrease in mortality and cardiovascular morbidity
or target organ damage caused by hypertension. Scientific evidence shows that simply
lowering blood pressure, tolerability, and cost alone can not be used in the selection of
hypertension medications. By considering these factors, drugs that are most useful are
diuretics, angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers
(ARBs), beta blockers, and calcium antagonists (CCB).
Most patients with hypertension require two or more antihypertensive medications to
achieve blood pressure targets desired. The addition of a second drug from a different class
of drug use began when single doses of commonly fail to achieve blood pressure targets. If
the blood pressure of 20/10 mm Hg above exceeds the target, may be considered to
initiating therapy with two drugs. That must be considered is the risk of orthostatic
hypotension, especially in patients with diabetes, autonomic dysfunction, and the elderly.

CHAPTER 3. NURSING
3.1 Assessment
3.1.1 Health History
Health history is an assessment of health status, both current health status (history of
present illness), past health status (past medical history), and the health status of the family
(family history).
a. Disease History Now
A process or workflow how complaints can occur. When inside the main complaint does
not explain how could a major complaint in the hypertension that arises, then in the history
of present illness raised. In this assessment could arise various other complaints. That
needs to be asked on the client is to process complaints regarding hypertension that could
happen, any measures taken to alleviate the patient and family complaints that arise as a
result of hypertension (including the treatment that has been done), how the process until
the patient was taken to hospital. For example if the hypertension is usually the patient
feels dizzy. Things that are asked include:
1) Description of dizziness or headaches experienced by the patient
2) When the dizziness arises?
3) What causes dizziness due to the increase in blood pressure experienced by the patient is
getting worse?
4) Is the patient has used drugs to relieve the symptoms of hypertension?
5) Are the side effects of the drugs consumed whether or not to dizziness or headache that
felt?
6) And so on.
b. Past medical history
Examines whether the patient ever suffered illness in the past. This is done to determine
whether the disease earlier it had suffered an impact on emerging disease in patients at this
time. It is necessary to study whether patients had a history of hypertension once and never
MRS with the same complaint. In addition it should also be asked whether the patient had
suffered from diseases associated with cardiovascular disease.

c. Family Disease History

Family health history is aimed to find whether there is heredity or congenital. It asked were
there any family members who had suffered from hypertension before. Assessment on
family medical history should not forget to include genogram.
3.1.2 Assessment: NANDA, Pattern Gordon
patterns NANDA
a. Pattern-Health Management Health Perception
Which need to be studied:
How do clients and families deal with problems that exist eg hypertension drug what is
given when the patient's blood pressure to rise
How is the patient and his family control the environment that supports healing patients
with hypertension
Is the patient has been checked out regularly to health care facilities
History of hospitalization and surgery
Does the patient's blood pressure checked often
The extent to which patients and families know the results of tests done by patients
Factor in health-related risks eg lifestyle and socioeconomic status
b. Metabolic-Nutritional Patterns
Which need to be studied:
Habit number of meals and snacks consumed by patients
Types of food and drinks are often consumed
Explain the good food and drink consumed to patients for 24 hours
Is there an increase or decrease in weight
Is there a change in appetite
Diet 3 the last day or the last 24 hours

c. Elimination pattern
Which need to be studied:
The habit patterns of BAK for hypertension
Habit CHAPTER patterns for hypertension
The use of drugs to aid excretion
d. Pattern-Exercise Activity
Which need to be studied:
Daily activities performed by patient
Does the client like to do sports
The type of exercise that often do patients
The ability to care for themselves due to hypertension today
Does the client using tools such as crutches or a cane due to hypertension experienced
Is the energy level decreased during hypertension
The working environment of patients
e. Rest-Sleep Patterns
Which need to be studied:
The habit of sleeping passion everyday
Confidence culture
Do patients using medications that facilitate patient to rest or sleep
Schedule rest and relaxation that is done by the patient
Are there any symptoms of disruption of sleep patterns emerging
Assess the factors that relate eg aging process
f. Perception-Cognitive Pattern
Which need to be studied:
Overview of the senses patients
Is there any influence of hypertension with an overview of the five senses
The use of tools supporting the five senses eg glasses, hearing aids, etc.
Perception of discomfort
Level of education
The ability of patients and their families in making decisions
When where patients feel dizzy

g. Patterns of Self-Concept Self Perception

Which need to be studied:
social circumstances: job, family situation, social groups
Personal Identity: a description of yourself, strengths and weaknesses
The physical state: everything to do with the body, likes or dislikes
Self-esteem: feeling about yourself
Threats to self suffered from hypertension for example changing role
What do patients feel when suffering from hypertension
h. Pattern-Role Relationships
Which need to be studied:
Overview of the role related to family, friends, and coworkers
Satisfaction or dissatisfaction role
The effect of the change in health status
The importance of family support to patients suffering from hypertension
Relationships with other people's patients
Is the patient experienced health problems affecting the changing role and responsibilities
within the family, friends, work, or social activities.
i. Reproductive pattern-Sexuality
Which need to be studied:
Problems or sexual attention
Overview of sexual behavior
Do hiperensi suffered by patients interfere with sexual activity
Knowledge related to sexuality and reproduction
menstrual and reproductive history
Is the problem hypertensive patients who were naturally intrusive role of the patient as a
woman or man
j. Pattern Tolerance to Stress-Koping
Which need to be studied:
The nature of the stress experienced originators recently
The level of perceived stress
Overview of the general and specific response to the stress that comes

 The strategies used to cope with stress as well as its effectiveness

Changes in life and loss
coping strategies used
Assessment capabilities will control events experienced by patients
Knowledge and use stress management
Relationship stress management with the patient's family dynamics
History related to psychological problems
Who helped patients in the adaptation to hypertension disease that happened today
Is the patient experiencing stress due to hypertensive
k. Confidence pattern-Value
Which need to be studied:
cultural or ethnic background
The economic status, health behaviors related to cultural or ethnic group
The purpose of the patient's life
What is used is important for patients and their families
The health impacts of the spiritualized
Hope in the future related to the problems facing patients
patterns Gordon
1. Patterns of Perception and health Pemeliharaab
Patients say know about the importance of health so that if there is one sick family was
immediately taken to hospital.
2. Patterns Nutrition
a. before the pain
1) Eat: 3 x 1 day (rice, vegetable, side dish) is consumed 1 serving
2) Drink: 6-7 cups a day (water and tea)
b. during illness
1) Eat: 2 x 1 daily, diet BKRG of RS, exhausted servings
2) Drink: 5-6 cups size of 200 cc, 900 cc infusion types RI
3. The pattern of Elimination
a. before the pain
1) CHAPTER normal 2 times a day, solid, yellow.

2) normal BAK 6-8 times a day, yellowish color.

b. during illness
1) CHAPTER 1-2 times daily liquid, solid, yellow color, distinctive odor.
2) liquid BAK 6-8 times a day, a distinctive smell.
4. Rest and Sleep Patterns
1) Before you sick
Patients say before hospital bed 7-8 hours / day
2) During the illness
Patients sleep only 3-5 hours / day because of dizziness.
5. The pattern of perceptual
(Sight, hearing, taste, sensation)
1) Before you sick
a. Hearing the patient is already somewhat impaired
b. The patient has blurred vision
c. The tasting of patients still good
d. The sensation of the patient is still good
2) During the illness
a. Hearing the patient was somewhat disturbed because it is old
b. The patient has blurred vision
c. The tasting patients less well due to the patient's lips tasted bitter
d. The sensation of the patient is still go
6. Patterns of Self Perception
1) Before you sick
a) Anxiety: There is no anxiety or nervousness
b) Self-Concept: 2) During the illness
a) The client looked weak and pale
b) The level of client anxiety can be seen when the patient will be performed nursing
actions, frequently asked something about his illness
7. Pattern Role Relationships
a. Communication: In communicating patient communicates well with his family.

b. Relationships with others: Patients socialize well with the environment and his family,
proved many brothers or relatives who visit her.
c. Financial Capability: Families of patients can be classified in a middle-class social
groups.
8. Sexual and Reproductive Patterns
1) Before you sick
Patients already menopause
2) During the illness
Patients do not have sexual desire
9. Stress Tolerance Pattern
1) Before you sick
Patients said they were delighted to get along with people around
2) During the illness
Patients are seen as space for patient saturated diabatasi.
10. Confidence Patterns
1) Before you sick
Patients say the Islamic religion, and diligent in worship
2) During the illness
Patients do not carry out their daily prayer as usual because of illness, but patients always
pray for kesembuhanya.
3.1.3 Physical Examination
1. Weight and height: no weight gain
2. Hair: normal hair distribution, strong hair, hair net, no lesions, no tenderness in the head
3. Eyes: Asymmetrical, eyelashes normal distribution, examination fundoscopy for retinal
arteriolar narrowing, bleeding, exudates and edema, no tenderness eye area, conjunctiva
pink, white eye seklera there is redness, smaller pupil
4. Skin: Skin is clean, there are changes in skin color
5. Nose: symmetrical, nostril no deformity, no tenderness
6. Ear: symmetrical, no tenderness
7. Neck: no injury, no pemingkatan the JVP, noisy carotid artery and an enlarged thyroid

8. Mouth: symmetrical, black lip color purple

9. Lungs: Inspection (Asymmetric, mammary areola looks clean and black, no injury,),
palpation (asymmetric chest movement, vocal fremitus palpable on both sides, non-tender),
percussion (sonor), auscultation (rhythm irregular, tachypnea, breath sounds weziing)
10. Heart: inspection (Asymmetric, no injury in the thoracic), palpation (asymmetric chest
movement, vocal fremitus palpable on both sides, non-tender), pekusi (dullness),
auscultation (no sound heart in S3 and S4, no noisy heart, TD> 120)
11. Abdomen: no noise, no renal enlargement
12. Extremities: weakness or loss of pulse parifer and edema
13. Neurology: a sign of cerebral thrombosis and bleeding
3.1.4 Data Analysis and Problem
DS: - patients said kepalnya sore and stiff neck.
- Patients say pendangannya blurry and dizzy when standing and walking
- The patient says his body feels weak and difficult to carry out its activities independently
DO: - patients are seen painfully
- Pain scale 7
- Patients are seen to stagger when walking and always holding
- Patients are seen bedres
- Patients seen helped by other people while doing the activity ka
3.2 Nursing Diagnosis
a. Decreased cardiac output B.D. increased afterload
b. B.d activity intolerance weakness experienced by the patient due to hypertension
c. B.d acute pain headache
d. Needs more nutrients the body needs B.D. obesity

3.3 Planning Nursing

a. Nursing Diagnosis 1
Aim:
Criteria Results:
Participate in activities that degrade Td / workload of the heart.
Maintain TD in the range of individuals who can be accepted.
Paying attention to rhythm and frequency of the patient's heart stabildalam normal range.
b. Nursing Diagnosis 2
Aim:
Criteria Results:
Participate in activities that desired / required
Report an increase in tolerance activity can be measured
Demonstrate the decline in signs of intolerance physiology
c. Nursing Diagnosis 3
Aim:
Criteria Results:
Report lost or the pain or discomfort controlled
Disclose the method provides a reduction
Following the pharmacological regimen prescribed.
d. Nursing Diagnosis 4
Aim:
Criteria Results:
Identify the relationship between hypertension and obesity
Shows changes in diet (eg, choice of food, quantity, and so on), maintain a desirable
weight with maintenance of optimal health.
Conduct or maintain a proper exercise program individually.

3.4 Nursing Interventions

a. Nursing Diagnosis 1
Nursing Interventions:
Mandiri:
monitor TD. Measure on both arms / thighs for an initial evaluation.
Note the presence, quality and parifer central pulsation.
tone auscultation of heart and breath sounds.
Observe the color, moisture, temperature, and capillary refill time.
Record generalized edema / certain.
Provide a quiet neighborhood, convenient, reduce the activity / environment commotion.
Limit the number of visitors and length of stay.
Maintain restrictions on activities such as resting in bed / chair; uninterrupted rest period
schedule; help the patient to perform self-care activities as needed.
Perform actions were comfortable; such as back and neck massage, elevating the head of
the bed.
Encourage relaxation techniques, imagination guide, diversion activities.
Collaboration:
Give medications in accordance with the indications, for example:
1. thiazide diuretics, eg. Klorotiazid (Diuril); hydrochlorothiazide (Esidrix / hidroDIURIL);
bendroflumentiiazid (naturetin);
2. Loop diuretics, ie. Furosemide (Lasix); etakrinic acid (Edecrin), bumetanide (burmex);
3. Diuritik potassium-sparing, eg, spironolactone (Aldactone); triamterene (Dyrenium);
amilioride (midamore);
4. Inhibitor sympathetic, eg, propranolol (Inderal); metroponol (lepressor); atenolol
(ternomin); nadolol (corgard); methyldopa (Aldomet); reserpine (serpasil); clonidine
(Catapres);
5. vasodilators, eg, minoxidil (loniten); hydralazine (apresoline); calcium channel blockers,
eg, nifedipine (Procardia); verapamil (Calan);
6. agents antiadrenergik; alpha-1 blocker prazosin (minipres); tetazosin (Hytrin);
7. Nuron Adrenergic Blockers: guanadrel (Hyloree) quanetidin (Ismelin); reserpine
(Serpasil);

8. adrenergic inhibitors that work is central: clonidine (Catapres); guanabens (Wytension);

methyldopa (Aldomet)
9. The co-direct vasodilator: hydralazine (Apresoline); minoxidil; (Loniten)
10. The oral vasodilator that acts directly: diazoksid (Hyperstat); nitroprusside; (Nipride,
Nitropess)
11. Blocker ganglion ie., Guanetidin (Ismelin); trimetapan (Arfonad). ACE inhibitors, ie.,
Captopril (Capoten)
12. Give fluid and dietary sodium restriction as indicated
13. Prepare for the distinction when indicated
b. Nursing Diagnosis 2
Nursing Interventions:
1. Assess the patient's response to the activity, perhatiakn pulse rate more than 20 times per
minute above the frequency of breaks; significant increases in blood pressure during or
after activity (systolic pressure increased by 40mm / Hg or diastolic blood pressure
increased by 20mm / Hg); dyspnea or pain tones; excessive fatigue and weakness;
diaphoresis; dizziness or fainting.
2. Instruct the patient about energy saving techniques, eg., Using a bath seat, sit down
while combing the hair or brushing teeth, doing it slowly.
3. Encourage daily activity or self care gradually if it can ditolenransi. Provide assistance
as needed
c. Nursing Diagnosis 3
Nursing Interventions:
Mandiri:
1. Maintain bed rest during the acute phase
2. Give nonpharmacological measures to relieve headaches, for example; cold compress on
the forehead, back and neck massage, quiet, dim room light, relaxation techniques
(imagination guide, distraction) and leisure activities.
3. Eliminate or minimize vasoconstriction activity that can increase headaches, for
example; straining during defecation, coughing long, bent.

4. Assist patients in ambulation as needed

5. Give liquids, soft foods, regular oral care when bleeding nose or nasal pack has been
done to stop the bleeding.
Collaboration
Give as indicated: analgesics; antiansietas, for example; lorazepam (Ativan), diazepam
(Valium).
d. Nursing Diagnosis 4
Nursing Interventions:
Mandiri
1. Assess the patient's understanding of the direct relationship between hypertension and
obesity.
2. Discuss the importance of lowering caloric intake and limit fat intake, salt, and sugar as
indicated.
3. Set the patient's desire to lose weight
4. Review the daily caloric intake and diet selection
5. Set a weight loss plan that is realistic with patients, such as weight loss of 0.5 kg per
week.
6. Encourage the patient to keep a daily food intake, including when and where the meal is
done and the environment and the feeling around the time food is eaten.
7. Instruct and help choose the right foods, avoid foods with a high fat saturation (butter,
cheese, eggs, ice cream, meat) and cholesterol (fatty meats, egg yolks, canned products,
offal)
collaborative
Refer to a dietitian as indicated

CHAPTER 4. COVER
4.1 conclusions
Hypertension is defined as blood pressure above normal or persistent blood pressure where
the systolic pressure above 140 mmHg and diastolic pressure above 90 mmHg. Based on
the cause of hypertension is divided into two, namely primary hypertension or
hypertension with a cause that is not known for certain. Secondary hypertension is
hypertension caused by certain specific cause, such as kidney disease (acute
glomerulonephritis, chronic nephritis, polyarthritis disease, diabetic nephropathy),
endocrine diseases (hypothyroidism, hypercalcemia, acromegaly), koarktasioaorta.
4.2 Recommendations
The advice we can give is a hypertension treatment starts with lifestyle changes to help
lower blood pressure and reduce your risk of heart disease. If the changes do not provide
results, you may need to take medications to patients with hypertension, of course in
consultation with a doctor. Even if you have to take your medicine, even better if
accompanied by lifestyle changes that can help you reduce the amount of medications you
are taking.

BIBLIOGRAPHY
Brunner and Suddarth. 2002. Medical Surgical Nursing. Jakarta: EGC.
Carpenito, L.J. Nursing Diagnosis Handbook 2000 Edition 8. Jakarta. EGC.
Dalmartha, Setiawan and Nova Sutarina. 2008. Your Self Care Hypertension. Jakarta:
Spreaders Plus.
Dongoes, Marlynn.E.dkk.1999. Nursing Care Plans Issue 3. Jakarta: EGC.
NANDA. 2012. Nanda Nursing Diagnosis Guide. Yoyakarta: Prima Medika.
Rilantono, L et al. 2002. Textbook of Cardiology. Jakarta: University.