A.

Definition

Hypertension is a condition where the blood pressure found more than 160/95 mmHg
(WHO) also when the blood pressure reaches 140/90 mmHg or more for 13-50 years of age
and blood pressure reaches 180/95 mmHg for age above 50 years (Ulrich SP , 1986).

Hypertension is a systolic and diastolic blood pressure were not normal, the exact
limits of this disorder is uncertain. Acceptable values differ according to age and sex but in
general systolic ranges between 140-190 mmHg and diastolic between 90-95 mmHg is
considered a borderline hypertension (sylvia A, pierce. 533)

B. Classification

Based on the causes of hypertension were divided into 2 groups, namely:

a. Essential hypertension / primary hypertension of unknown cause or idiopathic

b. Secondary hypertension / renal

Various factors associated with essential hypertension, but there has been no
definitive information that can explain the cause.
C. Etiology :

1. Families with a history of hypertension

2. Excess sodium intake

3. Consumption of excess calories
4. Lack of physical activity
5. Intake excess alcohol
6. Low intake of potassium
7. Environment
8. The use of estrogen
9. Kidney disease
10. Renal vascular hypertension
11. Hypertension associated with pregnancy,
D. Sign and Symptoms

Sometimes it goes without symptoms of essential hypertension, and new symptoms

develop after like target organ complications in the kidneys, eyes, brain and heart.
Symptoms are headache, epistaxis, headache or migraine, angry, buzzing ears,
nosebleeds, difficulty sleeping and shortness of breath, heaviness nape, blurred eye-
worm.
Impaired cerebral seizures can be caused by hypertension, or symptoms due to
bleeding blood vessels of the brain in the form of paralysis, impaired consciousness even
coma. If these symptoms arise, is sign blood pressure needs to be lowered (Soeparman,
1999).

E. Pathophysiology

Influenced blood pressure and cardiac output peripheral resistance, so that all the
factors that affect cardiac output and peripheral resistance will affect the blood pressure.
Blood pressure can be easily written with the following formulation:

Blood pressure = cardiac output X peripheral Prisoners

In addition to cardiac output and peripheral resistance, blood pressure actually

influenced also by the right atrial pressure, but because the right atrial pressure is close to
zero, the value has no effect.

The cause of essential hypertension is not known with certainty although has many
causes such identify factors:

1. Atherosclerosis
2. Increased sodium intake
3. Baroroseptor
 4. Genetic factors

 Emotion / stress
Emotion / stress will stimulate the hypothalamus affects the sympathetic nervous going into
effect vasokontriktor increased cardiac work and blood pressure to rise.

 Smoke
Nicotine affects the secretion of renin causes stiffening of blood vessels occurs Atherosclerosis
will improve the heart and increases blood pressure.
 v Alcohol
Alcohol affects the secretion of renin causes stiffening of blood vessels occurs Atherosclerosis
will improve the heart and increases blood pressure.
 v High sodium / salt
Salt affects the secretion of ADH occurs so that urine retention increases blood volume causes
increased heart work and the tension rises.
 v High fat
Fat / cholesterol lipid make buildup in blood vessels will increase the work of the heart and
blood pressure rise.
 v Obesity
Obesity will increase the metabolism of calories, fat buildup of fat in the blood vessels of the
heart so Atherosclerosis increase tension increased.

F. Treatment .

 Non-Pharmacological Management
1. Reduction in salt intake. Weight loss can lower blood pressure accompanied by a
decrease in plasma renin activity and plasma levels of adosteron.
2. Activity
Clients are encouraged to participate in activities and medical and with limit
 adjusted in accordance with the capabilities such as walking, jogging, cycling or
swimming.
 Pharmacological Treatment
Broadly speaking, there are several things that need to be considered in granting
or selection of antihypertensive drugs, namely:
1. Have a high effectiveness.
2. Having toxicity and side effects are mild or minimal.
3. Allows the use of oral medications.
4. Not caused intolerance.
5. Relatively low drug prices so affordable by the client.
6. Allow long-term use.

G. Examination Diagnostic

1. Inspection Laboratorium

a. Hb / Ht: to examine the relationship of the cells to the volume of fluid (viscosity)
and may indicate risk factors such as: hipokoagulabilitas, anemia.
b. BUN / creatinine: provides information on perfusion / kidney function.
c. Glucose: Hyperglycemia (DM is the originator of hypertension) ketokolamin can
causes by expenditure levels.
d. Urinalysis: blood, protein, glucose, renal dysfunction indicated he fully and there
is Diabetes Mellitus.

2. CT Scan: Assessing the presence of cerebral tumor,

3. ECG: may show patterns of strain, where the vast, P wave elevation is one early sign
of hypertensive heart disease.
4. IUP: identifying causes of hypertension such as kidney stones, kidney repair.
5. Photo Chest: Shows the destruction of calcification in the valve area, cardiac
enlargement.
H. Complication
Generally the vital organs such as:
a) Eyes: focal spasm, constriction of arterioles, hemorrhage, exudates and papil weir
b) brain: cerebral infarction, rupture of blood vessels of the brain, death
c) Heart: heart failure
d) Kidney: renal failure

I. Nursing Diagnosis
 High risk of decreased cardiac output associated with increased after load,
vasoconstriction, myocardial ischemia, ventricular hypertrophy.
 Activity intolerance related to general weakness, imbalance between O2 supply
and demand.
 Impaired sense of comfort: pain (headache) is associated with increased cerebral
vascular pressure.
 Potential changes in tissue perfusion: cerebral, renal, cardiac related to circulatory
disorders.

J. Intervention

Nursing Diagnosis 1. :
High risk of decreased cardiac output associated with increased after load,
vasoconstriction, myocardial ischemia, ventricular hypertrophy.
Purpose: no increased after load, vasoconstriction does not occur, no myocardial
ischemia.
Criteria results: Clients can follow in activities that lower blood pressure / heart hard
work, maintaining TD in the range of individuals who can to achieve, the norms and
frequency stable heart patients normal range .
Intervention:

 Monitor BP, measured in both hands, use the right cuff and techniques.
 Note the presence, quality central and peripheral pulses.
 Tone auscultation of heart and breath sounds.
 Observe skin color, moisture, temperature and capillary refill time.
 Note the general edema.
 Provide a quiet, comfortable, reduce the activity.
 Maintain restrictions on activities such as breaking the bed / chair
 Help perform self-care activities as needed
 Perform actions such as a comfortable back and neck massage
 Encourage relaxation techniques, imagination guide, the transfer activity
 Monitor response to medications to control blood pressure
 Give fluid and dietary sodium restriction as indicated
 Collaboration for the provision of drugs as indicated.

Nursing Diagnosis 2. :
Activity intolerance related to general weakness, imbalance between O2 supply and
demand.
Objective: Activity patients fulfilled.
Criteria results: Clients can participate in activities at desired / required, reported an
increase in exercise tolerance that can be measured.
Intervention:

 Assess the patient's tolerance to the activity by using the parameters: pulse frequency of
20 per minute above the resting frequency, record blood pressure, dypsnea, chest pain,
severe fatigue and weakness, sweating, or fainting lazy. (Parameter shows patient for
physiological response to stress, the activity indicator and the degree of influence of
excess work / heart).
 Assess readiness to increase the activity of an example: the decline weakness / fatigue,
TD stable, pulse frequency, increased attention in activity and self-care. (Physiological
stability in rest to advance the level of individual activity).
 Push to promote activity / tolerance of self-care. (myocardiac during various activities
can increase the amount of oxygen available. Advancement of activity gradually to
prevent sudden increase in the work of the heart).
 Provide assistance as needed and encourage the use of a shower chair, brushing teeth /
hair by sitting and so on. (Energy saving techniques that reduce the use of energy and
help balance supply and oxygen demand).
 Encourage the patient to follow in choosing the period of activity. (As scheduled increase
tolerance for activity progress and cleared weakness).

Nursing Diagnosis 3. :
Impaired sense of comfort: pain (headache) is associated with increased cerebral vascular
pressure
Objective: Cerebral vascular pressure did not increase.
Criteria Results: The patient revealed the absence of headache and looked comfortable.
Intervention:

 Maintain bed rest, quiet neighborhood, a little light

 Minimize environmental distractions and stimuli.
 Limit activity.
 Avoid smoking or the use the use of nicotine.
 Give analgesia and sedation drugs to order.
 Give a fun action according to indications such as an ice pack, a comfortable position,
relaxation techniques, guided imagery, avoid constipation.

4 nursing diagnoses. :
Potential changes in tissue perfusion: cerebral, renal, cardiac related to circulatory
disorders.
Objective: Circulation body is not disturbed.
Criteria Results: Patients demonstrated improved tissue perfusion as indicated by: TD
within acceptable limits, no complaints of headaches, dizziness, laboratory values were
 within normal limits.
Intervention:

 Maintain bed rest; elevate the head of the bed.

 Assess blood pressure at admission in both arms; sleeping, sitting with arterial pressure
monitoring if available.
 Maintain fluid and drugs to order.
 Observe any sudden hypotension.
 Measure input and expenditure.
 Monitor electrolytes, BUN, creatinine to order.
 Ambulation according to ability; avoid fatigue.
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