Asuhan Keperawatan pada

Pasien dengan Hipertensi dan

Anemia

Muskhab Eko Riyadi

S.Kep., Ns., M.Kep., CWCS
Definisi Hipertensi

Sistolik diatas 140 mmHg

Diastolik diatas 90 mmHg
 Pahami !

COP = HR x SV

Tekanan Darah

Resistensi Perifer Total

(TPR)
H. Hiperdinamik

• Peningkatan frekuensi denyut jantung

• Peningkatan volume ekstrasel
H. Resistansi

• Vasokonsriksi perifer
• Peningkatan viskositas darah ( Hematokrit )
Jenis Hipertensi
• Hipertensi Primer/Essensial
 genetik
 lingkungan
 renin
 angiotensin
 Na dan K
Jenis Hipertensi
• Hipertensi Sekunder
 penyakit ginjal
HYPERTENSIVE EMERGENCY

Hypertensive emergency is a severe

type of hypertension by elevations in
SBP greater than 180 mm Hg and DBP
greater than 120 that are complicated by
risk for or progression of target-organ
dysfunction (examples include MI, HF).
Manifestasi Klinis
• Peningkatan TD
• Sakit kepala
• Epistaksis
• Telinga berdengung
• Rasa berat di tengkuk
• Mata berkunang
• Pusing
• Sukar tidur
Terapi Farmakologis
1. Diuretics Increase urine output by inhibiting sodium and
water reabsorption by the kidney > furosemide (Lasix)
2. Beta Blockers Decrease sympathtetic nervous system
resulting in decreased blood pressure, rate, contractility,
cardiac output, and renin > acebutolol (Sectral)
3. Angiotension-converting enzyme (ACE) inhibitors
Blocks production of angiotension II, a potent
vasoconstrictor; Reduces peripheral arterial resistance and
blood pressure. > captopril (Capoten)
4. Direct vasodilators Relax smooth muscles of blood
vessels causing vasodilation and decreased blood pressure.
> minoxidil (Loniten)
Hypertension lifestyle modifications
L —Limit salt, caffeine, and alcohol.
I —Include daily potassium and calcium.
F—Fight fat and cholesterol.
E—Exercise regularly.
S—Stay on your blood pressure regimen.
T—Try to quit smoking.
Y—Your medications are to be taken daily.
L—Lose weight.
E—End-stage complications will be avoided!
Definisi Anemia
The term anemia describes a condition
in which there is a deficiency of RBCs,
hemoglobin, or both, in the circulating
blood
A decrease in the numbers of RBCs

1. Impaired production of RBCs, as in

aplastic anemia and nutrition
deficiencies
2. Increased destruction of RBCs, as in
hemolytic or sickle cell anemia
3. Massive or chronic blood loss.
Etiologies
• DIETARY DEFICIENCIES > Iron and vitamin
B12 are all essential to production of healthy
RBCs
• HEMOLYSIS > Hemolysis is the destruction, or
lysis of RBCs. This may be a congenital disorder
or it may be caused by exposure to certain
toxins.
Signs and Symptoms
Symptoms of anemia include :
pallor, tachycardia, tachypnea,
irritability, fatigue, and shortness of
breath
Diagnostic Tests

A complete blood cell count (CBC) is

done to determine the number of RBCs
Activity intolerance related to tissue hypoxia and
dyspnea

EXPECTED OUTCOME: The patient will be able to complete ADLs

with minimal assistance.

1. Monitor vital signs to evaluate tolerance to activity

2. If the pulse or respiratory rate increases more than 20 percent
from baseline during activity, reduce the activity level
3. Assist the patient with self-care activities as needed
4. Place articles within easy reach of the patient
5. Encourage the patient to limit visitors, telephone calls, and
unnecessary interruptions
6. Administer oxygen as ordered to relieve dyspnea
7. Assist with blood transfusion as ordered if hemoglobin levels are
very low or symptoms are severe
Imbalanced nutrition: less than body requirements
related to disease, treatment, or lack of knowledge of
adequate nutrition

EXPECTED OUTCOME: The patient will be able to

appropriately select foods that will meet nutritional
requirements.

1. Consult a dietitian
2. Include foods high in iron for the patient with iron
deficiency and to consume iron-rich foods with vitamin C
3. Administer supplements as ordered
4. Administer intramuscular iron injections by the Z-track
method
Risk for injury: falls related to weakness and
dizziness

EXPECTED OUTCOME: The patient will be safe from

injury related to fall.

1. Assess the patient at risk for falls using a fall risk

assessment tool
2. Assist the patient to change positions slowly
3. Assist the patient with ambulation
EVALUATION

When successfully treated,

1. The patient will a normal level of activity
without shortness of breath or excess fatigue.
2. The patient should be able to explain the
correct treatment plan and therapeutic
measures for long-term prevention including
dietary choices and supplements as well as
self-care measures.
TERIMA KASIH
Reference
Williams, Linda S., Hopper, Paula D. (2007).
Understanding Medical Surgical Nursing 3th Edition.
Davis Company. Philadelphia
Smeltzer, Suzanne C., Bare, Brenda G. (1996). Brunner &
Suddarth Textbook of Medical Surgical Nursing.
Philadelphia
Tymbi, Barbara K., Smith, Nancy E. (2010). Introductory
Medical Surgical Nursing. Lippincott Williams
&Wilkins. Philadelphia