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Nurul Ilmi Hajar

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(PO.71.3.201.14.1.130)
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Prese
Nurul Khabliana
(PO.71.3.201.14.1.131)

???
Hypertension, is a long term medical condition in
which the blood pressure in the arteries is persistently

High Blood Pressure

elevated. Someone with hypertension having a blood

pressure reading of more than 140/90 mmHg.

Symptoms of
hypertension
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.

Much of no symptoms.
Pain in the back of the head.
Stiff neck.
Fatigue.
Nausea.
Shortness of breath.
Restless.
Vomiting.
Easily offended.
Hard to sleep.

ETIOLOGI
1.Primary hypertension
2.Secondary hypertension

Hemodynamics

and

physiologic

components

(plasma volume, activity of the renin-angiotensin

system)

vary,

indicating

that

primary

hypertension is unlikely to have a single cause.

Even if one factor is initially responsible, multiple
factors

1.Primary
are probably hypertension
involved in sustaining

elevated BP (the mosaic theory).

2.Secondary hypertension
Causes

include

primary

aldosteronism,

renal

parenchymal disease, connective tissue disorders,

obstructive

uropathy,

renovascular,

pheochromocytoma, Cushing syndrome, congenital

adrenal hyperplasia, hyperthyroidism, myxedema,
and coarctation of the aorta. Excessive alcohol
intake and use of oral contraceptives are common
causes

of

curable

sympathomimetics,

hypertension.

corticosteroids,

Use

cocaine,

of
or

licorice commonly contributes to worsening of

blood pressure control.

PATHOPHYSIOLOGY

In most patients, cardiac output is normal or slightly

increased, and total peripheral vascular resistance is
increased. This pattern is typical of primary
hypertension and hypertension due to primary
aldosteronism, pheochromocytoma, renovascular
disease, and renal parenchymal disease. In other
patients, cardiac output is increased (possibly
because of venoconstriction in large veins), and
total
peripheral
vascular
resistance
is
inappropriately normal for the level of cardiac
output. Plasma volume tends to be high in
hypertension due to primary aldosteronism or renal
parenchymal disease and may be quite low in
hypertension due to pheochromocytoma. Renal
blood flow gradually decreases as diastolic blood

CAUSES OF
HYPERTENSION
Smoking
Being overweight
Lack of physical activity
Too much salt in the diet
Drinking too much alcohol (more
than 1 to 2 drinks per day)
Older age
Family history of high blood
pressure (heredity)
Race (African Americans have high
blood pressure more often and more
severely than White Americans)
Having chronic kidney disease

COMPLICATIONS

COMPLICATIONS
Artery
damage
and
narrowin
g

Aneurys
m

Damage
to your
arteries

COMPLICATIONS
Corona
ry
artery
diseas
e

Enlarg
ed left
heart
Heart
failure

Damag
e to
your
heart

COMPLICATIONS
Stroke
Transien
t
ischemic
attack
(TIA)

Dementi
a

Damag
e to
your
brain

Mild
cognitiv
e
impairm
ent

COMPLICATIONS
Kidney
scarring
(glomeruloscle
rosis)
Kidney
failure

Damage
to your
kidneys

Kidney
artery
aneurys
m

COMPLICATIONS

Eye blood
vessel
damage
(retinopathy)

Fluid buildup
under the
retina
(choroidopathy
)

Damag
e to
your
eyes

Nerve
damage
(opticneuropa
thy).

CLINICAL MANIFESTATION
e
v
i
t
c
Subje
D a ta

Early morning headache

Light-headedness
tinnitus
Palpitasion
Fatigue
insomnia
Forgetfulness
irritability
Altered vision : white spots, blurring, or loss

CLINICAL MANIFESTATION
e
v
i
t
c
Obje
data

Epistaxis
Elevated blood pressure : systolic >140 mmHg,

diastolic >90 mmHg; narrowed pulse pressure

Retinal changes
Papilledema
Shortness of breath on slight exertion
Cardiac, cerebral, and renal changes

NURSING DIAGNOSIS
1.Acute

pain: headache related to increased

cerebral vascular pressure

2.Ineffective Tissue Perfusion:cerebral, renal,
cardiac related to impaired circulation.
3.Knowledge deficit related to lack of information
about the disease process and self-care.
4.Decreased Cardiac output related to increased
afterload, vasoconstriction, myocardial ischemia,
ventricular hypertrophy

E
N
A
L
P
E
R
A
C
G
N
N
I
O
S
I
T
R
A
T
NU
N
E
M
E
L
P
M
I
AND

Acute pain: headache related to

increased cerebral vascular
pressure
Goal :
The pressure does not
increase cerebral vascular
Nursing a. Maintain bed rest, quiet neighborhood, a
Implementas little light.
ion
b. Limit of patients.
c. Minimize disruption and environmental
stimuli.
d. Give a fun action according to indications
such as ice packs, the position of comfort,
relaxation
techniques,
counseling
imagination,avoid constipation.
e. Medical collaboration in providing analgesic
and sedative drugs.

Ineffective Tissue Perfusion:

cerebral, renal, cardiac related to
impaired circulation
circulation
Goalof:the body isThe
not impaired
g
Nursin
as
t
n
e
m
Imple
ion

a.Maintain bed rest, elevate the head

position in bed patients.
b.Assess blood pressure at admission in
both arms, sleeping, sitting with
arterial pressure monitoring if it is
available.
c. Measure the input and discharge.
d.Observe the sudden hypotension.
e.Ambulation within your means and
avoid fatigue in patients.
f. Monitor electrolytes, creatinine
according to medical advice.
g.Maintain fluids and medications
according to medical advice.

Knowledge Deficit Related To Lack Of

Information About The Disease Process
And Self-care

Goal : Patients are met in terms of

information about hypertension

g
sinDescribe
Nur1.
the nature of the disease and the
i
ntas
ofthe procedureand the treatment of
Implemepurpose
on hypertension.
2. Explain the importance of a peaceful environment
and theraupetik, and management of stressors.
3. Discuss the importance of maintaining a stable
weight.
4. Discuss the need for low-calorie diet, low in
sodium to order.
5. Discuss the importance of avoiding fatigue in the
activity.
6. Explain the need toavoid constipationin the
bowel movement.
7. Explain penetingnya maintain proper fluid intake,
amount allowed, restrictions such as caffeinated
coffee, tea and alcohol.
8. Discuss the symptoms of relapse or progression of
complications reported to the doctor: headache,
dizziness, fainting, nausea and vomiting.
9. Talk about drugs: the name, dosage, time of
administration, purpose and side effects or toxic

Decreased Cardiac output related to

increased afterload, vasoconstriction,
myocardial ischemia, ventricular
hypertrophy

Clients want to participate in

:
l
a
Go activities that lower blood pressure /
cardiac workload

1. Monitor your blood pressure .

Measure in both arms / thighs for
g
n
i
s
r
u
N
initial evaluation . Use the proper
tasi
n
e
m
e
l
p
Im
cuff size and accurate
on
technique .
2.Note the presence , quality of central and
peripheral pulses .
3.Auscultation of the heart tone , and breath
sounds .
4.Observe skin color , moisture , temperature ,
and capillary refill time .
5.Note the general edema / specific.

6. Provide a quiet, comfortable,

reduce, activity / environment
Nursing
tasi
commotion, limit the number of
n
e
m
e
l
p
Im
visitors and length of stay.
on
7. Maintain restrictions on activities, such as,
resting in bed / chair; schedule rest periods
without interruption; aids patients perform
self-care activities as needed.
8. Perform actions that comfortable, such as.,
Back and neck massage, elevating the head
of the bed.
9. Encourage relaxation techniques, manual
imagination, vision activities.
10.Monitor response to medication to control
blood pressure

EVALUATI
ON
1. Patients revealed the absence of headache and looked
comfortable
2. Patients demonstrating an improved tissue perfusion
as indicated by: blood pressure within acceptable
limits, no complaints of headache, dizziness, laboratory
values within normal limits.
3. Stable vital signs.
4. Urine output 30 ml / min
5. Patients can express their knowledge and skills of the
management of early treatment of hypertension.
6. Reported the use of drugs according to medical advice.
7. Demonstrate stable cardiac rhythm and rate within
patients normal range.
8. Maintain blood pressure within individually acceptable
range.