Nurul Ilmi Hajar (PO.71.3.201.14.1.

130)
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 elevated.
High Blood Pressure
Someone with hypertension having a blood pressure
reading of more than 140/90 mmHg.
 Classification of blood pressure for adults (JNC7)

Category systolic, mm Hg diastolic, mm Hg

Normal 90–119 60–79

High normal
120–139 80–89
(Prehypertension)

Stage 1 hypertension 140–159 90–99

Stage 2 hypertension 160–179 100–109

Stage 3 hypertension
≥180 ≥110
(Hypertensive emergency)

Isolated systolic hypertension ≥140 <90

Symptoms of hypertension
a. Much of no symptoms.
b. Pain in the back of the head.
c. Stiff neck.
d. Fatigue.
e. Nausea.
f. Shortness of breath.
g. Restless.
h. Vomiting.
i. Easily offended.
j. 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 are probably
involved in sustaining elevated BP (the mosaic theory).
1. Primary hypertension
 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 hypertension.
Use of sympathomimetics, corticosteroids, cocaine, 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 pressure increases
and arteriolar sclerosis begins
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 Aneurysm
narrowing

Damage to
your
arteries
COMPLICATIONS

Enlarged
left heart
Coronary
Heart
artery
failure
disease

Damage to
your heart
COMPLICATIONS

Stroke Dementia

Transient Mild
ischemic cognitive
attack (TIA) Damage to impairment
your brain
COMPLICATIONS
Kidney scarring
(glomerulosclerosis)
Kidney
Kidney
artery
failure
aneurysm

Damage to
your kidneys
COMPLICATIONS
Fluid buildup under
the retina
(choroidopathy)

Eye blood vessel

Nerve damage
damage
(opticneuropathy).
(retinopathy)

Damage to
your eyes
CLINICAL MANIFESTATION

 Early morning headache

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

 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
Acute pain: headache related to
increased cerebral vascular pressure

The pressure does not increase

cerebral vascular

a. Maintain bed rest, quiet neighborhood, a little light.

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
The circulation of
the body is not impaired
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

Patients are met in terms of

information about hypertension
1. Describe the nature of the disease and the purpose of the
procedure and the treatment of 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 to avoid constipation in 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 effects.
10.Explain the need to avoid drug-free, without a doctor's
examination
Decreased Cardiac output related to increased
afterload, vasoconstriction, myocardial
ischemia, ventricular hypertrophy
Clients want to participate in activities
that lower blood pressure / cardiac workload

1. Monitor your blood pressure . Measure

in both arms / thighs for initial evaluation
. Use the proper cuff size and accurate
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 commotion, limit
the number of visitors and length of stay.
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
 EVALUATION
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 patient’s normal
range.
8. Maintain blood pressure within individually acceptable range.
9. Participate in activities that reduce blood pressure /cardiac
workload.