Nursing Care Plan – Hypertension

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Hypertension (HTN) or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. It is the opposite of hypotension. Hypertension is classified as either primary (essential) or secondary. About 90–95% of cases are termed "primary hypertension", which refers to high blood pressure for which no medical cause can be found. The remaining 5–10% of cases (Secondary hypertension) are caused by other conditions that affect the kidneys, arteries, heart, or endocrine system

Pathophysiology of Hypertension


Although hypertension is usually treated in a community setting, management of stages III and IV with symptoms of complications/compromise may require inpatient care, especially when TOD is present. The majority of interventions included here can be used in either setting.


  1. Cerebrovascular accident/stroke
  2. Myocardial infarction
  3. Psychosocial aspects of care
  4. Renal failure: acute
  5. Renal failure: chronic
  6. Patient Assessment Database


May report :
  • Weakness, fatigue, shortness of breath, sedentary lifestyle
  • May exhibit:
  • Elevated heart rate
  • Change in heart rhythm
  • Tachypnea; shortness of breath with exertion


May report:
History of intermittent or sustained elevation of diastolic or systolic blood pressure; presence of atherosclerotic, valvular, or coronary artery heart disease (including myocardial infarction [MI], angina, heart failure [HF]) and cerebrovascular disease (reflecting TOD)
Episodes of palpitations, diaphoresis

May exhibit:
Elevated blood pressure (BP) (serial elevated measurements are necessary to confirm diagnosis) Note: Postural hypotension, when present, may be related to drug regimen or reflect dehydration or reduced ventricular function.

Bounding carotid, jugular, radial pulsations; pulse disparities, e.g., femoral delay as compared with radial or brachial pulsation; absence of/diminished popliteal, posterior tibial, pedal pulses

Apical pulse:
Point of maximal impulse (PMI) possibly displaced and/or forceful

Tachycardia, various dysrhythmias

Heart sounds:
Accentuated S2 at base; S3 (early HF); S4 (rigid left ventricle/left ventricular hypertrophy)
Murmurs of valvular stenosis
Vascular bruits audible over carotid, femoral, or epigastrium (artery stenosis); jugular venous distension (JVD) (venous congestion)

Discoloration of skin, cool temperature (peripheral vasoconstriction); capillary refill possibly slow/delayed (vasoconstriction)

Pallor, cyanosis, and diaphoresis (congestion, hypoxemia); flushing (pheochromocytoma)


May report:
History of personality changes, anxiety, depression, euphoria, or chronic anger (may cerebral impairment)
Multiple stress factors (relationship, financial, job-related)

May exhibit:
Mood swings, restlessness, irritability, narrowed attention span, outbursts of crying
Emphatic hand gestures, tense facial muscles (particularly around the eyes), quick physical movement, expiratory sighs, accelerated speech pattern


May report:
Past or present renal insult (e.g., infection/obstruction or past history of kidney disease)

May report:
  • Food preferences, which include high-salt, high-fat, high-cholesterol foods (e.g., fried foods, cheese, eggs); licorice; high caloric content; low dietary intake of potassium, calcium, and magnesium
  • Nausea, vomiting
  • Recent weight changes (gain/loss)
  • Current/history of diuretic use

May exhibit:
  • Normal weight or obesity
  • Presence of edema (may be generalized or dependent); venous congestion, JVD
  • Glycosuria (almost 10% of hypertensive patients are diabetic, reflecting TOD)


May report:
  • Fainting spells/dizziness
  • Throbbing, suboccipital headaches (present on awakening and disappearing spontaneously after several hours)
  • Episodes of numbness and/or weakness on one side of the body, brief periods of confusion or difficulty with speech (transient ischemic attack [TIA]); or history of cerebrovascular accident (CVA)
  • Visual disturbances (diplopia, blurred vision)
  • Episodes of epistaxis

May exhibit:
  • Mental status: changes in alertness, orientation, speech pattern/content, affect, thought process, or memory
  • Motor responses: decreased strength, hand grip, and/or deep tendon reflexes
  • Optic retinal changes: from mild sclerosis/arterial narrowing to marked retinal and sclerotic changes with edema or papilledema, exudates, hemorrhages, and arterial nicking, dependent on severity/duration of hypertension (TOD)


May report:
  • Angina (coronary artery disease/cardiac involvement)
  • Intermittent pain in legs/claudication (indicative of arteriosclerosis of lower extremity arteries)
  • Severe occipital headaches as previously noted
  • Abdominal pain/masses (pheochromocytoma)


(Generally associated with advanced cardiopulmonary effects of sustained/severe hypertension)

May report:
  • Dyspnea associated with activity/exertion
  • Tachypnea, orthopnea, paroxysmal nocturnal dyspnea
  • Cough with/without sputum production
  • Smoking history (major risk factor)

May exhibit:
  • Respiratory distress/use of accessory muscles
  • Adventitious breath sounds (crackles/wheezes)
  • Pallor or cyanosis


May report/exhibit:
  • Impaired coordination/gait
  • Transient episodes of numbness, unilateral paresthesias
  • Light-headedness with position changes
  • sexuality

May report:
  • Postmenopausal (major risk factor)
  • Erectile dysfunction (medication related)


May report:
  • Familial risk factors: hypertension, atherosclerosis, heart disease, diabetes mellitus, cerebrovascular/kidney disease
  • Ethnic/racial risk factors, e.g., more prevalent in African-American and Southeast Asian populations
  • Use of birth control pills or other hormones; drug/alcohol use

Discharge plan considerations:
  • DRG projected mean length of inpatient stay: 3.5 days
  • Assistance with self-monitoring of BP
  • Periodic evaluation of and alterations in medication therapy
  • Refer to section at end of plan for postdischarge considerations.

  1. Hemoglobin/hematocrit: Not diagnostic but assesses relationship of cells to fluid volume (viscosity) and may indicate risk factors such as hypercoagulability, anemia.
  2. Blood urea nitrogen (BUN)/creatinine: Provides information about renal perfusion/function.
  3. Glucose: Hyperglycemia (diabetes mellitus is a precipitator of hypertension) may result from elevated catecholamine levels (increases hypertension).
  4. Serum potassium: Hypokalemia may indicate the presence of primary aldosteronism (cause) or be a side effect of diuretic ­therapy.
  5. Serum calcium: Imbalance may contribute to hypertension.
  6. Lipid panel (total lipids, high-density lipoprotein [HDL], low-density lipoprotein [LDL], cholesterol, triglycerides, phospholipids): Elevated level may indicate predisposition for/presence of atheromatous plaquing.
  7. Thyroid studies: Hyperthyroidism may lead or contribute to vasoconstriction and hypertension.
  8. Serum/urine aldosterone level: May be done to assess for primary aldosteronism (cause).
  9. Urinalysis: May show blood, protein, or white blood cells; or glucose suggests renal dysfunction and/or presence of diabetes.
  10. Creatinine clearance: May be reduced, reflecting renal damage.
  11. Urine vanillylmandelic acid (VMA) (catecholamine metabolite): Elevation may indicate presence of pheochromocytoma (cause); 24-hour urine VMA may be done for assessment of pheochromocytoma if hypertension is intermittent.
  12. Uric acid: Hyperuricemia has been implicated as a risk factor for the development of hypertension.
  13. Renin: Elevated in renovascular and malignant hypertension, salt-wasting disorders.
  14. Urine steroids: Elevation may indicate hyperadrenalism, pheochromocytoma, pituitary dysfunction, Cushing’s syndrome.
  15. Intravenous pyelogram (IVP): May identify cause of secondary hypertension, e.g., renal parenchymal disease, renal/ureteral ­calculi.
  16. Kidney and renography nuclear scan: Evaluates renal status (TOD).
  17. Excretory urography: May reveal renal atrophy, indicating chronic renal disease.
  18. Chest x-ray: May demonstrate obstructing calcification in valve areas; deposits in and/or notching of aorta; cardiac enlargement.
  19. Computed tomography (CT) scan: Assesses for cerebral tumor, CVA, or encephalopathy or to rule out pheochromocytoma.
  20. Electrocardiogram (ECG): May demonstrate enlarged heart, strain patterns, conduction disturbances. Note: Broad, notched P wave is one of the earliest signs of hypertensive heart disease.

  1. Maintain/enhance cardiovascular functioning.
  2. Prevent complications.
  3. Provide information about disease process/prognosis and treatment regimen.
  4. Support active patient control of condition.

  1. BP within acceptable limits for individual.
  2. Cardiovascular and systemic complications prevented/minimized.
  3. Disease process/prognosis and therapeutic regimen understood.
  4. Necessary lifestyle/behavioral changes initiated.
  5. Plan in place to meet needs after discharge.

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