Hypertension is a medical that cause the narrowing of the blood vessels leading to exertion of excessive pressure against its walls. The heart works more than usual to maintain the high pressure resulting in persistent and abnormally high arterial blood pressure. The pressure of blood when the heart is beating has a value of 130mmHG or more, and the blood pressure values when the heart is resting between heart beats has a value of 80mmHG. Primary hypertension is the type with no known cause of high blood pressure. It develops gradually and may result from an individual’s lifestyle, environment, and change in the body due to growth. Secondary hypertension has causative factors such as medication, genetics, or underlying health conditions (Oparil et al., 2018).
The etiology of hypertension revolves around environmental, genetic, and pathophysiological factors. A vast percentage of about 90 to 95% of individuals suffering from hypertension acquired the disease due to genetic factors. People who have family members who have hypertension have a heritability of the condition for up to 35 to 50%. Environmental factors have also been considered to be causative agents of hypertension. High intakes of sodium, excess alcohol intake, high mental stress, sleep apnoea, and poor sleep quality are environmental factors lead to this disease. In addition to the genetic and environmental factors, there are pathophysiological factors like an increase in salt absorption that causes volume expansion, increased activation the brain to increase heart rate, and triggering the body system involved in maintain blood pressure. These changes increase the pressure of blood circulation in the heart triggering this disease (Oparil et al., 2018).
Very few individuals have signs and symptoms that indicate they have hypertension. The rest of the population with hypertension is asymptomatic. The most common symptoms are headaches mood disorders that range from irritability, low mood, and frustration. Constipation, backache, chest tightness, nosebleeds, and reduced vision are common disease symptoms. When a patient shows such signs, the probability is that the hypertension disease has reached its severe stage (Goodhart, 2016).
Since most individuals are asymptomatic, the best way to diagnose if an individual is suffering from hypertension is through regular clinical office visits to have blood pressure measurements. It is the most efficient method of diagnosing hypertension, and it helps to categorize the level of blood pressure, ascertain risk factors and guide the management of the disease. Other ways of measuring high blood pressure outside of the clinical office setting are at home or ambulatory blood pressure monitoring that are done at regular intervals (Oparil et al., 2018).
According to Oparil et al. (2018), another diagnostic measure is through screening. The patients are to be screened based on the history of clinical visits, physical examination, and routine laboratory investigations. Physical examinations are done to diagnose hypertension by determining the target organ damages and secondary causes of the disease. Physical examinations help the doctor rule out certain conditions similar to hypertension. Laboratory investigations detect risk factors and eliminate the risk of secondary hypertension among patients. It also helps to detect clinical and subclinical damages to internal body organs and estimate the rates of cardiovascular disease.
Subjective and objective data types are encountered when attending to patients. Subjective data is information from a patients point of view. These data may include visible events that they have noticed with their bodies, their emotional state and physical and mental problems they have observed. On the other hand, objective data is data that a nurse obtains through what they can see (Inger et al., 2017). Objective data is measurable and is obtained through the physical examination of a patient. Objective data includes laboratory test results, systolic and diastolic blood pressure, sleep duration, respiration for identifying chest tightness and checking on the eyes to gauge vision strength helps the nurse capture this data.
Subjective data can be obtained when a nurse inquires about common hypertension symptoms like chest pain, shortness of breath, and pulse. The family history of high blood pressure disease and patients’ daily activities would also provide subjective data. Subjective and objective data will give a nurse the background of the patients’ medical health, the signs and symptoms experienced, and hence define the treatment plan. However, objective data is more helpful than the two types of data. A nurse will conduct further investigation on a patient’s concerns, obtain first information from observation and measurements, and figure out the treatment process of the condition.
Laboratory tests that helps monitor the motion of the heart, determine the heart’s structure and show how the heart is pumping is through echocardiography imaging. Other tests that help assess organ damage from the disease are blood tests, lipid profile levels, and urine tests for determining secondary causes of hypertension and kidney damage (Inger et al., 2017).
The first-line treatment for hypertension is anti-hypertensive drug classes like thiazide diuretics of low and high doses. Studies have shown that they are the most effective since they are best proven to reduce mortality and morbidity rates. They are most efficient in primary and secondary prevention of cardiovascular conditions among patients with moderate to severe hypertension (Wright et al., 2018). The second-line treatment of hypertension is through beta-blockers, calcium channel blockers, angiotensin II receptor blockers, and alpha-blockers. They are essential in managing the side effects of the first-line treatment and providing treatment in cases where the first line of treatment failed.
There are several classes of medications used to treat hypertension. Diuretics class of medications help the body rid sodium and water excesses. It also helps to regulate blood pressure. Most common types of diuretics are thiazide diuretics, potassium-sparing diuretics and combination diuretics. Chlorthalidone, spironolactone and amiloride hydrochloride plus hydrochlorothiazide are examples of siuretic medications. Beta-blockers are another class of medications that helps in reducing the heart rate and the output of the blood, thereby lowering the blood pressure. Common beta-blockers medicines are atenolol, nadolol, and betaxolol. Angiotensin II receptor blockers are a class of medications that causes arteries to become narrow. They ensure that the blood vessels remain open hence reducing blood pressure. Examples of medications of this class are candesartan and valsartan (Oparil et al., 2018).
Apart from medications, there are various therapeutic interventions for managing hypertension. Meditations are the focusing of the mind on a particular thought or thing. It is considered a therapeutic intervention that minimizes the risk of heart and blood vessel diseases. It reduces the dependence on medications and increases the ability of the blood vessels to open up, thus reducing blood pressure. Omega-3 fatty acid supplements and garlic supplements also benefit patients by lowering blood pressure .
Different classes of hypertension medications have distinct side effects. The common side effects of hypertension medications of class Angiotensin II receptor blockers are occasional dizziness, and they may cause injury or death to pregnant women. Beta-blockers class of medications cause side effects like insomnia and symptoms of asthma. The diuretic class of medications causes a decrease in the supply of potassium minerals in a patient’s body. Diabetic patients suffering from hypertension experience increased blood sugar levels when using diuretic medications.
In some cases, patients may end up not taking medicines as prescribed. The high cost of medications may render patients unable to buy prescribed drugs and hence not take medications accordingly. Lack of symptoms also contributes to not taking medications. When patients feel like there are no improvements in health before and after taking medications, they may see no reason to continue with medication. Factors like lack of lifestyle modifications and limited access to care contribute to low adherence to hypertension medications (Carey et al., 2018).
With the diagnosis of hypertension, further laboratory investigations are necessary. Imaging techniques such as kidney or renal artery and adrenal imaging helps to understand abdominal pathology to identify the extensive organ failure of the kidneys concerning hypertension disease. Brain CT scans can help identify organ failure of the brain that is identified by hemorrhagic brain injury that results from hypertension. Blood laboratory tests are also vital as they help identify sodium and potassium levels in the blood. High sodium levels significantly indicate hypertension in a patient (Unger et al., 2020).
Patients with this condition are at a high risk of cardiovascular diseases. Heart attack and strokes are typical among patients with severe hypertension. Patients are also at risk of aneurysms, which weaken the blood vessels that lead to bulging and even ruptures that can become life-threatening. Hypertension is also associated with vision loss. Due to high blood pressure, the eyes’ blood vessels may be torn or narrow, leading to blindness.
There are several safety measures that patients with hypertension must consider while at home. They should increase physical activity and exercises such as walking, resistance, and aerobic training. Studies reveal that regular physical exercises contribute to good health and lowering blood pressure. Overweight individuals should prioritize weight loss to keep fit, reduce blood pressure and minimize the risk of potential medical problems. Measures like cutting down on sugar and carbohydrate intake are essential in managing weight. It is also advisable to take less sodium, processed foods and stop smoking and drinking alcohol.
There are challenges that threaten patients from not seeking medical care. The costs of diagnosing and treating patients with hypertension are considerable high. Poor economy results to a heavy burden on relatives and friends who participate in provision of funds to cater for these costs leading to a low affordability rate. Such conditions forces patients to do away with seeking medical attention. Health insurance coverage is a major boost when it comes to treating medical intensive conditions. However, patients who lack of medical insurance may find it challenging to cater for medical expenses and treatment. Patients may end up seeking medical interventions when their conditions have reached advanced stage where the risk of mortality is high.
Activity intolerance that involves assessing physical activity and mobility is a physical nursing diagnosis of hypertension. The nurse can monitor the blood pressure and pulse rate. Ineffective therapeutic regimen management is an education nursing diagnosis (Blumenthal et al., 2019). Such diagnosis are prominenet among patients who lack basic information regarding their conditions. It is especially because majority of people with hypertension are asymptomatic. Patients may also lack financial means of understanding, diagnosing and treating their medical conditions. A psychosocial nursing diagnosis is the lack of control over a patient’s condition. Being in a posiyion where you don’t know what to do or managing a medical condition may seem frustrating and can cause loss of hope and even lead to depression (Cuevas et al., 2017). The health assessment priorities for nursing diagnosis include minimizing the development of cardiovascular diseases, maintain a healthy heart, create awareness on hypertension, and reducing the sodium levels in the blood.
According to Thomas et al. (2019), patient education programs are crucial ways of imparting health literacy knowledge to patients. The study of American Association journals and other medical articles will impart patients with knowledge of hypertension. Nurses should establish of activity goals alongside patients with hypertension to manage their condition. Such activities include regular exercises to help improve their breathing and lower blood pressure. Exercises also aid in strengthening the muscles and improve their capacity to perform functions (Pandey et al., 2018). Provision of emotional support is an intervention for psychosocial conditions. Support can be provided by enhancing the confidence of patients to overcome the challenges of their conditions by incorporating words of encouragement when conversing with them. Nurses should encourage patients to express themselves and air their views (Blumenthal et al., 2019).
The goals that span a short period for hypertension treatment is reducing blood pressure. It also aims at regulating the contractility of the blood vessels. Goals that relate to a long time include reducing the mortality rate among patients with this disease and reducing retinopathy due to changes in vision and cardiovascular heart diseases. Another long-term goal is to regulate renal activity by stimulating the kidneys to eliminate water to reduce blood pressure (Kim et al., 2019).
Patient outcomes are worse when patients undergo intensive therapy without signs of organ damage during the diagnosis and treatment of hypertension. Asymptomatic outpatients under hypertension treatment are not associated with better outcomes for managing high blood pressure. Intensification of therapies for discharged patients is characterized by an increase in positive outcomes once organ damage or failure (Rastogi et al., 2021).
Patients suffering from hypertension need discharge instructions to manage their condition. One crucial instruction is taking medicines on time. The patients should set strategies to be integrated into patients’ routines to help them keep track of when to take medications. It should involve taking one’s blood pressure regularly, recording the results, and taking prescribed medications as directed. Lifestyle changes are an instruction that will help the patient to maintain a healthy lifestyle by managing weight gain and loss, cutting back on salt, following the eating plan on Dietary Approaches to Stop hypertension. Exercise programs, controlling stress, and breaking smoking habits are also ways of changing lifestyle to manage hypertension.
Follow-up care by hypertension patients should be made as directed by the healthcare staff. It reduces the chances of admitting patients back to the hospitals, and limit death. The patients should seek immediate emergency care if they experience symptoms like extreme drowsiness, weakness of the limbs, changes in vision, unexplained bleeding, and blood pressure measurements that surpass 180/110.
References
Blumenthal, J. A., Zhu, Y., Koch, G. G., Smith, P. J., Watkins, L. L., Hinderliter, A. L., Hoffman, B. M., Rogers, J. G., Chang, P. P., O’Connor, C., Johnson, K. S., & Sherwood, A. (2019). The modifying effects of social support on psychological outcomes in patients with heart failure. Health Psychology, 38(6), 502–508. https://doi.org/10.1037/hea0000716
Carey, R. M., Muntner, P., Bosworth, H. B., & Whelton, P. K. (2018). Prevention and control of hypertension: JACC health promotion series. Journal of the American College of Cardiology, 72(11), 1278-1293.
Doi: 0.016/j.jacc.2018.07.008
Cuevas, A. G., Williams, D. R., & Albert, M. A. (2017). Psychosocial factors and hypertension: a review of the literature. Cardiology clinics, 35(2), 223-230.
Doi: 10.1016/j.ccl.2016.12.004
Inger, H. E., Rogers, D. L., McGregor, M. L., Aylward,S. C., & Reem, R. E. (2017). Diagnostic criteria in pediatric intracranial hypertension. Journal of American Association for Pediatric Ophthalmology and Strabismus, 21(6), 492-495.
https://doi.org/10.1016/j/jaapos.2017.08.003
Oparil, S., Acelajado, M. C., Bakris, G. L., Berlowitz, D. R., Cifkova, R., Dominiczak, A. F., Grassi, G., Jordan, J., Poulter, N.R., …, & Whelton, P. K. (2018). Hypertension. Nature reviews. Disease primers, 4, 18014.
https://doi.org/10.1038/nrdp.2018.14
Pandey, A., Patel, K. V., Vaduganathan, M., Sarma, S., Haykowsky, M. J., Berry, J. D., & Lavie, C. J. (2018). Physical activity, fitness, and obesity in heart failure with preserved ejection fraction. JACC: Heart Failure, 6(12), 975-982. https://www.jacc.org/doi/abs/10.1016/j.jchf.2018.09.006
Rastogi, R., Sheehan, M. M., Hu, B., Shaker, V., Kojima, L., & Rothberg, M. B. (2021). Treatment and outcomes of inpatients hypertension among adults with noncardiac admission. JAMA internal medicine, 181(3), 345-352.
Doi: 10.1001/jamainternmed.2020.7501
Thomas, R. J., Beatty, A. L., Beckie, T. M., Brewer, L.C., Brown, T. M., Forman, D. E., … & Whooley, M. A. (2019). Home-based cardiac rehabilitation: a scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation, 140(1), e69-e89. Doi: 10.1161/CIR.0000000000000663
Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., …, & Schutte, A. E. (2020). 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension, 75(6), 1334-1357.
https://doi.org/10.1161/HYPERTENSIONAHA.120.15026
Wright, J. M., Musini, V. M., & Gill, R. (2018). First-line drugs for hypertension. Cochrane Database of systematic review, (4).
Doi: 10.1002/14651858.CD001841.pub3
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