| Nursing Interventions |
Rationale |
| Assess readiness and blocks to learning. Include significant other (SO). |
Misconceptions and denial of the diagnosis because of long-standing feelings of well-being may interfere with patient/SO willingness to learn about disease, progression, and prognosis. If patient does not accept the reality of a life-threatening condition requiring continuing treatment, lifestyle/behavioral changes will not be initiated/sustained. |
| Define and state the limits of desired BP. Explain hypertension and its effects on the heart, blood vessels, kidneys, and brain. |
Provides basis for understanding elevations of BP, and clarifies frequently used medical terminology. Understanding that high BP can exist without symptoms is central to enabling patient to continue treatment, even when feeling well. |
| Avoid saying “normal” BP, and use the term “well-controlled” to describe patient’s BP within desired limits. |
Because treatment for hypertension is lifelong, conveying the idea of “control” helps patient understand the need for continued treatment/medication. |
| Assist patient in identifying modifiable risk factors, e.g., obesity; diet high in sodium, saturated fats, and cholesterol; sedentary lifestyle; smoking; alcohol intake (more than 2 oz/day on a regular basis); stressful lifestyle. |
These risk factors have been shown to contribute to hypertension and cardiovascular and renal disease. |
| Problem-solve with patient to identify ways in which appropriate lifestyle changes can be made to reduce modifiable risk factors. |
Changing “comfortable/usual” behavior patterns can be very difficult and stressful. Support, guidance, and empathy can enhance patient’s success in accomplishing these tasks. |
| Discuss importance of eliminating smoking, and assist patient in formulating a plan to quit smoking. |
Nicotine increases catecholamine discharge, resulting in increased heart rate, BP, vasoconstriction, and myocardial workload, and reduces tissue oxygenation. |
| Reinforce the importance of adhering to treatment regimen and keeping follow-up appointments. |
Lack of cooperation is a common reason for failure of antihypertensive therapy. Therefore, ongoing evaluation for patient cooperation is critical to successful treatment.Compliance usually improves when patient understands causative factors and consequences of inadequate intervention and health maintenance. |
| Instruct and demonstrate technique of BP self-monitoring. Evaluate patient’s hearing, visual acuity, manual dexterity, and coordination. |
Monitoring BP at home is reassuring to patient because it provides visual/positive reinforcement for efforts in following the medical regimen and promotes early detection of deleterious changes. |
| Help patient develop a simple, convenient schedule for taking medications. |
Individualizing medication schedule to fit patient’s personal habits/needs may facilitate cooperation with long-term regimen. |
| Explain prescribed medications along with their rationale, dosage, expected and adverse side effects, and idiosyncrasies, e.g.:Diuretics: Take daily doses (or larger dose) in the early morning;Weigh self on a regular schedule and record;
Avoid/limit alcohol intake;
Notify physician if unable to tolerate food or fluid;
Antihypertensives: Take prescribed dose on a regular schedule; avoid skipping, altering, or making up doses; and do not discontinue without notifying the healthcare provider. Review potential side effects and/or drug interactions;
Rise slowly from a lying to standing position, sitting for a few minutes before standing. Sleep with the head slightly elevated. |
Adequate information and understanding that side effects (e.g., mood changes, initial weight gain, dry mouth) are common and often subside with time can enhance cooperation with treatment plan.Scheduling minimizes nighttime urination.Primary indicator of effectiveness of diuretic therapy.
The combined vasodilating effect of alcohol and the volume-depleting effect of a diuretic greatly increase the risk of orthostatic hypotension.
Dehydration can develop rapidly if intake is poor and patient continues to take a diuretic.
Because patients often cannot feel the difference the medication is making in blood pressure, it is critical that there is understanding about the medications’ working and side effects. For example, abruptly discontinuing a drug may cause rebound hypertension leading to severe complications, or medication may need to be altered to reduce adverse effects.
Measures reduce severity of orthostatic hypotension associated with the use of vasodilators and diuretics. |
| Suggest frequent position changes, leg exercises when lying down. |
Decreases peripheral venous pooling that may be potentiated by vasodilators and prolonged sitting/standing. |
| Recommend avoiding hot baths, steam rooms, and saunas, especially with concomitant use of alcoholic beverages. |
Prevents vasodilation with potential for dangerous side effects of syncope and hypotension. |
| Instruct patient to consult healthcare provider before taking other prescription or over-the-counter (OTC) medications. |
Precaution is important in preventing potentially dangerous drug interactions. Any drug that contains a sympathetic nervous stimulant may increase BP or counteract antihypertensive effects. |
| Instruct patient about increasing intake of foods/fluids high in potassium, e.g., oranges, bananas, figs, dates, tomatoes, potatoes, raisins, apricots, Gatorade, and fruit juices and foods/fluids high in calcium, e.g., low-fat milk, yogurt, or calcium supplements, as indicated. |
Diuretics can deplete potassium levels. Dietary replacement is more palatable than drug supplements and may be all that is needed to correct deficit. Some studies show that 400 mg of calcium/day can lower systolic and diastolic BP. Correcting mineral deficiencies can also affect BP. |
| Review signs/symptoms requiring notification of healthcare provider, e.g., headache present on awakening that does not abate; sudden and continued increase of BP; chest pain/shortness of breath; irregular/increased pulse rate; significant weight gain (2 lb/day or 5 lb/wk) or peripheral/abdominal swelling; visual disturbances; frequent, uncontrollable nosebleeds; depression/emotional lability; severe dizziness or episodes of fainting; muscle weakness/cramping; nausea/vomiting; excessive thirst. |
Early detection of developing complications/decreased effectiveness of drug regimen or adverse reactions to it allows for timely intervention. |
| Explain rationale for prescribed dietary regimen (usually a diet low in sodium, saturated fat, and cholesterol). |
Excess saturated fats, cholesterol, sodium, alcohol, and calories have been defined as nutritional risks in hypertension. A diet low in fat and high in polyunsaturated fat reduces BP, possibly through prostaglandin balance in both normotensive and hypertensive people. |
| Help patient identify sources of sodium intake (e.g., table salt, salty snacks, processed meats and cheeses, sauerkraut, sauces, canned soups and vegetables, baking soda, baking powder, monosodium glutamate). Stress the importance of reading ingredient labels of foods and OTC drugs. |
Two years on a moderate low-salt diet may be sufficient to control mild hypertension or reduce the amount of medication required. |
| Encourage patient to establish an individual exercise program incorporating aerobic exercise (walking, swimming) within patient’s capabilities. Stress the importance of avoiding isometric activity. |
Besides helping to lower BP, aerobic activity aids in toning the cardiovascular system. Isometric exercise can increase serum catecholamine levels, further elevating BP. |
| Demonstrate application of ice pack to the back of the neck and pressure over the distal third of nose, and recommend that patient lean the head forward, if nosebleed occurs. |
Nasal capillaries may rupture as a result of excessive vascular pressure. Cold and pressure constrict capillaries to slow or halt bleeding. Leaning forward reduces the amount of blood that is swallowed. |
| Provide information regarding community resources, and support patient in making lifestyle changes. Initiate referrals as indicated. |
Community resources such as the American Heart Association, “coronary clubs,” stop smoking clinics, alcohol (drug) rehabilitation, weight loss programs, stress management classes, and counseling services may be helpful in patient’s efforts to initiate and maintain lifestyle changes. |
Pancreatitis, which is the inflammation of the pancreas, can be acute or chronic in nature. It may be caused by edema, necrosis or hemorrhage. In men, this disease is commonly associated to alcoholism, peptic ulcer or trauma; in women, it’s associated to biliary tract disease. Prognosis is usually good when pancreatitis follows biliary tract disease, but poor when the factor is alcoholism. Mortality rate may go as high as 60% when the disease is associated from necrosis and hemorrhage. (Schilling McCann, 2009)
Nursing Diagnosis: Imbalanced Nutrition Less Than Body Requirements
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis: Risk for Imbalanced Nutrition Less Than Body Requirements
NURSING DIAGNOSIS: Risk for Imbalanced Nutrition: Less Than Body Requirements
NURSING DIAGNOSIS: Nutrition: imbalanced, less than body requirements
Nursing Diagnosis: Nutrition: imbalanced, less than body requirements
NURSING DIAGNOSIS: Nutrition: imbalanced, less than body requirements
NURSING DIAGNOSIS: Nutrition: imbalanced, less than body requirements