Nursing management

• Nursing Assessment
  • Subjective Data
    • Important Health Information
      • Past health history: Known duration and past workup of high BP; cardiovascular, cerebrovascular, renal, or thyroid disease; diabetes mellitus; pituitary disorders; obesity; dyslipidemia; menopause or hormone replacement status
      • Medications: Use of any prescription or over-the-counter, illicit, or herbal drugs or products; previous use of antihypertensive drug therapy
    • Functional Health Patterns
      • Health perception–health management: Family history of hypertension or cardiovascular disease; tobacco use, alcohol use; sedentary lifestyle; health literacy; readiness for change
      • Nutritional-metabolic: Usual salt and fat intake; weight gain or loss
      • Elimination: Nocturia
      • Activity-exercise: Fatigue; dyspnea on exertion, palpitations, exertional chest pain; intermittent claudication, muscle cramps; usual pattern and type of exercise
      • Cognitive-perceptual: Dizziness; blurred vision; paresthesias
      • Sexual-reproductive: Erectile dysfunction, decreased libido
      • Coping–stress tolerance: Stressful life events
  • Objective Data
    • Cardiovascular
      • SBP consistently >140 mm Hg or DBP >90 mm Hg for patients 150 mm Hg or DBP >90 mm Hg for patients >60 years old.
      • Orthostatic changes in BP and HR; bilateral BPs significantly different; abnormal heart sounds; laterally displaced apical pulse; diminished or absent peripheral pulses; carotid, renal, or femoral bruits; peripheral edema
    • Gastrointestinal
      • Obesity (BMI ≥30 kg/m2); abnormal waist-hip ratio
    • Neurologic
      • Mental status changes
  • Possible Diagnostic Findings
    • Abnormal serum electrolytes (especially potassium)
    • Increased BUN, creatinine, glucose, cholesterol, and triglyceride levels
    • Proteinuria, albuminuria, microscopic hematuria
    • Evidence of ischemic heart disease and Left Ventricular Hypertrophy on ECG
    • Evidence of structural heart disease and left ventricular hypertrophy on echocardiogram; evidence of arteriovenous nicking, retinal hemorrhages, and papilledema on funduscopic examination
  • BP Measurement
    • Take in both arms initially
    • Proper size and placement of cuff
    • Can use forearm if needed
      • Document site
    • Assess for orthostatic hypotension
      • BP and HR supine, sitting, and standing
      • Measure within 1 to 2 minutes of position change
      • Positive if decrease of 20 mm Hg or more in SBP, decrease 10 mm Hg or more in DBP, or increased 20 beats/minute or more in heart rate

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