Nursing Care Plan: DEFICIENT KNOWLEDGE, NATURE OF & COMPLICATIONS OF HYPERTENSION/MANAGEMENT REGIMEN – RISK FOR INEFFECTIVE THERAPEUTIC REGIMEN MGT.

knowledge deficit and non compliance

Nursing Care Plan for Hypertension:

The effective treatment of hypertension requires the patient to make a commitment to lifelong therapy and lifestyle modification. Nursing care plan for hypertension interventions should  focus on teaching the patient and the family about the disease, its associated risk factors, and the importance of the adherence to the medical regimen.

Nursing Care Plan for Hypertension Related Factors:

Deficient Knowledge:

  • Cognitive limitation
  • Lack of interest
  • Lack of information

Risk for Ineffective Management:

  • Complexity of regimen
  • Financial costs
  • Social support deficits
  • Fears about treatment and possible side effects
  • Conflicting health values

AS EVIDENCED BY

  • Statement of misconceptions, knowledge gaps
  • Request for information
  • Lack of questions

Nursing Care Plan for Hypertension PLAN AND OUTCOME

  • Patient verbalizes understanding of the disease & its long-term effects on target organs.
  • Patient describes self-help activities to be followed.
  • Patient describes system for taking medications.
  • Patient describes positive effort to lose weight & restrict sodium as appropriate.
  • Patient verbalizes intention to follow prescribed regimen.

NURSING CARE PLAN FOR HYPERTENSION INTERVENTIONS

ON GOING ASSESSMENT

  • Assess knowledge of disease and prescribed management.  Patients need to understand that hypertension is a chronic, lifelong disease in which they have a vital role in effective management.

THERAPEUTIC INTERVENTIONS

  • Encourage questions about hypertension and prescribed treatments.  Knowledge serves to correct faulty ideas.
  • Involve family or significant others.  They can effectively provide support with the treatment regimen.  Family members also need to be screened for hypertension because of its familial tendency.
  • Instruct the patient that hypertension cannot be diagnosed with only one measurement.  There are wide variations in “normal” blood pressure over the course of a day or week due to biological and diurnal effects.  Thus the JNC-7 states that a diagnosis can be established only with the average of 2 or more BP readings on 2 or more occasions.
  • Instruct the patient to self-measure BP and suggest home monitoring equipment as appropriate.  This provides the patient with a sense of control and ability to seek prompt medical attention.
  • Plan teaching in stages, providing information in the following areas:
  1. Definition of hypertension, differentiating between systolic and diastolic pressures; prehypertension.
  2. Causes of hypertension.  Patients need to realize that 90% of hypertension is not related to primary cause.
  3. Risk factors: family history, obesity, diet high in saturated fat and cholesterol, smoking and stress.  Implementing lifestyle changes is the cornerstone of treatment.
  4. Nature of disease and its effect on target organs (e.g., renal damage, visual impairment, heart disease, stroke).  There are few signs and symptoms associated with hypertension until target organ damage occurs.
  5. Treatment goal “control” versus “cure”.  Hypertension is a chronic, lifelong disease.  It is treated with medication and lifestyle changes.  Treatment should not be stopped because the patient feels better or has problems with medication side effects.
  6. Rationale and strategy for weight reduction (if overweight).  Of all lifestyle changes, weight reduction has most consistently demonstrated BP-lowering effects.  Studies show weight reduction lowers BP at all ages and in all genders.  A body mass index of 25 or higher is strongly correlated with increased BP.  Weight loss of just 10 pounds can lower BP.
  7. Rationale & strategy for adopting the Dietary Approaches to Stop Hypertension (DASH) diet. The DASH diet is high in fruits, vegetables and low-fat dairy products and low in total and saturated fats.  Studies report an average reduction in systolic BP of 8 to 14 mm Hg.
  8. Rationale and strategies for low- sodium diet. Dietary sodium contributes to fluid retention and elevated BP, although not all patients are “salt sensitive” and lower blood pressure with sodium restriction. Patients find it difficult to adhere to salt reduction. Therefore attention needs to be directed to level of knowledge about fresh versus canned foods versus fast foods, cultural preferences, and financial ability to purchase low-salt foods.
  9. Common medications: thiazide diuretics, ?-blockers, angiotensin II receptor blocker (ARBs), calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors. A wide range of medications is available. Coexisting “compelling conditions” also guide drug selection.
  10. Establishment of medication routine considering daily activities and sleep habits.  This will minimize the chance of error and encourage better compliance with therapy.
  11. Possible side effects of medications.  Warn the patient of possible side effects so that he or she understands what to do if they occur.  Explain that not all persons experience side effects.  If they do occur and are bothersome (pedal edema, fatigue, hypokalemia, impotence), discuss them with the health care provider before discontinuing medications.  Side effects are the most common reason for noncompliance with medications.
  12. Interaction with over-the-counter drugs such as cough and cold medicines, aspirin compounds and herbal medications.  These drugs have a vasoconstricting effect.
  13. Rationale and strategy for reduction of alcohol intake.  Research indicates that alcohol intake of more than 3 to 4 standard drinks per day is associated with high BP.  Limit alcohol consumption to no more than 2 drinks per day for men and 1 drink per day for women.
  14. Need for potassium-rich foods (e.g., fruit juices, bananas) as appropriate.  Some diuretics are potassium wasting; however, most ACE inhibitors and ARBs retain potassium.
  15. Smoking cessation.  Smoking causes vasoconstriction and contributes to reduced tissue oxygenation by reducing oxygen availability.
  16. Role of physical exercise.  Research supports a positive effect of exercise in maintenance of weight loss as well as BP lowering.
  17. Relaxation techniques to combat stress.  These can influence physiological responses that aggravate hypertension.
  18. Signs and symptoms to report to health care provider: chest pain, shortness of breath, edema, weight gain greater than 2 pounds per day or 5 pounds per week, nosebleeds, changes in vision, headaches and dizziness.
  • Observe the following safety measure:
  1. Avoid sudden changes in position.  This reduces severity of orthostatic hypotension.  This is especially evident in older patients with longstanding hypertension that is reduced too rapidly.
  2. Avoid hot tubs and saunas.  These cause vasodilation and potential hypotension.
  3. Avoid prolonged standing; wear support stockings as needed.  Standing can cause venous pooling.
  • Include patient in planning treatment regimen.  Patients who become co-managers of their care have a greater stake in achieving a positive outcome.

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