Assessment for Hypertension
Patient Identity
- Name, age, gender, occupation, marital status.
Medical History
- Family history of hypertension, diabetes mellitus, dyslipidemia, coronary heart disease, stroke or kidney disease.
- The length and degree of high blood pressure before and outcomes and side effects of antihypertensive drugs before.
- History or current symptoms of coronary heart disease and heart failure, cerebrovascular disease, peripheral vascular disease, diabetes mellitus, gout, dyslipidaemia, bronchial asthma, sexual dysfunction, kidney disease, other diseases that manifest and information drugs taken.
- Assessment of risk factors including dietary fat, sodium, and alcohol, the number of cigarettes, physical activity level, and weight gain since early adulthood.
- History drugs or other substances that can increase blood pressure , including oral contraceptives, nonsteroidal anti-inflammatory drugs, liquorice, cocaine and amphetamines. Attention also to the use of erythropoietin, cyclosporine or steroids for the same disease.
- Personal factors, psychosocial, and environmental that could affect the outcome of antihypertensive treatment including family situation, work environment, and educational background.
Assessment
Activity / Rest
- Symptoms : weakness, fatigue, shortness of breath, monotonous lifestyle.
- Signs : increased heart rate, changes in heart rhythm, tachypnea.
- Symptoms : history of hypertension, atherosclerosis, coronary heart disease / valve and cerebrovascular disease, episodes of palpitations, precipitation.
- Signs : The increase in blood pressure (BP serial measurements of the increase required for diagnosis), postural hypotension (possibly related to the drug regimen). Pulse : clear pulsation of the carotid, jugular, radial, femoral pulse differences such pulse slows, as compensation for radial or brachial pulses ; pulse popliteal, posterior tibial, pedalis no palpable or weak. Frequency / rhythm : tachycardia, various dysrhythmias . Heart sounds : sounds s2 on the base ; s3 (early CHF) ; s4 (shift left ventricular / left ventricular hypertrophy). Valvular stenosis murmur . Carotid vascular rustling sound above, femoral, or epigastric (arterial stenosis). Jugular venous distention (venous congestion). Extremities : skin discoloration, cold temperatures (peripheral vasoconstriction) ; capillary may be slow / delayed (vasoconstriction). Skin - pale, cyanosis and diaphoresis (congestion, hypoxemia) ; redness (pheochromocytoma).
Ego integrity
- Symptoms: History personality changes, anxiety, depression, euphoria, or angry chronic (may indicate cerebral damage).
- Signs : The whirlwind of mood, anxiety, continuous narrowing of attention, a cry which exploded. Empathy hand gestures, facial muscle tension (especially around the eyes), rapid physical movements, breathing heaved, increased speech patterns.
- Symptoms : Impaired renal current or past (eg, infection / obstruction or a history of kidney disease the past).
- Symptoms : The food is preferred, which may include foods high in salt, high fat, high cholesterol (such as fried foods, cheese, eggs) ; sugars are colored black ; high calorie content. Nausea, vomiting. Changes in body weight lately (increase / decrease). History of the use of diuretics.
- Signs : Normal weight or obese. Edema (general or specific as possible) ; venous congestion, jugular venous distention ; glycosuria (almost 10 % of hypertensive patients are diabetic).
- Symptoms : Complaints of dizziness / headaches. Pulsed, suboccipital headache (occurs when wake up and disappear spontaneously after a few hours). Episodes of numbness and / or weaknesses on one side of the body. Impaired vision (diplopia, blurred vision). Episodes of epistaxis.
- Signs : Mental status : changes in waking, orientation, pattern / talk content, affect, thought processes, or memory (memory). Motor response : a decrease in grip strength and / or deep tendon reflexes. Changes in retinal optics : from sclerosis / mild to severe arterial narrowing and sclerotic changes with edema or papilloedema, exudates, and hemorrhage depending on the weight / length of hypertension.
- Symptoms : angina (coronary artery disease / heart involvement). Intermittent pain in the legs / claudication (arteriosclerosis in the arteries indication).
- Symptoms: respiratory distress / use of accessory muscles of respiration. Additional breath sounds (crackles / wheeze). Cyanosis.
- Symptoms : Impaired coordination / gait. Episodes of transient paresthesias unilateral postural hypotension.
- Symptoms : family risk factors : hypertension, atherosclerosis, heart disease, diabetes mellitus, cerebrovascular disease / kidney. Ethnic risk factors, such as African-Americans, South East Asia. The use of birth control pills or other hormones ; use of drugs / alcohol.
Physical Examination
- Measurement of height and weight and calculation of BMI (Body Mass Index) is the weight in kilograms divided by height in square meters.
- Measurement of blood pressure.
- Examination of the cardiovascular system, especially the size of the heart, evidence of heart failure, carotid artery disease, renal, and other peripheral and aortic coarctation.
- Examination of the lungs presence of crackles and bronchospasm, and noisy abdomen, enlarged kidneys and other tumors.
- Examination of the optic fundus and nervous system to determine the possibility of cerebrovascular damage.
5 Nursing Diagnosis for Hypertension
- Risk for decreased cardiac output related to vasoconstriction of blood vessels.
- Activity intolerance related to general weakness, imbalance between supply and demand of O2.
- Impaired sense of comfort : pain : headache related to increased cerebral vascular pressure.
- Imbalanced Nutrition Less than Body Requirements related to inadequate nutritional intake, cultural beliefs, monotonous lifestyle.
- Ineffective individual coping related to ineffective coping mechanisms , unmet expectations , unrealistic perceptions .
