NURSING CARE OF GERONTIK

HYPERTENSION

PRESENTED BY:

PRADHEVI ANGELITA WIJAYA

GRADE : II.A

POLYTHENIC OF HEALTH MINISTRY OF HEALTH

PALEMBANG

NURSING MAJOR

2014-2015
 HYPERTENSION

A. Definition

Hypertension is a condition of the systolic pressure exceeds 140 mmHg or

diastolic blood pressure higher than 90 mmHg. This diagnostic can be
ascertained by measuring the average blood pressure at two separate times
(FKUI, 2001).

According to WHO (1978) limits the blood pressure is considered normal

is 140/90 mmHg and blood pressure at or above 160/95 mmHg declared as
hypertension. Hypertension is an increase in blood pressure above normal is
when the systolic pressure (top) 140 mmHg or more and diastolic pressure
(bottom) of 90 mmHg or more.

Classification of Blood Pressure In Adults according to JNC VII

Classification of Blood Pressure in Adults according to JNC VII

Category Systolic Blood Pressure Diastolic Blood Pressure

Normal < 120 mmHg (and) < 80 mmHg

Pre-hypertension 120-139 mmHg (or) 80-89 mmHg

Stage of disease 1 140-159 mmHg (or) 90-99 mmHg

Stage of disease 2 >= 160 mmHg (or) >= 100 mmHg

In isolated systolic hypertension, systolic blood pressure to 140 mmHg or

more, but diastolic blood pressure less than 90 mmHg and diastolic pressure is
still within normal range. Hypertension is often found in the elderly. With age,
almost everyone experienced an increase in blood pressure; systolic pressure
continues to increase until the age of 80 years and diastolic pressures continue
to increase until the age of 55-60 years, then decrease slowly or even declined
 drastically.

B. Etiology
1. Age
Hypertension will increase at the age of 35 years is clearly raising the
incidence of arterial disease and premature death.
2. Gender
Man is generally occurs higher incidence than woman. But in middle age,
the incidence in females began to increase, so at the age of 65 years, the
incidence is higher in woman.
3. Race
Hypertension in the black skin at least twice than white skin.
4. Lifestyle
Factors such as education, income and lifestyle factors patients have been
studied, with no clear outcome. Low income, low education levels and life
or a stressful job seems associated with a higher incidence of hypertension.
Obesity is also seen as a major risk factor. Smoking is seen as a high risk
factor for hypertension and coronary artery disease. Hypercholesterolemia
and hyperglycemia are the main factors for the development of
atherosclerosis associated with hypertension.

Based on the causes, hypertension were divided into 2 groups:

1. Primary hypertension / essential

A hypertension of unknown cause, usually associated with heredity
and environment.
2. Secondary hypertension
Is a cause of hypertension which can be known with certainty, such as
vascular disorders and kidney disease.

C. Pathophysiology

The mechanisms that control the constriction and relaxation of blood

vessels located at the center of vasomotor, the brain medulla. This stems from
the central vasomotor sympathetic nerve pathways, which continues down to
the spinal cord and spinal column out of the sympathetic ganglia in the thorax
and abdomen. Vasomotor center stimulation is delivered in the form of an
impulse that moves downward through the sympathetic nervous system to the
sympathetic ganglia. At this point, the preganglionic neurons release
acetylcholine, which will stimulate the post-ganglion nerve fibers to the blood
vessels, where the release of noreepineprin lead to constriction of blood
vessels. Various factors such as anxiety and fear can affect the response to
stimuli vasoconstriction of blood vessels. Individuals with hypertension are
very sensitive to norepinephrine, although it is not clear why it could happen.

At the same time that the sympathetic nervous system stimulates the
blood vessels in response to emotional stimuli, the adrenal glands are also
stimulated, resulting in additional vasoconstriction activity. The adrenal
medulla secretes epinephrine, which causes vasoconstriction. Adrenal cortex
to secrete cortisol and other steroids, which can strengthen the vasoconstrictor
response of blood vessels. Vasoconstriction resulting in decreased flow to the
kidneys, causing release of renin. Renin stimulates the formation of
angiotensin I is then converted into angiotensin II, a potent vasoconstrictor,
which in turn stimulates aldosterone secretion by the adrenal cortex. This
hormone causes the retention of sodium and water by the kidney tubules,
causing an increase in intra-vascular volume. All these factors tend to trigger a
state of hypertension.

For consideration of gerontology. Structural and functional changes in

the peripheral vascular system responsible for blood pressure changes that
occur in the elderly. These changes include atherosclerosis, loss of elasticity of
the connective tissue and a decrease in vascular smooth muscle relaxation,
which in turn lowers the ability of distension and tensile strength of blood
vessels. Consequently, the aorta and large arteries decreases its ability to
accommodate the volume of blood pumped by the heart (stroke volume),
resulting in a decrease in heart fraudulent and increased peripheral resistance
(Brunner & Suddarth, 2002).
D. Clinical Manifestations
In the majority of patients, hypertension causes no symptoms, although
inadvertently some of the symptoms occur simultaneously and reliably
associated with high blood pressure (when in fact it is not). Symptoms in
question is headache, bleeding from the nose, dizziness, flushed face and
fatigue; which could have occurred both in patients with hypertension, or a
person with normal blood pressure. If hypertension is severe or chronic and
untreated, can result in the following symptoms:
Headache
Fatigue
Nausea
Breathless
Restless
The views become blurred that occurs because of damage to the brain, eyes,
heart and kidneys. Sometimes patients with severe hypertension experienced a
loss of consciousness and even coma due to brain swelling. This state is called
hypertensive encephalopathy, which require immediate action.
Signs and symptoms of hypertension can be divided into: (Edward K Chung,
1995).
a. No Symptoms
No specific symptoms that may be associated with increased blood
pressure, in addition to the determination of arterial pressure by the
examining physician. This mean arterial hypertension will never be
diagnosed if arterial pressure was not measured.
b. Symptoms Prevalent
It is often said that certainly the most common symptoms that
accompany hypertension include headache and fatigue. In fact, this is
certainly the most common symptom that affects the majority of
patients who seek medical attention.
E. Complications
As a result of prolonged hypertension is
The obstruction of coronary insufficiency
Heart failure
Renal Failure
Impaired nerve system
F. Examination Support
1. Examination Laboratory
Hb / Ht: to assess the relationship of the cells to the volume of fluid
(viscosity) and may indicate risk factors such as: hipokoagulabilitas,
ane mia. BUN / creatinine.
2. CT Scan
Assessing cerebral tumor, encelopati
3. ECG
May show the strain pattern, in which the area, the P wave elevation is
one of the early sign of hypertensive heart disease.

G. Management
1. Non-Pharmacological Treatment
Diet Restriction or reduction of salt intake. Weight loss can lower
blood pressure coupled with a decrease in plasma renin activity
and plasma levels in adosteron.
Activity
Clients are encouraged to participate in activities and adjusted
with medical restrictions and in accordance with abilities such as
walking, jogging, cycling or swimming.

2. Pharmacologic Treatment
In accordance with the recommendation of WHO / ISH by considering
the condition of the patient :
Start low doses are available, increase if the response is not yet
optimal, for example beta blockers ACE agent.
The combination of two drugs, low doses are better than one high-
dose drug. Example: diuretics with beta blockers.
If there is no response to the drug, the response is minimal or no
side effects other dressing DHA
Choose the work 24 hours, so that only once a day will improve
compliance.
Patients with diabetes and kidney insufistention early treatment is
the high normal blood pressure.
 NURSING CARE OF GERONTIK

1. Assessment of Nursing
A. Identity Of The Patient
Name
Gender
Age
Address
Religion
Medical diagnosis
B. The Patient Health History
Main complaint
History of present illness
History of the disease ago
Family disease history
C. Daily Activity Patterns
a. Activity / Rest
Symptoms:
Weakness, fatigue, shortness of breath, monotonous lifestyle.
Signs:
 Heart frequency increases, changes in heart rhythm, tachypnea.
b. Circulation
Symptoms:
History of hypertension, atherosclerosis, coronary heart
disease/valve and cebrocaskuler disease, episodes of
palpitations, perspiration.
Signs:
Increase blood preessure, valvular stenosis murmur, jugular
venous distention, pale skin, cyanosis, cold temperatures
(peripheral vasoconstriction) capillary may slow

c. Ego Integrity
Symptoms:
History personality changes, anxiety, multiple stress factors
(relationships, finances, work-related).
Signs:
Explosion of mood, anxiety, continue narrowing attention, cries
burst, facial muscle tension, breathing heaved, increased speech
patterns.
d. Elimination
Symptoms:
Impaired renal or current (such as obstruction or a history of
kidney disease in the past).
e. Food / fluids
Symptoms:
Preferred that includes foods high in salt, fat and cholesterol,
nausea, vomiting and changes lately of weight (up / down),
history the use of diuretics
Signs:
Normal body weight or obesity, edema, glikosuria.
f. Neurosensori
Symptoms:
Complaints dizziness, headache, impaired vision (diplobia,
blurred vision, epistakis).
Signs:
Mental status, changes in waking, orientation pattern / talk
content, effects thought processes, decrease in the strength of the
hand
g. Pain / discomfort
 Symptoms:
Angina (coronary artery disease / heart involvement), headache.

h. Breathing
Symptoms:
Dyspnea related activities / work tachypnea, orthopnea, dyspnea,
cough with / without the formation of sputum, history of smoking.
Signs:
Respiratory distress / respiratory accessory muscle use additional
breath sounds (wheezing), cyanosis.
2. Nursing Diagnosis
a. High risk reduction in cardiac output associated with increased
Afterloadvasokontriksi.
b. Activity intolerance related to general weakness.
c. Acute pain, headache associated with increased cerebral vascular
pressure.
d. Nutrition change more than body requirements related to the
metabolic monotonous lifestyle.
3. Nursing Interventions
a. A decrease in cardiac output or high risk of an increase in
afterload vasoconstriction
Purpose:
Decreased cardiac output does not occur Expected outcomes Clients
can rest in peace Rhythm and heart rate stabilized in the normal range
(80 100 x / min and regular). The blood pressure within normal limits
(BP <140/90 mmHg, n = 80 -100x / min, R = 16 22 x / i, S = 36 -37o
Intervention:
Observation of vital signs every day, especially blood pressure.
Rational: Comparison of increasing pressure is a picture of vascular
involvement
Observations color of skin, moisture and temperature
Rational: These things identify any decompensation / decrease in
cardiac output
Note the presence of edema general / specific
Rational: Can identify heart failure, kidney damage and vascular
Give a comfortable position (elevating the head of the bed)
Rational: Decrease the risk of increased intracranial pressure
Encourage relaxation techniques (take a deep breath)
Rational: To provide comfort and maximize lung expansion
Collaboration Diuretics and vasodilators fluid restricted diet Na
Rational: Reducing the burden on the heart.
b. Activity intolerance related to general weakness
 Purpose:
Client activity does not interfere with the outcomes improvement in
exercise tolerance vital signs within normal limits
Intervention:
Examine client's response to the activity
Rational: Determine the choice of further intervention
Observation vital signs
Rational: Knowing the parameters assist and assess the physiological
response to activity
Observe for chest pain, dizziness, fatigue and fainting.
Rational: If there is an indicator, work-related fatigue level of activity
Teach how to save energy
Rational: Helps balance between supply and demand O2
Give encouragement to perform the activity.
Rational: Advances increased activity towards preventing sudden
cardiac work

c. Impaired sense of comfort: headaches associated with increased

cerebral vascular pressure
Purpose:
Clients feel comfortable
Criteria Results:
Headache missing
Dizziness missing

Intervention:
Maintain bed rest during the acute phase.
Rational: Minimize stimulation / increase reabsorption
Give a cold compress, teach relaxation techniques
Rational: Action that decreases cerebral vascular pressure and block
the sympathetic response effectively and eliminate the
headaches.
Give an explanation how to minimize activity vasokontrisi
Rational: Activity that increase vasoconstriction causes headaches.
Assist patients in ambulansi as needed
Rational: Dizziness is always associated with headache
d. Changes in nutrients than the body needs relating to excessive
inputs with respect to metabolic needs
Purpose:
Changes in nutrients than the body needs is resolved outcomes BB
accordance with the ideal height and weight
Intervention:
Examine the patient's understanding of the relationship between
obesity and hypertension
Rational: Obesity is the additional risk of high blood pressure
Examine the daily caloric intake and diet selection
Rational: Determine intervention options more
Talk / discuss the importance of lowering caloric intake and limit salt
intake of fat and sugar as indicated
Rational: Foods such as high salt, fat and sugar support the
occurrence of atherosclerosis and obesity predisposes hypertension
Weigh weight per day
Rational: The inclusion of hydration client with an increase /
decrease in Hypertension
Refer to nutritionists as indicated.
Rational: Provide counseling and assistance to meet individual diet