Nursing diagnosis and hypertension

Dear Mom,

I know you have another appointment with the doctor regarding your high blood pressure. So I wanted to mention some areas that the nurse might want to discuss with you. There are several things that are important to monitor when one has high blood pressure. These are choices and habits that will effect your blood pressure, and consequently, your health. So it is really important that you think about how you handle these situations and be ready to discuss them with the nurse.

The nurse will ask you about your diet and whether you are able to maintain a healthy weight through eating a balanced diet, including vegetables and fruits. Also, she/he will want to answer any questions you might have about your understanding of what makes a healthy diet for management of blood pressure.(1)  She/he would like to know if you understand the steps that you need to take to manage your blood pressure and why this is important for your long term health.(1)  Your medications, how you take them and whether any side effects are making it hard to stay on schedule should be discussed.(1)  The nurse will also ask if you have had any shortness of breath, pain in your chest, episodes of feeling lightheaded or dizzy.(2) 

I understand from that you and Dad like to go out to restaurants several times a week and you are wondering how that will work with following a American Heart Association diet. So I hope you bring up these issues when you meet with the nurse. I am sure she would be happy to talk with you about your concerns.

Take care Mom, and I will be seeing you soon,

Your daughter, Mary




Following is some more info that can help you as the nurse for this patient:

Hopper, Student workbook for Understanding medical surgical nursing.

1 Ackley, B. (2008). Nursing diagnosis handbook: An evidence-based guide to planning care (8th ed.). St. Louis, Mo.: Mosby Elsevier.

2 Nanda Nursing Interventions. (n.d.). Retrieved February 28, 2015, from http://nandanursinginterventions.blogspot.com/2012/05/4-nursing-diagnosis-interventions-for.html

3 Hopper, P., & Williams, L. (2007). Student workbook for Understanding medical surgical nursing (3rd ed., p. 428). Philadelphia: F.A. Davis.

How nurses support patients with high blood pressure

(1)Bengtson, RNT PhD, A., & Drevenhorn, MA, RN, E. (2003, January 1). The Nurse's Role and Skills in Hypertension Care. Retrieved February 20, 2015, from http://www.medscape.com/viewarticle/463185_5

The journal article, The Nurse's Role and Skills in Hypertension Care, offered a comprehensive view of how important the nurse's care can be to patient's that have hypertension.  I had not considered the advantages nurses have such as time, educational role and lack of "white coat syndrome".  Reading this article strengthened my conviction to become a nurse! 

The Nurse's Role and Skills in Hypertension Care

Hypertensive Medications Unravelled

Dear Mom,

In my nursing classes we are learning about all of the different approaches that might be used to help treat a person's high blood pressure.  I know that you have told me in the past that your doctor keeps changing your blood pressure medications and you were wondering why.  As a child, you taught me that everyone is different.  And this principle applies to how we respond to medicine as well.  The doctors know approximately how people will respond to blood pressure medications.  So they start with the general type or types of medication that will work for your specific issues.  Such as a person with high blood pressure alone would have different medication options than a person with high blood pressure and kidney disease.

Once the doctor has selected a medication(s) for the person, they then follow how the patient is doing on the medication(s).  Do the medications work -- is their blood pressure coming down?  How does the patient feel on the medication -- are they having undesirable side effects?  Then they do fine tuning for each patient based upon their response.  You can click on the link below to check out how your drugs help manage your high blood pressure and the following list of side effects of two of the more common drugs.

As always, give me a call if you have any questions on this information.  I hope it answers your questions, but let me know if I have just added a bunch of new questions to your list!

Mary


Types of Blood Pressure Medications and what they do in our bodies

Blood-Pressure Medications Chart

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Two of the main therapies of treating hypertension are diuretics such as Lasix (Furosemide) and ACE Inhibitors such as Lisinopril and Vasotec.1  Side effects that people normally see are:

Lasix (common side effects)2

• High uric acid or low magnesium
• Loss of appetite
• Spasm of the bladder

Lasix (serious side effects)2

• Blood pressure that changes dramatically when you sit or stand up
• Drug hypersensitivity syndrome, Erythema multiforme, Erythroderma, Stevens-Johnson syndrome, Toxic epidermal necrolysis due to drug
• Inflammation of the Pancreas
• Agranulocytosis, Aplastic anemia, Thrombocytopenia
• Anaphylactoid reaction, Anaphylaxis

Lisinopril (common side effects)2

• Chest pain, Low blood pressure (up to 11% ), dizziness (5% to 7% )
• Dizziness (12% to 19% ), Headache
• Cough

Lisinopril (serious side effects)2

• Low blood pressure (Severe) (9% )
• Stevens-Johnson syndrome (1% or more ), Toxic epidermal necrolysis (1% or more )
• High potassium levels (2.2% to 6% )
• Intestinal swelling
• Allergic reaction due to insect stings or Dialysis
• Acute kidney failure, Kidney impairment (2.4% )
• Painful swelling of the Head and Neck

1 Madhur, MD, PhD, M. (2014, September 30). Hypertension Medication (D. Maron, MD, FACC, FAHA, Ed.). Retrieved February 14, 2015, from http://emedicine.medscape.com/article/241381-medication#2

2 Retrieved from  http://www.micromedexsolutions.com.offcampus.lib.washington.edu/micromedex2/librarian/PFDefaultActionId/evidencexpert.DoIntegratedSearch

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High Blood Pressure -- Signs and Symptoms

Dear Mom,

Yes, Mom, it is not uncommon for patients to be surprised when they hear they have high blood pressure (or hypertension as the doctors like to call it!).  The reason is that high blood pressure rarely has any recognizable symptoms. (1)  Most people walk around this earth feeling just fine, and then one year they have their annual checkup and learn their blood pressure is high.  This is so common!  

Of course there is the rare case when an individual develops a severe headache, severe anxiety, nosebleed or just can't catch their breath because of high blood pressure.  These people are usually in a hypertensive crisis and someone needs to call 911 right away.  Either the difference between their systolic pressure and their diastolic pressure is high or the systolic is above 180 or the diastolic is above 110.(1) Remember systolic is when the heart muscle pushes the blood out of the heart on its journey through the body and diastolic is when your heart muscle takes a break between pumps.

This is why high blood pressure is often called "The Silent Killer", because it is rarely felt by the person.

I can't emphasize enough how important it is for people to have their annual check-up with their health care provider.  I know you and dad are very faithful about seeing your doctor at least annually.  Please encourage your friends to do so as well.  If they can't see a doctor for some reason, encourage them to go to a pharmacy that has a blood pressure machine.  Most are free and if their blood pressure is different than 120/80, they can talk to the pharmacist about what to do.

And remember, even when people have not been diagnosed with high blood pressure, it is a good idea for them to take their blood pressure monthly -- again the machine at the pharmacy is a good place to go.  The reason I say this is because, our blood pressure can sometimes increase just because of a stressful day.  When a person takes their blood pressure regularly, they get to know their blood pressure range -- this is an important step in taking care of ourselves!

So Mom, when you went to the doctor, he measured different aspects of your body and the fluids in your body to look for signs of high blood pressure.  With this disease, signs are more telling than symptoms!  Here is a list of exams or tests that your doctor might have done to look for signs of (diagnosing) your high blood pressure:

-- Physical exam including your blood pressure and an eye exam

--Urinalysis

--Blood tests (BMP, CBC, Serum lipid profile, serum uric acid)

-- 12-lead ECG (measuring the impulses of your heart) (2)

Mom, I hope this helps and let me know what other questions you may have about hypertension:)

Mary

(1)  Understand Your Risk for High Blood Pressure. (n.d.). Retrieved February 7, 2015, from http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/UnderstandYourRiskforHighBloodPressure/Understand-Your-Risk-for-High-Blood-Pressure_UCM_002052_Article.jsp

(2)  Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Harding, M. (2014). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (9th ed., p. 715). St. Louis: Elsevier Mosby.