Clinical Research: Hypertension 1

Clinical Research Guidelines – Generic

HYPERTENSION

Medical Diagnosis (Overview of disease and cause):

• Normal blood pressure is defined as systolic blood pressure less than 120 mm Hg and
diastolic blood pressure less than 80 mm Hg in adults. Hypertension is defined as when
systolic BP is at or above 140 mm Hg and/or diastolic BP is at or above 90 mm Hg. This
only for those who do not have diabetes mellitus. (Ignatavicius & Workman, 2010, p.
796). Patients may also have ‘white coat hypertension’ which is a phenomenon when
patients exhibit elevated blood pressure in a clinical setting but not in a regular setting, in
their homes for example.

• There are no known causes for essential hypertension, but the following are considered as
associated risk factors: family history of hypertension, high sodium intake, excessive
calorie consumption and/or alcohol intake, physical inactivity, and low potassium intake.
(Ignatavicius & Workman, 2010, p. 798).

• Secondary hypertension may also be related to these factors, such as renal vascular and
renal parenchymal disease, primary aldosteronism, pheochromocytoma, cushing’s
disease, coarctation of the aorta, brain tumors, encephalitis, psychiatric disturbances, and
pregnancy. Medications such as estrogen, glucocorticoids, or mineralocorticoids also
could be contributing factors to secondary hypertension.

Usual Clinical Manifestations (signs and symptoms – holistic):

• Hypertension may not produce signs or symptoms initially, a patient may not learn about
his hypertension until it's picked up on a routine assessment. (Woods, 2004). Control of
hypertension has resulted in major decreases in the risk of cardiovascular morbidity and
morality. (Ignatavicius & Workman, 2010, p. 796).

• Malignant hypertension is a rapidly progressive condition. It is a severe type of elevated

blood pressure with symptoms such as morning headaches, blurred vision, and dyspnea
and/ or symptoms of uremia which is an accumulation in the blood of substances
ordinarily eliminated in the urine. The patients with malignant hypertension are often in
their 30s, 40s and 50s with a systolic BP greater than 200 mm Hg and a diastolic BP
greater than 150 mm Hg or 130 mm Hg with pre-exsisting complications. It is important
to monitor those patients with malignant hypertension closely as renal failure, left
ventricle failure, or stroke may occur. (Ignatavicius & Workman, 2010, p. 797).

Associated lab values and diagnostic tests including normal values:

Although there are no lab tests proven to diagnose essential hypertension, there are many
available to assess possible causes for secondary hypertension.

- Presence of protein, red blood cells, pus cells, and casts in the urine, elevated levels of
blood urea nitrogen (BUN), and elevated serum creatinine levels help indicate renal
disease
- Urinary test results are positive when there is a presence of catecholamines in patients
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with pheochromocytoma
- An elevation in levels of serum corticoids and 17-ketosterroids in the urine indicate
Cushing’s disease
- Electrocardiogram (ECG) determines the degree of cardiac involvement, left atrial and
ventricular hypertrophy is the first ECG sign of heart disease resulting from hypertension.
- X-rays are inefficient in the diagnosis of hypertension. Routine chest radiograph may be
of assistance in recognizing cardiomegaly, heart enlargement. (Ignatavicius & Workman,
2010, p. 799).
-
Medical/Surgical Interventions prescribed by the physician:
Most clients with hypertension need two or more medications to adequately control the goal of
blood pressure of less than 140/90 mm Hg, or 130/80 mm Hg for those with renal disease or
diabetes.
The physician prescribes drug therapy are listed as follows: (Ignatavicius & Workman, 2010, p.
801-802).

- Diuretics: Thiazide diuretics, such as hydrochlorothiazide. Loop-diuretics, such as Lasix.

C. Potassium-sparing diuretics, such as aldactone.
- Calcium Channel Blocking Agents, such as amlodipine, diltiazem.
- Angiotensin-Converting Enzyme (ACE) Inhibitors, such as captopril, enalapril.
- Angiotensin II Receptor Antagonists, such as candesartan, losartan.
- Aldosterone Receptor Antagonists, such as eplerenone.
- Beta-Adrenergic Blockers.
- Central alpha agonists.
-
Implications for Nursing
• Nursing assessments needed (physical, psychological, social, spiritual, economic):
• The nurse would first ask the client about age; ethnic origin or race; family history of
hypertension; average dietary intake of calories, sodium and potassium-containing foods,
alcohol; and exercise habits. Any past or present history of renal or cardiovascular disease
and current use of medications would also be assessed.

• Then the nurse now asks the clients whether they have had experiences of headaches,
dizziness, or fainting. Obtain blood pressure readings in both arms. It is vital that two or
more readings are taken for each client. Check the blood pressure in different positions,
such as lying, sitting, and standing, in order to detect orthostatic hypotension. Observe
vascular changes in the retina. Identify the several conditions that produce secondary
hypertension.

• Now assess for psychosocial stressors that can worsen hypertension and that may affect
the client’s ability to collaborate in treatment. Job-related and other life stressors are
evaluated, as well as the client’s response to these stressors. Ask the client about past
coping strategies to control hypertension.

• The last one is the client’s economic status. Ask the client is the head of the household or
not, the income and heath insurance is affected or not, and so on, and observe the client’s
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spiritual status.

• Common nursing diagnoses

- Deficient Knowledge related to information misinterpretation or unfamiliarity with
information resources
- Risk for Ineffective Therapeutic Regimen Management related to non adherence to
treatment.

• Usual nursing interventions for holistic care (treat, teach, refer):

For clients with essential hypertension, the nurse initially recommends the following lifestyle
modifications:
- Sodium restriction.
- Weight reduction.
- Moderation of alcohol intake.
- Exercise.
- Relaxation.
- Tobacco and caffeine avoidances.

Ensure patients are on appropriate drug therapy and teach the clients right concepts. Clients who
require pharmacological treatment to control essential hypertension usually need to take
medication for the rest of their lives.

For emergency care of clients with hypertension crisis, the following can be used to intervene:
- Place the client in a semi-Fowler’s position.
- Administer oxygen.
- Administer IV nitroprusside (Nitropride) nicardipine, (Cardene IV), or labetalol
(Normodyne). Monitor blood pressure every 5 to 15 minutes until the diastolic pressure is
also below 90 and not less than 75; then monitor blood pressure every 30 minutes.
- Observe for neurologic or cardiovascular complications.

• Include client/family teaching

Instruct the patient about sodium restriction, weight maintenance or reduction, alcohol restriction,
stress management and exercise. It is also important to instruct the need to stop the use of tobacco
(smoking), if necessary. Providing oral and written information about the indications, dosage, the
times for administration, side effects and drug interactions could also be useful for the client.
Urge patients to report any undesired/unpleasant side effects. (Ignatavicius & Workman, 2010, p.
803).

• Include psychosocial consideration

Hypertension is a chronic illness so it is vital to allow patients to verbalize feelings about the
disease and its treatment. Their involvement in the collaborative plan of care can lead to control
of the disease and prevent complications. They are likely to care about their health when advised
to do so.
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References:
Ignatavicius, D. & Workman, M. (2010). Medical-surgical nursing (6th ed.). St. Louis, MO: Elsevier Mosby.

Woods, A. (2004). Loosening the grip of hypertension. Nursing. 34(12), 36-46. Retrieved Feb15, 2011, from
ProQuest
Nursing journals database.