HYPERTENSE

(TASK SURGICAL MEDICAL NURSING I )

GROUP I
1. AGUNG KURNIAWAN (21118003)
2. DANDI IRAWAN (21118009)
3. INDRI ANGGRAINI (21118018)
4. KHARIZMA DINNAR (21118023)
5. LARAS WULANDARI (21118024)
6. NILAM CAHAYA (21118031)
7. RISVA HUDDALINAS (21118037)
8. RIZKIA PRAMADANI (21118038)
9. SASKIA PUTRI RAHMADANI (21118038)
10. SRI WACHYUNI (21118047)
11. UMMI AGUSTIRA (21118049)

SUPERVISOR :

SUKRON S.Kep.Ns.,M.Kep

NURSING SCIENCE PROGRAM INSTITUTE OF HEALTH

SCIENCE MUHAMMADIYAH PALEMBANG ACADEMIC
YEAR 2019/2020
 THE FOREWORD

We are thankful for saying the presence of allah SWT because of the
blessings of grace and luck so that we can complete this task entitled
“hypertension” on time and as well as possible.

As for the purpose of writing this paper is to add insight about hypertension
for readers and writers. We would like to thanks for Mr. Sukron S.Kep.,Ns.,M.Kep
as a lecturer in the field of surgical medical nursing I who has given this task so as
to increase our knowledge and insight. We realize, our task is far from perfect.
Therefore, constructive critism and suggestions we will look forward to for the
improvement of this task.

Palembang, Tuesday 17 september 2019

Sincere, the writer

Group 1

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Tables Of Content
Chapter one pereliminary............................................................................1

Background...........................................................................................1

Purpose.................................................................................................2

Chapter two basic concept....................................................................3

Definition..............................................................................................4

Anatomy and pshyology......................................................................4

Etiology................................................................................................6

Pathophysiology...................................................................................7

Clinical Manifestations.........................................................................8

Management.........................................................................................9

Complications.....................................................................................10

Intervention and Rational focus...........................................................14

Conclusion..........................................................................................20

Suggestion...........................................................................................20

Reference.............................................................................................20

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i
 CHAPTER I
PRELIMINARY
`
A. Background

In developed countries hypertension is one of the main health problems. In Indonesia,

hypertension is also a health problem that needs to be considered by health workers who work in
primary health care because of its high travel rates and the long-term consequences that it causes.
Based on the cause, hypertension is divided into 2 groups, namely primary hypertension with
unknown cause or idiopathic and secondary hypertension, namely hypertension caused by other
diseases. Epidemologically 30% of the world's population is sensitive to table salt poisoning
which can cause hypertension. There are several factors that influence hypertension prevention
such as race, age, obesity, excessive salt intake, and a family history of hypertension. For
symptoms of hypertension itself, patients usually complain of headache, dizzy eyes, nausea,
hypertension is not a true killer disease, but it is classified as The Sillent Killer (silent killer).
This disease is not real symptoms and must be aware of and needs to be treated as early as
possible because chronic hypertension if ignored, will suddenly bring havoc, such as heart
attacks and strokes. (Aziza, Lucky, 2007) In the United States 15% of the adult white group and
25% -30% of the adult black group are hypertensive patients.

According to the National Health and Nutrition Examinition Survey report in the last two
decades there has been an increase in the percentage of people's awareness of hypertension from
50% to 84%, the percentage of hypertensive patients receiving treatment that is from 36% to
73% and the percentage of hypertensive patients whose blood pressure is controlled from 16 %
to 55%. (Suyono, Slamet, 2003) In Indonesia until now there has not been a multicenter
investigation that can describe hypertension prevention precisely. According to Boedie Darmojo
in his writings compiled from various studies, reported that 1.8 - 28.6% of Indonesia's population
over the age of 20 are hypertensive patients. , 56%) compared to the number of cases of
hypertension in other districts or cities in Central Java. The fewest cases were in Tegal district,
516 cases (0.15%). While in the Surakarta area the number of hypertension sufferers was around
27.8%. (Health Profile of Central Java Province, 2004) Based on data obtained from the PKM
Muhammadiyah Surakarta hospital, hypertension sufferers who were hospitalized at PKU

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Muhammadiyah Surakarta hospital in 2011 were 309 cases, and in 2012 this was calculated from
January - April 2012 as many as 130 cases.

A. purpose

1. General Purpose
About a general description of hypertension nursing care
2. Special Purpose
Jelly:
a. Able to do hypertension assessment
b. Able to formulate a diagnosis of hypertension
c. Able to develop hypertension nursing plans
d. Able to perform hypertension nursing actions
e. Able to arrange hyperten nursing evaluation

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 CHAPTER II
BASIC CONCEPTS

A. Definitions

Hypertension is defined as persistent blood pressure where the systolic pressure is

above 140 mmHg and the diastolic pressure is above 90 mmHg. (Smeltzer, 2001)
According to WHO, hypertension is an increase in systolic pressure greater or equal to
160 mmHg and or diastolic pressure equal to or greater than 95 mmHg. (Nasrin, 2003).
Hypertension is defined by the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure JNC as pressures higher than 140/90
mmHg and classified according to severity, have a range from normal high blood pressure to
malignant hypertension.
So it can be concluded that hypertension is a persistence blood pressure where the
systolic pressure is above 140 mmHg and the diastolic pressure is above 90 mmHg and is
classified according to the severity, has a range of normal blood pressure.
Clinically the degree of hypertension according to Rahardjo (2000) can be grouped
according to the recommendations of "The Sixth Report of The Join National Committee,
Prevention, Detection and Treatment of High Blood Pressure" (JNCVI) as follows:

Category Systolic (mmHg) Diastolic (mmHg)

optimal <120 <80

Normal 120 – 129 80 – 84

High Normal 130 – 139 85 – 89

Hypertension

Grade 1 (Lightweight) 140 – 159 90 – 99

Grade 2 (medium) 160 – 179 100 – 109

Grade 3 (weight) 180 – 209 100 – 119

Grade 4 (very heavy) >210 >120

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B. Anatomy and Physiology

1. Anatomy
The cardiovascular system is a transport system that carries respiratory gas, nutrients,
hormones and other substances to and from body tissues. The cardiovascular system is built
by:
A. Heart
The heart is an organ that consists of muscles. The heart muscle is a special network
because it is seen from the shape and composition of the same as the latitude muscle, but
the way it works is the same as smooth muscle that is outside our will (influenced by the
autonomic nervous system).
Heart shape resembles a banana heart, the upper part is blunt (the heart base) and is
called the cord base. At the bottom is rather pointed, called the cordic apex.
The location of the heart in the front of the chest cavity (anterior mediastinal cavity),
the lower left from the middle of the chest cavity, above the diaphragm, and the base is
behind the left between the ribs V and VI two fingers under the papillae mamae. In this
place there is a heart called a cord chakra.
The size of the heart is about the size of a right hand grip and weighs approximately
250 - 300 grams.
a. Heart lining

Endocardium is a layer of the heart that is located on the inside which consists of
endothelial tissue or the lining of the lining lining the endothelial cavity or the lining of
the lining of the surface of the heart cavity.
Myocardium is the core layer of the heart consisting of heart muscles, these heart
muscles form muscle bundles, namely:
a. A circular muscle of the atria, which is on the left / right side and the cord base that
forms the portico or cord auricle.
b. Ventricular muscle bundles, which form the chambers of the heart, are circulated
from the atrioventricular ring to the apex of the heart.

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 c. The roundabout of the ventricular muscles is the dividing wall between the foyer
room and the chambers of the heart.
b. Valves - heart valves
In the heart there are valves - valves that are very important meaning in the
composition of blood circulation and movement of the human heart.
a. Valcula biscuspidalis, there is between the dextra atrium with the ventricle dextra
consists of 3 valves.
b. biscuspidalis vein, located between the atrial sinistra with ventricular sinistra
consisting of 2 valves.
c. the artillery pulmonary semilunar vulva, located between the ventricular dextra and
the pulmonary artery, where blood flows to the lungs.
d. the aortic semilunaris vein, located between the ventricular system with the right
aorta, blood flows throughout the body.

B. Blood vessels
a. arteries
Arteries are types of blood vessels that come out of the heart that carry blood
throughout the ventricular sinistra called the aorta. Arteries have 3 layers that are strong and
thick but are elastic and consist of 3 layers.
1. Intimate / internal tunica. Lapisa is most deeply related to blood and consists of
endothelial tissue.
2. Media Tunica. The middle layer consisting of muscle tissue consisting of smooth muscle
tissue.
3. External tunics / adventesia. The outermost layer is made up of overtime connective
tissue which strengthens the walls of the arteries.

b. Capillary
Capillaries are very small blood vessels palpated from the smoothest branches of
the arteries so they are not visible except from under a microscope. Webbing capillaries
in all body tissues. Capillaries then meet each other into larger blood vessels called
veins.

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 c. Veins (veins)
Veins carry dirty blood back to the heart Some important veins:
1. Superior vena cava
The return veins entering the right atrium carry dirty blood from the head region,
thorax and upper extremities.
2. Vena cava inferor
Veins that return dirty blood to the heart from all organs of the lower body.
3. Jugular vein cava
Veins that return dirty blood from the brain to the heart.

specifically the atrial delivery system to the ventricles there is a 1/10 second
slowdown between the way the heart implants and the atrium into the ventricles. This
allows the atrium to contract before the ventricles, the atrium acts as a primary pump for
the ventricles and ventricles and then provides the main source of energy for the
movement of blood through the vascular system.

C. Etiology
Hypertension based on the cause according to Mansjoer (2000) can be divided into 2
major groups namely:
1. Essential hypertension (primary hypertension)
is hypertension with unknown cause, also called idioptic hypertension, about 95% of
cases. Many factors influence it, such as genetics, environment, hyperactivity, sympathetic
nervous system, renin-angiostenin system, defects in Na excretion, increase in intracellular
Na and Ca, and factors that increase risk, such as obesity, alcohol, smoking.
Primary hypertension is found in more than 90% of people with hypertension, while
the remaining 10% is caused by secondary hypertension. Although primary hypertension is
not known with certainty the cause, research data have found several factors that often
cause hypertension. These factors are as follows:

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 a. Heredity
The heart has 4 separate pumps. Two primary atrial pumps and 2 ventricular power
end the period of heart contraction until the next contraction is called the heart cycle. Each
cycle is initiated by the spontaneous generation of action potentials at the SA (sinotrial)
node located in the right atrium posterium wall near the mouth of the superior vena cava.
The action potential runs quickly through atrioventricular (AV) into vebtrikel, because the
arrangement of statistical data proves that a person will be more likely to get hypertension if
his parents are hypertension sufferers.

b. Individual characteristic
Individual characteristics that influence the onset of hypertension are age (if age
increases TD increases), gender (male higher than female) and race (black race is more than
white)
c. Living habits
Life habits that often cause hypertension are high salt consumption (in excess of 30
grams), obesity or overeating, stress and other influences such as smoking, drinking
alcohol, taking drugs (ephedrine, prednisone, epinephrine).

2. Secondary hypertension is hypertension caused by other diseases

D. Pathophysiology

The mechanism that controls the constriction and relaxation of blood vessels is
located centrally in the vasomotor, in the brain medulla. From the center of this vasomotor
begins the sympathetic nerve pathway, which continues down to the spinal cord and out of
the spinal cord medulla column of the sympathetic ganglia in the thorax and abdomen.
Vasomotor central stimulation is delivered in the form of impulses that move down through
the sympathetic nervous system to the sympathetic ganglia. At this point, preganglionic
neurons release acetylcholine, which will stimulate post-ganglion nerve fibers into blood
vessels, where the release of noreepineprin results in blood vessel constriction. Various
factors such as anxiety and fear can affect the response of blood vessels to excitatory
vasoconstriction. Individuals with hypertension are very sensitive to norepinephrine, although

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 it is not clearly known why this can occur. At the same time when the sympathetic nervous
system stimulates blood vessels in response to emotional stimuli, the adrenal glands are also
stimulated, resulting in additional vasoconstrictive activity. Adrenal medulla secretes
epinephrine, which causes vasoconstriction. The adrenal cortex secretes cortisol and other
steroids, which can strengthen the vasoconstrictor response of blood vessels. Vasoconstriction
which results in decreased flow to the kidneys, causing the release of rennin.

where the release of noreepineprin results in constriction of blood vessels. Various

factors such as anxiety and fear can influence Rennin to stimulate the formation of
angiotensin I which is then converted to angiotensin II, a powerful vasoconstrictor, which in
turn stimulates aldosterone secretion by the adrenal cortex. This hormone causes sodium and
water retention by the kidney tubules, causing an increase in intra-vascular volume. All of
these factors tend to trigger hypertension for consideration of gerontology. Structural and
functional changes in the peripheral vessel system are responsible for changes in blood
pressure that occur in old age. These changes include atherosclerosis, loss of connective
tissue elasticity and reduction in relaxation of vascular smooth muscle, which in turn
decreases the ability of blood vessels to distend and stretch. Consequently, the aorta and large
arteries diminish their ability to accommodate the volume of blood pumped by the heart
(stroke volume),

resulting in decreased cardiac cheat and increased peripheral resistance (Smeltzer,

2002)

E. Clinical Manifestations

1. Physical examination may show no abnormalities other than high blood pressure.
2. There may be changes in the retina with hemorrhage, exudate, arteriolar constriction, and
papillary edema.
3. Symptoms usually indicate vascular damage related to organ systems caused by affected
blood vessels.
4. Coronary artery disease with angina is a common result.
5. Pathological changes in the kidneys (nocturia and azotemia)

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 6. Left ventricular hypertrophy occurs; heart failure
7. Cerebral vascular involvement and trenent ischemia attacks

F. Management
1. Non-pharmacological management or lifestyle changes
Reducing salt intake and efforts to lose weight are the first steps in the treatment of
hypertension. Limiting salt intake to 60 mmol / day, means not adding salt at mealtime. It
will be difficult to implement because it will reduce salt intake tightly and
will drastically affect a patient's eating habits. In several investigations it was found
that a diet low in saturated fat can reduce the risk of cardiovascular disease. By doing
regular physical activity can reduce peripheral resistance so that it can reduce blood
pressure.
Other lifestyle changes are avoiding risk factors such as smoking, drinking alcohol,
hyperlipidemia, stress. Smoking can increase blood pressure, alcohol is known to increase
blood pressure so avoiding alcohol means avoiding the possibility of getting hypertension.
Relaxation such as meditation, yoga or hypnosis can control the autonomic nervous system
with the possibility to also reduce blood pressure.

2. Pharmacological management or treatment of hypertension

The decision to start giving antihypertensive drugs is based on several factors such as the
degree of elevated blood pressure, the presence of target organ damage and the presence of
clinical manifestations of cardiovascular disease or other risk factors. above 85 or 95
mmHg and systolic above 130 to 139 mmHg it is necessary to start drug therapy (Smeltzer,
2001)
The types of hypertension drugs are as follows:

a. Diuretic
The way this medicine works is by increasing the volume of urine and spending
Sodium (salt) through the urine. The medicine for diureti that is commonly given is
thiazide. Side effects of the disease "gout" and sugar levels in DM slightly increased.

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 b. Beta Bloker
Works by inhibiting the work of stress hormones namely adrenaline on the heart and
blood vessels. Side effects of fatigue and lethargy, weak legs and hands (feet) feel cold.
Which include namely asebutolol, alprenolol, propanolol, timolol, pindolol, etc.

c. Calcium antagonist
Calcium antagonists work by reducing the amount of calcium that enters the muscle
cells of the blood vessel walls and heart and reduces muscle tension. This reduced muscle
tension results in a decrease in blood pressure. Side effects are headache, red face and
ankle swelling. This class of drugs such as nifedipine, diltiazim, verapamil, amlodipin,
felodipin and nicardipine.

d. Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor) enzyme inhibitors.

ACE inhibitors inhibit the substance produced by the kidneys, which is responsible
for narrowing the small arteries. Side effects: a drastic decrease in blood pressure, taste
disorders and a tickling cough. for example losartan, valsartan and irbesartan.
e. Vasodilators
Works by dilating the arteries directly. Side effects of vasodilators slightly increase
heart rate and cause
ankle swelling. Included in this group are doxazazine, prazosin, hydralazine, minoxidil,
diazosid and sodium nitroprusid.
f. Sympathetic inhibitors
Inhibition of sympathetic activity can occur in the vasomotor centers of the brain such
as in the administration of methyldopa and clonidine or at the peripheral nerve endings
such as reserpine and guanetidine.

G. Complications
Some complications of hypertension that may arise
1. Effects on congestive heart, stroke and angina pectoris
2. Heart failure
3. Damage to blood vessels is not in the form of rupture of a blood vessel stroke and damage
to blood vessel walls

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 4. Kidney failure
5. Damage to the eye that causes treatment problems until blindness.

H. Focus assessment according to diagnosis (2000)

1. Activity / rest
Symptoms: Weakness, fatigue, shortness of breath, monotonous lifestyle
Signs: Increased heart frequency, changes in heart rhythm, tachypnea
2. Circulation
Symptoms : History of hypertension, atherosclerosis, coronary heart disease,
cerebrovascular disease
Signs : Increased BP, postural hypotension, tachycardia, skin discoloration, cold
temperature
3. Ego Integrity
Symptoms : History of personality changes, anxiety, depression, euphoria, multiple
stress factors
Signs : Mood bursts, anxiety, continuous narrowing of attention, bursting crying,
facial muscles tense, breathing sigh, increased speech patterns
4. Elimination
Symptoms : Current or past kidney disorders
5. Food / Liquid
Symptoms : Preferred foods that can include foods high in salt, fat and cholesterol
Signs: BB normal or obese, the presence of edema
6. Neurosensory
Symptoms : Dizziness / dizziness complaints, headache, throbbing headache, throbbing,
visual disturbances, epistaxis episodes
Signs : Changes in orientation, decreased grip strength, optical retinal changes
7. Pain / discomfort
Symptoms : Angina, pain disappearing in the legs, severe occipital headache, abdominal
pain
8. Breathing

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 Symptoms : Dyspnea associated with activity, tachypnea, orthopnea, proximal nocturnal
dyspnea, coughing with or without sputum, smoking history
Signs : Respiratory distress / use of respiratory accessory muscles, additional breath
sounds, cyanosis
9. Security
Symptoms : Impaired coordination, way of walking
Signs : Episodes of transient unilateral paresthesia, postural hypotension
10. Learning / Counseling
Symptoms :Family risk factors; hypertension, atherosclerosis, heart disease, DM,
kidney disease
11. Activity / rest
Effect : Weakness, fatigue, shortness of breath, monotonous lifestyle
Signs : Increased heart frequency, changes in heart rhythm, tachypnea
12. Circulation
Effects : History of hypertension, atherosclerosis, coronary heart disease,
cerebrovascular disease
Signs : Increase in BP, posture of hypotension, tachycardia, skin discoloration,
cold temperature
13. Ego Integrity
Effects: History of personality changes, anxiety, depression, euphoria, multiple stress
factors
Signs : Mood bursts, anxiety, continuous narrowing of attention, bursting crying, facial
muscles tense, breathing sigh, increased speech patterns
14. Elimination
Symptoms: Current or past kidney disorders
15. Food / Liquid
Effect : Foods that contain protein, fat and cholesterol
Signs : BB normal or obese, there is edema
16. Neurosensory
Cause : Compelling complaints, headaches, throbbing headaches, throbbing, visual
disturbances, epistaxis episodes
Signs : Intuitive changes, Decreased grip strength, changes in the optical retina

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17. Pain / discomfort
Cause : Angina, pain disappearing in the legs, severe occipital headaches, abdominal
pain
18. Breathing
Cause : Dyspnea associated with activity, tachypnea, orthopnea, proximal nocturnal
dyspnoea, coughing or with no spuctum, smoking publications
Signs : Increase in BP, posture of hypotension, tachycardia, skin discoloration, cold
temperature
19. Ego Integrity
Effects : History of personality changes, anxiety, depression, euphoria, multiple stress
factors
Signs : Mood bursts, anxiety, continuous narrowing of attention, bursting crying, facial
muscles tense, breathing sigh, increased speech patterns
20. Elimination
Symptoms : Current or past kidney disorders
21. Food / Liquid
Symptoms : Preferred foods that can include foods high in salt, fat and cholesterol
Signs : BB normal or obese, the presence of edema
22. Neurosensory
Symptoms : Dizziness / dizziness complaints, headache, throbbing headache, throbbing,
visual disturbances, epistaxis episodes
Signs : Changes in orientation, decreased grip strength, optical retinal changes
23. Pain / discomfort
Symptoms : Angina, pain disappearing in the legs, severe occipital headache, abdominal
pain
24. Breathing
Symptoms : Dyspnea associated with activity, tachypnea, orthopnea, proximal nocturnal
dyspnea, coughing with or without sputum, smoking history
Signs : Respiratory distress / use of respiratory accessory muscles, additional
breath, cyanosis
25. Security
Symptoms : Impaired coordination, way of walking

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 Signs : Episodes of transient unilateral paresthesia, postural hypotension
26. Learning / Counseling
Symptoms : Family risk factors; hypertension, atherosclerosis, heart disease, DM,
kidney disease, Ethnic risk factors, use of birth control pills or
hormones

Supporting investigation
a. BUN : memebrikan information about perfusion / kidney function
b. Glucose : hyperglycemia can be caused by an increase in catecholamines
c. Serum potassium : hypokalemia can indicate the presence of primary aldosterone
d. Serum calcium : increase can cause hypertension
e. Serum cholesterol and triglycerides : an increase can form the presence of atheromatous
plaque
f. thyroid examination : hyperthyroidism can cause vasoconstriction and hypertension
g. urine / serum aldosterone levels : assess primary aldosteronism (cause)
h. urinalysis : signal kidney dysfunction
i. Gout : hyperuricemia has implications for risk factors for hypertension
j. urine steroids : indicate hyperadrenalism
k. IVP : find out the cause of hypertension
l. Chest image : shows calcification obstruction in the valve area, enlargement of
the heart
m. CT skan : examines cerebral tumors, CSV, encephalopathy
n. ECG : Can show heart enlargement, stretch patterns, conduction disorders.

I. INTERVENTION AND RATIONAL FOCUS

1. High risk of decreased cardiac output associated with increased afterload, vasoconstriction,
myocardial ischemia, ventricular hypertrophy
Purpose :
Afterload does not increase, vasoconstriction does not occur, myocardial ischemia does not
occur
Expected results :
- Participate in activities that decrease TD

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- Maintain TD in an acceptable range
- Showing stable heart rhythm and frequency Interventions:
a. Monitor TD, measure on both hands, use appropriate cuffs and techniques.
Rational:
comparisons of pressure have provided a more complete picture of the involvement / area
of vascular problems.
b. Note the presence, quality of central and peripheral pulses
Rational:
Carotid, jugular, radial, femoral pulses may be observed / palpated. Legs may decrease
reflecting the effects of vasoconstriction and venous congestion.
c. Auscultate cardiac tone and breath sounds
Rational:
S4 is commonly heard in patients with hypertension due to atrial hypertrophy.
d. Observe skin color, humidity, temperature and capillary filling time.
Rational:
The presence of pale, cold, moist skin, may be associated with vasoconstriction or prove
decompensation or decreased cardiac output.
e. Note general rational edema:
Can identify heart failure, kidney damage, or vascular.
f. Provide a quiet environment, comfortable, reduce activity.
Rational :
helps to reduce sympathetic excitement, increase relaxation
g. Maintain restrictions on activities such as bed rest / rational chairs:
reduce stress and tension that affect blood pressure and hypertension disease.
h. Perform comfortable actions such as back and neck massage. Rational:
reduce discomfort and can reduce sympathetic stimulation.
i. Encourage relaxation techniques, guide the imagination, rational diversion activities:
Can reduce stressful stimuli, create a calming effect, thus lowering blood pressure.
j. Monitor response to drugs to control blood pressure. Rational:
The response to "stepped" drug therapy consisting of diuretics, sympathetic inhibitors and
vasodilators) depends on the individual and the senoregic effects of the drug

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2. Pain (headache) associated with increased cerebral vascular pressure Objective:
Cerebral vascular pressure does not increase Expected results:
Patient expresses absence of headache and looks comfortable Intervention:
a. Maintain bed rest, a quiet environment, a little lighting Rational:
Minimize stimulation / increase relaxation
b. Give non-pharmacological measures to eliminate headaches such as cold compresses on
the forehead, back and neck massage, calm down, dim the room lights
Rational :
action that decreases cerebral vascular pressure
c. Limit vasoconstriction activity that can cause headaches; eg straining during chapters, long
coughing and bowing.
Rational :
3. Pain (headache) associated with increased cerebral vascular pressure Objective:
Cerebral vascular pressure does not increase Expected results:
Patient expresses absence of headache and looks comfortable Intervention:
a. Maintain bed rest, a quiet environment, a little lighting Rational:
Minimize stimulation / increase relaxation
b. Give non-pharmacological measures to eliminate headaches such as cold compresses on
the forehead, back and neck massage, calm down, dim the room lights
Rational :
action that decreases cerebral vascular pressure
c. Limit vasoconstriction activity that can cause headaches; eg straining during chapters, long
coughing and bowing.
Rational :
Activities that increase vasoconstriction cause headaches with increased cerebral vascular
pressure

4. Risk of changes in tissue perfusion: cerebral, kidney, heart related to circulatory disorders
Purpose :
Uninterrupted body circulation Expected results:
- The patient demonstrates improved tissue perfusion as indicated by: TD within acceptable
limits, no complaints of headaches, dizziness, laboratory values within normal limits.

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 - 30 ml / minute urine output
- Vital signs stable
Intervention :
a. Maintain bed rest
b. Elevate the head of the bed
c. Assess blood pressure when entering in both arms; sleep and sit with arterial blood pressure
monitoring if available
d. Ambulation according to ability
e. Observe for sudden hypotension
f. Measure admission and expenses
g. Maintain fluids and medicines according to the program
h. Monitor electrolytes, BUN, creatinine according to the program

5. Intolerant activities related to general weaknesses Purpose:

Point out there are no general weaknesses. Expected results Participate in desired activities
Report improvement in tolerance of measurable activities Interventions:
a. Assess the patient's response to the activity, noting the pulse frequency more than 20 times
per minute above the resting frequency.
Rational:
Mentioning the parameters helps in assessing the physiological response in the stress of
activity and, if there is an indicator of work performance related to the level of activity.
b. Instruct patients about saving energy, for example using a chair when bathing, sitting while
combing hair or brushing teeth, doing activities slowly.
Rational :
Energy saving techniques reduce energy reduction, also helps balance the supply and
demand for oxygen.
c. Give encouragement to do activities / self-care gradually if it can be tolerated, give help as
needed
Rational :
The gradual progress of activity to prevent an increase in cardiac work suddenly provides
help only to the extent of needing to encourage independence in carrying out activities

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6. Changes in nutrition associated with excessive metabolic needs
Patients show changes in eating patterns Criteria results:
The patient is able to maintain the desired body weight by maintaining health.
Intervention:
a. Assess the patient's understanding of the ongoing relationship between hypertension and
obesity.
Rational:
Obesity is an additional risk of high blood pressure due to the disproportion between aortic
creased cardiac output associated with increased body mass.
b. Discuss the importance of reducing calorie intake and limit the intake of fat, salt, and sugar
as indicated.
Rational:
Errors in eating habits support atherosclerosis and obesity, which are predisposing to
hypertension and its complications.
c. Determine the patient's desire to lose weight.
Rational:
Individuals must desire to lose weight.
d. Instruct and help choose the right foods, avoid foods that are high in saturated fats.
Rational:
Avoiding foods high in saturated fats and cholesterol is important in preventing the
development of atherogenesis.
e. Refer to nutritionist as indicated.
Rational:
Providing counseling and assistance by meeting individual dietary needs
7. Individual coping is not actively associated with situational crisis Objectives:
Able to express awareness of coping skills Expected results:
demonstrate the use of skills
Identify potential stressful situations and take steps to avoid.
Intervention:
a. Assess the effectiveness of coping strategies by observing behavior, for example, the desire
to participate in treatment plans.
Rational:

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 b. Adaptive mechanism needs to change one's lifestyle to overcome chronic hypertension.
Record reports of sleep disturbances, increased fatigue in concentration damage, decreased
headache tolerance.
c. Help the patient to identify specific factors and possible strategies to overcome them.
Rational:
The introduction of stressors is the first step in changing one's response to stressors.

8. Lack of knowledge related to lack of information about the disease process

Purpose:
States understanding about the disease process. Expected results
States an understanding of the disease process and treatment regimen. Interventions:
a. assess patient readiness and barriers to learning. Including the closest person.
Rational: misconceptions and denying diagnosis because of feelings of well-being that
have long been enjoyed by patients' interest in studying disease.
b. Set and declare a normal TD limit.
Provides a basis for understanding about increasing blood pressure and clarifying
frequently used medical terms.
c. Help the patient in identifying cardiovascular risk factors that can be changed, for example
obesity, a diet high in saturated fat and cholesterol, a monotonous lifestyle.
Rational:
These risk factors show a relationship in supporting hypertension and cardiovascular and
kidney disease
d. Discuss the importance of stopping smoking
The rational nicotine increases release of ketokolamin, results in an increase in heart
frequency, blood pressure and vasoconstriction and increases myocardial workload
9. High risk of non-compliance is associated with negative side effects of therapy and lack of
confidence in the treatment needed without symptoms (Carpenito, 2000)
Purpose:
Patients adhere to self-regulation Criteria results:
Patients believe that treatment is important for hypertension Interventions:
a. Explain to the patient that a rise in blood pressure typically has no symptoms.
b. Emphasize on the patient the possibility of life threat if blood pressure is not controlled.

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c. Explain to the patient the possible effects of stroke in future kidney failure or coronary
disease.
d. Involve the family in providing information that leads to nursing planning.
e. Explain the possible side effects of antihypertensive drugs eg: impotence, vertigo, tell the
patient to consult a doctor for alternative medicine

CHAPTER III
CLOSING

A. Conclusion
Hypertension is a persistent blood pressure where the systolic pressure is above 140
mmHg and the diastolic pressure is above 90 mmHg and clarified according to the
severity, has a range of normal blood pressure. Hypertension is related to the work of
cardiovaskular system. Hypertension (Mansjoer,2000) is divided into major groups,
namely : essential hypertension (primary hypertension) and secondary hypertension.

B. suggestion
It’s important to the reader to keep the cardiovaskular system. The abnormal condition of
cardiovaskular system may impact the blood pressure and can cause the Hypertension.
Also, the reader must life healthy and keep the diet to make heart more healthy and
farthest of Hypertension.

C. references
Smeltzer dan Bare, 2002. Buku Ajar Keperawatan Medikal Bedah. Alih Bahasa Yasmin
Asih. Jakarta: Buku kedokteran EGC
Aziza, Lucky. 2007. Hipertensi The Silent Killer. Jakarta:Yayasan Penerbitan Ikatan
Dokter Indonesia
Cerpenito, Lynda Juall. 2009. Diagnosa Keperawatan. Aplikasi Pada Praktek Klinis.
Edisi IX. Alih Bahasa : Kusrini Semarwati Kadar. Jakarta: Buku Kedokteran EGC

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