From the Guidelines
The immediate nursing intervention for a patient with hypertension is to assess the patient's blood pressure accurately and determine if it constitutes a hypertensive emergency or urgency. For severely elevated blood pressure (typically >180/120 mmHg with end-organ damage), notify the healthcare provider immediately while positioning the patient with the head elevated, maintaining a calm environment, and preparing for potential IV antihypertensive medications such as labetalol (10-20 mg IV), nicardipine (5 mg/hr IV), or hydralazine (10-20 mg IV) 1.
Key Considerations
- For less severe elevations without symptoms, administer prescribed oral medications such as amlodipine (5-10 mg), lisinopril (10-20 mg), or metoprolol (25-100 mg) as ordered, considering the latest guidelines from the 2020 international society of hypertension global hypertension practice guidelines 1.
- Throughout this process, monitor vital signs every 5-15 minutes depending on severity, assess for symptoms like headache, vision changes, chest pain, or neurological deficits, and document intake and output.
- The choice of initial drug therapy may be with any drug class currently indicated for the treatment of hypertension, with ACE inhibitors, β-blockers, and diuretics being preferred agents for initial therapy due to their benefits in reducing cardiovascular disease events 1.
Monitoring and Follow-Up
- Patients with hypertension should be seen as often as needed until adequate blood pressure control is obtained and then seen as necessary, with regular monitoring of renal function and serum potassium levels if ACE inhibitors or ARBs are used 1.
- Before beginning treatment, patients with elevated blood pressures should have their blood pressure reexamined within 1 month to confirm the presence of hypertension unless the systolic blood pressure is ≥ 160 mmHg or the diastolic blood pressure is ≥ 100 mmHg, in which case treatment should be immediately initiated 1.
From the Research
Nursing Intervention for Hypertension
The immediate nursing intervention for a patient with hypertension involves a comprehensive approach to manage and control blood pressure. This includes:
- Assessing the patient's condition and medical history to identify potential causes of hypertension 2
- Providing patient education on lifestyle modifications, such as diet and exercise, to help manage blood pressure 3
- Monitoring blood pressure regularly and adjusting treatment plans as needed 4
- Collaborating with the healthcare team to develop and implement a personalized treatment plan 2
Medication Management
Nurses play a crucial role in medication management for patients with hypertension. This includes:
- Administering and monitoring antihypertensive medications, such as ACE inhibitors, beta-blockers, calcium blockers, and diuretics 5
- Educating patients on the importance of adherence to medication regimens and potential side effects 5
- Adjusting medication doses and types as needed to achieve optimal blood pressure control 5
Lifestyle Modifications
Nurses can also promote lifestyle modifications to help patients manage hypertension. This includes:
- Encouraging patients to follow a healthy diet, such as the DASH diet, which has been shown to reduce blood pressure 6
- Promoting regular physical activity and stress reduction techniques, such as exercise and meditation 3
- Providing guidance on sodium intake and other dietary factors that can impact blood pressure 6
Ongoing Monitoring and Evaluation
Ongoing monitoring and evaluation are critical components of nursing intervention for hypertension. This includes:
- Regularly assessing blood pressure and adjusting treatment plans as needed 4
- Monitoring for potential complications of hypertension, such as cardiovascular disease and kidney damage 3
- Evaluating the effectiveness of treatment plans and making adjustments as needed to achieve optimal blood pressure control 4