Chapter 1:NURSING MANAGEMENT
The primary nursing responsibilities for long-term management of hypertension are to
assist the patient in reducing BP and complying with the treatment plan. Nursing actions
include patient and family teaching, detection and reporting of adverse treatment effects,
compliance assessment and enhancement, and evaluation of therapeutic effectiveness.
Patient and family teaching includes the following: (1) nutritional therapy, (2) drug
therapy, (3) physical activity, (4) home monitoring of BP (if appropriate), and (5) tobacco
cessation (if applicable).
o Home monitoring of BP should include daily BP readings when treatment is
initiated or medications are adjusted and weekly once the BP has stabilized. A log
of the BP measurements should be maintained by the patient. Devices that have
memory or printouts of the readings are recommended to facilitate accurate
o A major problem in the long-term management of the patient with hypertension is
poor compliance with the prescribed treatment plan. The reasons include
inadequate patient teaching, unpleasant side effects of drugs, return of BP to
normal range while on medication, lack of motivation, high cost of drugs, lack of
insurance, and lack of a trusting relationship between the patient and the health
The prevalence of hypertension increases with age. The lifetime risk of developing
hypertension is approximately 90% for middle-aged (age 55 to 65) and older (age >65)
normotensive men and women.
A number of age-related physical changes contribute to the pathophysiology of
hypertension in the older adult.
In some older people, there is a wide gap between the first Korotkoff sound and
subsequent beats (auscultatory gap). Failure to inflate the cuff high enough may result in
underestimating the SBP.
Older adults are sensitive to BP changes. Reducing SBP to less than 120 mm Hg in a
person with long-standing hypertension could lead to inadequate cerebral blood flow.
Older adults produce less renin and are more resistant to the effects of ACE inhibitors
and angiotensin II receptor blockers.
Orthostatic hypotension occurs often in older adults because of impaired baroreceptor
Orthostatic hypotension in older adults is often associated with volume depletion or
chronic disease states, such as decreased renal and hepatic function or electrolyte imbalance.
To reduce the likelihood of orthostatic hypotension, antihypertensive drugs should be
started at low doses and increased cautiously.
Hypertensive crisis is a severe and abrupt elevation in BP, arbi