Nursing Diagnosis: Knowledge Deficit | Hypertension

Nursing diagnosis: Knowledge deficit [Learning Need] regarding condition, treatment plan, self-care, and discharge needs related to lack of knowledge and recall, information misinterpretation, cognitive limitation, and denial of diagnosis

Possibly evidenced by

Verbalization of the problem

Request for information

Statement of misconception

Inaccurate follow-through of instructions, inadequate performance of procedures

Inappropriate or exaggerated behaviors, such as hostility, agitation, or apathy

Desired Outcomes/Evaluation Criteria—Client Will

Knowledge: Hypertension Management

Verbalize understanding of disease process and treatment regimen.

Identify drug side effects and possible complications that necessitate medical attention.

Maintain BP within individually acceptable parameters.

Describe reasons for therapeutic actions and treatment regimen.

Nursing care plan intervention with rationale

1. Assist client in identifying modifiable risk factors, such as obesity; diet high in sodium, saturated fats, and cholesterol; sedentary lifestyle; smoking; alcohol intake of more than

2 ounces per day on a regular basis; and a stressful lifestyle.

Rationale: These risk factors contribute to hypertension and cardiovascular and renal disease.

2. Problem-solve with client to identify ways in which appropriate lifestyle changes can be made to reduce modifiable risk factors.

Rationale: Changing “comfortable or usual” behavior patterns can be very difficult and stressful. Support, guidance, and empathy can enhance client’s success in accomplishing his or her health goals.

3. Discuss importance of eliminating smoking, and assist client in formulating a plan to quit smoking. Refer to smoking cessation program or healthcare provider for helpful medications.

Rationale: Nicotine increases catecholamine discharge, resulting in increased heart rate, BP, vasoconstriction, and myocardial workload, and reduces tissue oxygenation.

4. Reinforce the importance of adhering to treatment regimen and keeping follow-up appointments.

Rationale: Lack of engagement in the treatment plan is a common reason for failure of antihypertensive therapy. Therefore, ongoing evaluation for client participation is critical to successful treatment. When client understands causative factors and consequences of inadequate intervention and is motivated to achieve health, the client typically participates in

treatment interventions.

5. Instruct and demonstrate BP self-monitoring technique. Evaluate client’s hearing, visual acuity, manual dexterity, and coordination.

Rationale: Monitoring BP at home is reassuring to client because it provides visual feedback to determine treatment outcomes and helps promote early detection of deleterious changes.

6. Help client develop a simple, convenient schedule for taking medications.

Rationale: Individualizing schedule to fit client’s personal habits may make it easier to get in the habit of including antihypertensives in healthcare management activities.

7. Explain prescribed medications along with their rationale, dosage, expected and adverse side effects, and particular traits, such as the following:

Rationale: Adequate information and understanding about side effects can enhance client’s commitment to the treatment plan. For instance, mood changes, initial weight gain, and dry mouth are common and often subside with time.

7.1. Diuretics: Take daily or larger dose in the early morning. Weigh self on a regular schedule and record. Avoid or limit alcohol intake.

Rationale: Scheduling doses early in the day minimizes nighttime urination. Primary indicator of effectiveness of diuretic therapy. The combined vasodilating effect of alcohol and the volumedepleting effect of a diuretic greatly increase the risk of orthostatic hypotension.

a. Notify physician if unable to tolerate food or fluid.

Rationale: Dehydration can develop rapidly if intake is poor and client continues to take a diuretic.

7.2. Antihypertensives: Take prescribed dose on a regular schedule; avoid skipping, altering, or making up doses; and do not discontinue without notifying the healthcare provider. Review potential side effects and drug interactions, and discuss need for informing healthcare provider about onset of adverse effects such as ED.

Rationale: Because clients often cannot feel the difference the medication is making in BP, it is critical that there be understanding about the medication’s actions and side effects. For example, abruptly discontinuing a drug may cause rebound hypertension leading to severe complications, or medication may need to be altered to reduce adverse effects. Note: Many drugs used to treat hypertension have been linked to ED. Drugs may need to be changed or dose adjusted.

a. Rise slowly from a lying to standing position, sitting for a few minutes before standing. Sleep with the head slightly elevated. Suggest frequent position changes and leg exercises when lying down.

Rationale: Measures reduce potential for orthostatic hypotension associated with the use of vasodilators and diuretics.

b. Recommend avoiding hot baths, steam rooms, and saunas, especially with concomitant use of alcoholic beverages.

Rationale: Prevents vasodilation with potential for dangerous side effects of syncope and hypotension.

c. Instruct client to consult healthcare provider before taking other prescription or over-the-counter (OTC) medications.

Rationale: Any drug that contains a sympathetic nervous stimulant may increase BP or counteract effects of antihypertensive medications.

8. As indicated, instruct client about increasing intake of foods and fluids high in potassium, such as oranges, bananas, figs, dates, tomatoes, potatoes, raisins, apricots, Gatorade, and fruit juices, and foods and fluids high in calcium, such as low-fat milk, yogurt, or calcium supplements.

Rationale: Some diuretics can deplete potassium levels. Dietary potassium is desirable means of correcting deficits and may be more palatable to the client than drug supplements. Correcting mineral deficiencies can also affect BP.

9. Review the signs and symptoms that require the client to notify the healthcare provider, such as headache present on awakening that does not abate; sudden and continued increase of BP; chest pain; shortness of breath; irregular or increased pulse rate; significant weight gain (2 lb/day or 5 lb/wk); peripheral or abdominal swelling; visual disturbances; frequent, uncontrollable nosebleeds; depression or emotional lability; severe dizziness or episodes of fainting; muscle weakness or cramping; nausea or vomiting; or excessive thirst.

Rationale: Early detection and reporting of developing complications, decreased effectiveness of drug regimen, or adverse reactions allows for timely intervention.

10. Explain rationale for prescribed dietary regimen—usually a diet low in sodium, saturated fat, and cholesterol.

Rationale: Excess saturated fats, cholesterol, sodium, alcohol, and calories have been defined as nutritional risks in hypertension. A diet low in fat and high in polyunsaturated fat reduces

BP, possibly through prostaglandin balance in both normotensive and hypertensive people.

11. Help client identify sources of sodium intake, such as table salt, salty snacks, processed meats and cheeses, sauerkraut, sauces, canned soups and vegetables, baking soda, baking powder, and monosodium glutamate. Stress the importance of reading ingredient labels of foods and OTC drugs.

Rationale: A moderately low-salt diet may be sufficient to control mild hypertension or reduce or eliminate the need for drug therapy needed to control BP.

12. Encourage foods rich in essential fatty acids, such as salmon, cod, mackerel, and tuna.

Rationale: Omega-3 fatty acids in fish tend to relax artery walls, reducing blood pressure. They also make blood thinner and less likely to clot.

13. Encourage client to establish a regular exercise program, incorporating aerobic exercise within client’s capabilities. Stress the importance of avoiding isometric activity.

Rationale: Besides helping to lower BP, aerobic activity aids in toning the cardiovascular system. Isometric exercise can increase serum catecholamine levels, further elevating BP.

14. Demonstrate application of ice pack to the back of the neck and pressure over the distal third of nose, and recommend that client lean head forward if nosebleed occurs.

Rationale: Nasal capillaries may rupture as a result of excessive vascular pressure. Cold temperature and pressure constrict capillaries to slow or halt bleeding. Leaning forward reduces the amount of blood that is swallowed.

15. Provide information regarding community resources, and support client in making lifestyle changes. Initiate referrals, as indicated.

Rationale: Community resources, such as the American Heart Association, “coronary clubs,” stop smoking clinics, alcohol or drug rehabilitation, weight loss programs, stress management classes, and counseling services may be helpful in client’s efforts to initiate and maintain lifestyle changes.