Hypertension nursing issues and nursing diagnoses

Hypertensive emergencies, stroke, renal insufficiency.

To be honest, many patients have more misunderstandings about hypertension than the types of antihypertensive drugs I have seen. Last week, I met a 42-year-old freight driver at a community free clinic. His blood pressure was measured at 190/110 and he waved his hand and said, "I don't feel anything, so I don't need to take medicine." This blind spot in the understanding of the disease is exactly the most troublesome problem in nursing - high blood pressure is like a sneaky thief doing damage. It usually does not move. By the time you feel pain, dizziness, or dizziness, it has already tormented the blood vessels and heart. When encountering an acute-stage patient with such a headache that he cannot open his eyes or even turn his head with difficulty, we must first make a clear nursing diagnosis that the pain is caused by the dilation of intracranial blood vessels due to elevated blood pressure. At this time, do not give painkillers. Instead, let the patient recline in a semi-recumbent position, take a short-acting antihypertensive drug, and retest the blood pressure every 15 minutes. For most people, if the blood pressure drops by 20-30mmHg, the headache symptoms will be relieved immediately.

In addition to this obvious discomfort, more often we have to worry about risks that are invisible to patients. I used to take care of a 72-year-old man whose blood pressure was usually well controlled. However, he would sit up suddenly when he got up in the morning. One time, he fainted in the bathroom and broke his forehead. This is a typical injury risk caused by orthostatic hypotension, and it is also the top three nursing diagnosis for patients with hypertension. We usually tell elderly patients repeatedly that they should "take three steps slowly" when getting up: lie down for 30 seconds when you wake up, sit up for 30 seconds, put your feet on the edge of the bed and wait for 30 seconds before standing again. The bathroom must be covered with non-slip mats. Don't be too troublesome. If you fall and cause cerebral hemorrhage, it will be too late to regret. By the way, here is a small practical detail. Many elderly people like to cross their legs or raise their arms to the level of their heads when measuring their blood pressure. In this way, the measured value can be 10-15mmHg higher than the actual value. There was a patient who always said that he measured blood pressure at home. The pressure was normal, but it was high as soon as I arrived in the clinic. I went to his home for a checkup and found out that the posture was wrong. After correcting it, the value immediately dropped to 130/80. These small details are not listed in the textbook, but they are useful information that our front-line nurses have learned.

When it comes to specific intervention plans, there are actually many controversial points in the industry that are not completely unified. For example, regarding exercise intervention, the old-school view in the early days was that people with high blood pressure should move less, especially if the systolic blood pressure exceeds 160, and they must stay in bed. However, the latest guidelines now are that as long as the systolic blood pressure does not exceed 180 and there are no obvious dizziness or headaches, regular moderate-intensity exercise (such as brisk walking and Tai Chi) can help stabilize blood pressure. Among the patients I have managed myself, those who insist on walking for 40 minutes every day have reduced their antihypertensive pills by half in half a year. There is also a standard for salt restriction. It was previously stated that it should not exceed 6g per day, but now the American Heart Association recommends that it be reduced to 2.3g. There are also studies that young patients who are not sensitive to salt can relax appropriately. Our current approach is not one-size-fits-all: if you are a young person who eats less salt and has a normal metabolism, there is no need to be so stuck that you dare not even touch soy sauce. But if you are a middle-aged and elderly patient with a family history and abdominal obesity, it is more prudent to try to control the daily salt amount within 5g. This includes weight control. In the past, it was required that the BMI must be reduced to below 24. Now we are not too stuck for the elderly over 70 years old. They have less muscle mass, and being a little fatter will be more resistant. As long as the waist circumference does not exceed the standard and they can walk and jump normally, it is much better than starving to lose weight.

As for the potential complications that everyone is most worried about, there is actually no need to be overly anxious. As long as the blood pressure is stabilized below 130/80 for a long time, the risk of target organ damage can be reduced by more than 60%. When we give health education to patients now, we don’t just follow the guidelines. We adjust them according to their living habits: for example, if you like to drink, don’t ask them to quit all at once. First, reduce the amount of alcohol you drink from half a catty a day to one or two pounds, and then gradually reduce the amount. ； If you like to smoke, don't smoke in the house first, gradually reduce the amount, and the best plan is to stick to it.

To put it bluntly, hypertension is a chronic disease that requires lifelong management. There is never a standard answer to nursing care. Every patient’s living habits, underlying diseases, and tolerance are different. What we can do is break down the professional stuff and explain it clearly, and accompany them to slowly find the control method that suits them best. This is much more useful than rigidly applying standards.