Blood pressure is a measurement of the force against the walls of your arteries as the heart pumps blood through the body.
Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as two numbers -- for example, 120 over 80 (written as 120/80 mmHg). One or both of these numbers can be too high.
The top number is your systolic pressure.
• It is considered high if it is over 140 most of the time.
• It is considered normal if it is below 120 most of the time.
The bottom number is your diastolic pressure.
• It is considered high if it is over 90 most of the time.
• It is considered normal if it is below 80 most of the time. nlm.nih.gov Nursing Diagnosis for Hypertension
Decreased Cardiac Output related to increased afterload, vasoconstriction, myocardial ischemia, ventricular hypertrophy
Nursing Intervention for Hypertension
• Monitor blood pressure
• Note the central and peripheral pulse quality
• Auscultation of heart and breath sounds
• Observe skin color, moisture, temperature and capillary filling time
• Observe the general edema
• Provide quiet environment, comfortable
• Suggest to reduce activity.
• Maintain restrictions on activities such as recess ditemapt bed / chair
• Help perform self-care activities as needed
• Perform actions such as a comfortable back and neck massage
• Encourage relaxation techniques
• Give fluid restriction and sodium diet as indicated.
Nursing Diagnosis for Hypertension
Risk for Ineffective Tissue perfusion: Peripheral, Renal, Gastrointestinal, Cardiopulmonary related to impaired circulation
Nursing Intervention for Hypertension
• Maintain bed rest, elevate head of bed
• Assess blood pressure at admission in both arms, sleeping, sitting with arterial pressure monitoring if available
• Maintain fluid and drugs.
• Observe the sudden hypotension.
• Measure inputs and expenditures
• Monitor electrolytes, BUN, creatinine.
• Ambulation according to ability; avoid fatigue
A community nursing diagnosis is a clinical statement of an actual or potential health problem in a community. A nurse bases identification on her professional judgment, in order to create a plan for improvement.
1. Basis o While medical doctors treat diseases and conditions, nurses treat the physical, psychological, social or cultural problems that arise from a disease or condition. A community nursing diagnosis promotes wellness.
Scope
o A community nursing diagnosis focuses on health promotion among a specific group of people in one place over a period of time. Therefore, a community can describe a city, a school or a given population, such as the homeless.
Purpose
o The community nursing diagnosis is used to identify available resources, develop educational materials and plan interventions to address illness or improve health within the population.
Components
o A community nursing diagnosis includes three parts: a problem or risk statement (illness or desired improvement), related factors (cause or etiology) and the signs and symptoms (based on confirmed subjective and objective assessment data).
Classification
o The North American Nursing Diagnosis Association (NANDA) is a recognized authority on nursing diagnoses and maintains a standardized database of nursing diagnostic terminology.
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