Hypertension & nursing diagnosis - page 2

My patient has chronic hypertension and is two days post-op. My professor pretty much told me to pick ineffective tissue perfusion as my nursing diagnosis but when none of the careplan books that I... Read More

  1. by   denise_amor
    dytonite....
    thanks a lot..... but right now i'm in the midst of confusion since this is my first time.
  2. by   black35
    trying to do a care plan on a pt. with hypertension, what would be a good nursing diagnosis,goal,implementation,rational, and evaluation for this pt. :spin:
  3. by   black35
    thank you aways this is first time on this site as well.
  4. by   Daytonite
    Quote from black35
    trying to do a care plan on a pt. with hypertension, what would be a good nursing diagnosis,goal,implementation,rational, and evaluation for this pt. :spin:
    Read post #13 above. Nursing diagnoses, goals and nursing interventions are all based on the list of abnormal assessment data (symptoms) of hypertension that the patient has. See the thread that I directed that poster to for directions on how to write the care care plan. If you still can't figure out how to do it, ask more specific questions.
  5. by   airasofia
    community diagnosis is hypertension do you have any guides I can follow for it? Hypertension and I mean every house of we visited in the community at least two of the older people in the family has hypertension. And we visited 50 houses
  6. by   Daytonite
    Quote from airasofia
    community diagnosis is hypertension do you have any guides I can follow for it? Hypertension and I mean every house of we visited in the community at least two of the older people in the family has hypertension. And we visited 50 houses
    If your focus is the community then your assessment needs to reveal that the etiology of this hypertension relates to something they all have in common since it will be the underlying cause you will want to address and target your interventions at. At least that would be my thinking.
  7. by   shinneh
    hello. my question is somewhat related to the post:
    what if the client had seizures because of her hypertension so the doctors did an emergency C/S, the client has history of hypertension, she is fat. can i put something related to pre eclampsia in my diagnosis?
  8. by   Daytonite
    Quote from shinneh
    hello. my question is somewhat related to the post:
    what if the client had seizures because of her hypertension so the doctors did an emergency c/s [c-section], the client has history of hypertension, she is fat. can i put something related to pre eclampsia in my diagnosis?
    you need read about what is going on medically with this patient so you understand what is happening before attempting to do your own diagnosing of her nursing problems. pre-eclampsia that progresses to seizures is eclampsia. what i know and have found about eclampsia is that the cause is unknown, but that hypertension and glomerulonephritis are risk factors. obesity isn't even mentioned as contributing it. her seizure would have been controlled and treated first, then any hypertension treated and put under control. once the patient has been stabilized the baby is usually delivered as soon as feasible and safe by the most expedient method. if you read the emedicine article and the pathophysiology of eclampsia you will note that there are interesting proposals of why some pregnant mothers develop hypertension and pre-eclampsia.
    i assume you are writing a care plan about this patient, so first of all you need to collect data that are going to be clues to nursing diagnoses that might be present. nursing diagnoses are based on the abnormal data that has been collected about the patient and her responses to her medical condition.
    • did she go into a coma?
    • what is the blood pressure?
    • is there any edema? where is it? did you take circumferential measurements of the limbs?
    • was there any headache? epigastric pain? how did you evaluate and measure the pain?
    • was there any protein in the urine?
    • how many seizures did the patient have? what kind of seizures were they? was magnesium given?
    • did the patient have any injuries as a result of the seizure activity, especially in the mouth?
    • have magnesium and calcium levels been done? what are they?
    • since this patient has had a c-section, she is a postoperative patient with an incision. did she have a general anesthetic or an epidural? the care plan must show that she is being monitored for the following complications of epidural anesthesia:
      • hypotension
      • rash around the epidural injection site
      • nausea and vomiting from the opiates administered
      • pruritis of the face and neck caused by some epidural narcotics
      • respiratory depression up to 24 hours after the epidural
      • cerebrospinal fluid leakage and spinal headache from accidental dural puncture
      • sensory problems in the lower extremities
    she also needs to be monitored for the following complications as a result of having the type of surgery that she has had:
      • thrombophlebitis in the lower extremity
      • elevated or depressed temperature
      • any number of problems with the incision/wound (dehiscence, evisceration, infection)
      • urinary retention
      • constipation
      • surgical pain
      • nausea/vomiting (paralytic ileus)
    obesity is the least of her problems at this time.
  9. by   shinneh
    ah. i thought obesity is somewhat related to the high blood pressure. thank you very much,.
  10. by   Daytonite
    Quote from shinneh
    ah. i thought obesity is somewhat related to the high blood pressure. thank you very much,.
    You need to go back to why this C-section was done. There may have been HTN, but the fact that the patient has seizures makes this a case of eclampsia and much more serious. What is the gestational age of the fetus? Was this the mother's first baby? Also, this mother is now a post-op patient. You have a lot of issues to consider for this care plan. Many nursing problems to address on this care plan.
  11. by   shinneh
    the fetus is 39 wks AOG, mother's first baby. baby is normal. the mother is 80 kg, 5 ft. i just checked her chart and see that it is ecclampsia. they already administer MgSO4 . she has an apresoline IV, and that helps normalize her BP. her BP (if w/o meds) is 190/120
  12. by   shinneh
    thank you. i will do my best in this care plan
  13. by   Daytonite
    Quote from shinneh
    the fetus is 39 wks AOG, mother's first baby. baby is normal. the mother is 80 kg, 5 ft. i just checked her chart and see that it is ecclampsia. they already administer MgSO4 . she has an apresoline IV, and that helps normalize her BP. her BP (if w/o meds) is 190/120
    A care plan is like taking a snapshot and addressing all the problems going on in the picture at that time the photo was taken. Are you care planning for her labor and delivery or now, after she has delivered. You need to be clear on that. The history of what has happened to her is important, but don't get so hung up on it that you fail to deal with what is going on now.

    Some of the things to consider now: What is her blood pressure now? What are her electrolyte values because fluid excesses or deficits are a problem to consider. Did she sustain any injuries as a result of the seizures as these are problems to care plan for. Are more seizures likely (Risk for Injury)? Assess the lungs for function (Risk for Ineffective Breathing Pattern or Risk for Ineffective Airway Clearance). Assess the C-section wound because this is a nursing problem (Impaired Tissue Integrity). Is she moving around since delivery (Impaired Physical Mobility or Activity Intolerance)? What does she know about the treatment of her HTN (Deficient Knowledge, hypertension)?

close