Hypertension & Nursing Diagnosis

[labcat01, BSN, RN]

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 have relate hypertension to ineffective tissue perfusion. (My patient had no edema, good peripheral pulses, but abnormal H&H).

Any thoughts would be greatly appreciated!

[Daytonite, BSN, RN]

Hypertension is a symptom of hypoxia due to inadequate concentrations of oxygen in the blood. That is your connection to ineffective tissue perfusion. Normally, I would say that hypertension has something to do with either renal or cardiac problems. What other medical diagnoses does this patient have? What kind of surgery did she have? Was she on any medications for hypertension prior to admission? If this hypertension just showed up post-op then I would look at pain or anxiety as potential causes. The blood loss has left the patient anemic. She doesn't have enough rbcs to carry enough oxygen to her tissues.

Your related factor (cause) of the ineffective tissue perfusion is the abnormal h&h and if you have some abnormal abgs that would be good too. A possible nursing diagnostic statement might be:

Ineffective tissue perfusion: cardiopulmonary r/t decreased hemoglobin concentration in blood aeb

[signs and symptoms of hypoxia: hypertension, restlessness, dyspnea, tachycardia, diaphoresis, cyanosis]

[labcat01, BSN, RN]

Thanks! She did have very high blood pressure on admission and is taking HTN medicine (so I can't really blame it all on the surgery). She says she has "White Coat Syndrome" and her only other chronic condition was hypothyroidism.

[Daytonite, BSN, RN]

White coat hypertension is: "blood pressure rise secondary to anxiety may be observed in 20-30% of patients. this may be avoided by having patients rest prior to measurement, having a nurse check the blood pressure, or arranging to have the blood pressure monitored at home. development of hypotensive symptoms on medications is an indication of white coat hypertension. white coat hypertension can also be evaluated by the use of a 24-hour ambulatory monitor."

From "hypertension" by sat sharma, md and claude kortas, md. on emedicine at https://emedicine.medscape.com/article/241381-overview

[mysterious_one, ASN, RN]

I have a question to this, I had a patient with hypertension also and was thinking of that same nursing diagnosis. Could you have used: risk of altered tissue perfusion, peripheral r/t possible vascular abnormalities ?

[Daytonite, BSN, RN]

Any time you put the two words "risk for" in front of any nursing diagnosis you are now saying that the problem doesn't exist, but could. your nursing interventions would then focus on preventing the occurrence of this problem. Ineffective tissue perfusion is the official nanda terminology for this diagnosis not altered tissue perfusion. altered tissue perfusion is older terminology that is no longer used.

[mysterious_one, ASN, RN]

daytonite said:

mysterious_one. . .any time you put the two words "risk for" in front of any nursing diagnosis you are now saying that the problem doesn't exist, but could. your nursing interventions would then focus on preventing the occurrence of this problem. ineffective tissue perfusion is the official nanda terminology for this diagnosis not altered tissue perfusion. altered tissue perfusion is older terminology that is no longer used.

thank you daytonite

i wasn't aware that altered was an old version, i have to change that. i was using that for my major care plan, ( i have an old care plan book ).

i am aware that " risk for" means that the problem does not exist yet, that's why i thought maybe the origanal poster could use that one instead. (maybe not the peripheral type as in my patients case, but the cardiopulmonary one instead)

[donfaj90]

Our CI told us to make case study and NCP about our pt. who has hpn. This pt. has only undergone delivery but unfortunately her child died coz of prematurity. I don't have enough knowledge to solve this problem. Help me!

[Daytonite, BSN, RN]

donfaj90 said:

Our CI told us to make case study and NCP about our pt. who has hpn. This pt. has only undergone delivery but unfortunately her child died coz of prematurity. I don't have enough knowledge to solve this problem. Help me!

You have lots of knowledge that gives you clues about the problems this patient would have. Whether you are doing case studies on hypothetical patients or real patients you are, in effect, being a detective collecting clues (making an assessment, separating out the abnormal data), then putting the clues together to come up with the problems (determining the patient's problems, determining their nursing diagnoses), and finally solving the problems (performing nursing interventions to treat the problem). That's what nursing, and the nursing care plan specifically is all about.

For nursing, we look at how the patient responds to their situation. For your assignment, the patient has

• hypertension
• just gave birth
• the baby that she gave birth to died

To find the problems a person with hypertension would have, the first thing you do is look at the signs and symptoms (clues) of hypertension:

• B/P over 140/90
• dizziness
• fatigue and/or confusion
• palpitations
• epistaxis
• blurred vision
• bounding pulse
• S4 heart sound
• in the late stages
  • peripheral edema
  • hemorrhages
  • papilledema of the eye due to hypertensive retinopathy
  • possible formation of an abdominal aneurysm
  • bruits over the abdominal aorta, femoral arteries and/or carotid arteries

Those symptoms (clues) are the abnormal data that you would look for in a real patient and they would form the foundation of this patient's nursing problems (nursing diagnoses). Deceased Cardiac Output, Ineffective Tissue Perfusion: cerebral, Disturbed Sensory Perception, visual and Deficient Fluid Volume. You also look at the complications of the disease for things the person could be at risk for and either teach the patient how to avoid those things or develop strategies to help the patient avoid experiencing them altogether:

• other heart disease
• renal failure
• loss of sight
• stroke

Think of the typical problems and complications a lady who goes into labor and delivers a baby is going to have. If you don't know, look it up and read about it in an OB nursing textbook because for a normal delivery there are still a lot of problems and complications a new mother can have. It wasn't so long ago that women regularly died in childbirth or of massive infection after delivery.

What kind of problem(s) would you think a new mother would have if her baby has died? How would you feel?

Do you still think you don't have enough information to write this case study and nursing care plan?

[labcat01, BSN, RN]

Daytonite- have you ever taught nursing?

If not, you might be missing your calling :)

[donfaj90]

daytonite,

Thanks a lot for your recommendation. I used altered tissue perfusion: cerebral r/t decreased hemoglobin as my nursing diagnoses...

I also consulted my CI for further explanation heheheheheh...to adjunct more things .. Thank you very much ... hope you'll help me again and again

[denise_amor, BSN, RN]

hi dytonite,

i got homework about hypertension and i don't have any idea yet on how to make a nursing diagnosis can u help about this.... the chief complaint of patient is headache, associated numbness of extremities , nape pain, dizziness, difficulty of breathing, BP 160/100... thnx