Nursing Essay on Hypertension Management

This nursing essay discusses the management of hypertension. It covers the pathophysiology of hypertension, nursing models for holistic care, and interventions for patients. The essay also provides recommendations for lifestyle modifications and medication. Read more on Desklib.

Nursing essay

Table of Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY...................................................................................................................................3
Policy .....................................................................................................................................9
Case Study............................................................................................................................10
CONCLUSION .............................................................................................................................13
REFERENCE.................................................................................................................................14

INTRODUCTION
Long term condition is the health related problem or illness which can be just manage or
controlled by the different medication and treatment but can not be cure (Joglekar, Sastry,
Coulson 2018). Such type of health care issues are asthma, hypertension, diabetes, arthritis etc.
health care organization (NHS) provide different types of primary and secondary care to their
population which is facing the long term disease. Primary care system involve the community
and GPs services, in which health care organization provide the services such as community
health awareness, home care professional, residential care professionals and availability of care
facility's at conmen region. Secondary care is related to the specialized treatment at hospital with
higher skilled specialist. This report is considering the patient management who is seafaring from
the hypertension, patent whit hypertension need the long term treatment and care. Because it is a
long term medical condition, where blood pressure increases more then the normal limit and it is
causes due to the bad lifestyle and stress.
MAIN BODY
Pathophysiology
This is the field of scientific study in which pathology and psychology work together to
find-out the psychological cause of the disease or health care problem. Along with the analysis
of its fundamental mechanism. In this report the health care issue is hypertension and long term
condoning of patient, is consider, analysed and evaluated. According to the Andrew Hughes
2017 Hypertension prevalence estimates in England, research journal. It has been analysed that
approx 11.8 million of adults from the age group of 16 to older in England is was seafaring from
hypertension. Estimated as 26.2% of the adult population.
Hypertension Pathophysiology
blood flow and pressure is manage by the four mechanisms inside the body such as
Sympathetic nervous system activities , vascular endothelium activities, renal system
functioning and activities of endocrine system. Sympathetic nervous system is the process
of the response for a specific situation, such as rest and danger (Sarkar, Webster, and
Gallacher 2018). Which is activated inside the body by sensing the situation, where

hormones are secreted for particular type of seances. So the unbalanced secretion of
hormones cases the high blood pressure, by effecting other three mechanism. SNS
activity's in response of the different situation increases or decreases the blood pressure. It
increases the heart rate by cardiac contraction. The increasing heart rate, along with the
cardiac contraction causes the vasoconstriction of peripheral arterioles. Which simulate the
secretion of renin from kidney and then RAAS activation is occur which increases the
blood pressure with the aid of angiotensin production. Vascular endothelium which plays
important role in the blood pressure by the production of vasoactive substances, such as
nitric acid and endothelin and this substance work as potent vasoconstrictors, which cause
the high blood pressure (Etyang, Warne, Kapesa 2016). The renal system is can be a
contributor of hypertension, by its increased reabsorption of sodium and water into the
blood. The endocrine system imbalanced hormone secretion is can also be a cause of
hypertension, such as the increased the angiotensin- 2 stimulate secretion of aldosterone
from adrenal cortex. Which causes the high blood pressure through sodium and water
retains on blood. Hypertension some time not posses the major symptoms, and in some
cases it can be analysed by the symptom's such as sever headache, fatigue, chest pain,
shortness of breath.

So for the long term condition of hypertension the pathophysiology which should be
follow is explain in the table 1.
TABEL 1
Pathophysiology of hypertension
Vascular reactivity this involves the test like DTM, BART to test blood pressure.
Circulating blood volume test is necessary in order to find-out the reason of higher blood
pressure because blood volume effects the central venous pressure. The test method is use is
known as red cell mass test and blood volume test (Ombada, and Ombada 2020).
Vascular calibre this is the process of analysing the microvascular structural variation which
can be the symptom's and reason of cardiovascular issues.
Blood viscosity this is the medical test procedure use to analyse the thickness of individual
blood which affects the blood flow from the blood vessels.
Cardiac output involve different test procedure to analyse cardiac activity's, Pulmonary artery
catheter, Echocardiogram.
Blood vessel
Neural stimulation this involves the test to analyse the neural stimulation and hormone secretion
to find-out the causes or mechanism of the hypertension in individual.
Nursing model use to asses and fulfil holistic needs long term condition patient
PRECDE-PROCEED is the most common and effective health care framework use to asses
and fulfil patient holistic needs. It involves the assessment of social, physical and
psychological needs of public for the designing, implementing and evaluation of health
care programs and promotion in order to meet their needs. PRECEDE facilitates the
structure which aid to asses the needs, and helps to plan the public health programs with
the targeting and focusing method's. PROCEED, this model provide the structure to
implementing those programs effectively along with its evaluation. It frame work is
influenced by the individual and environmental factors (Nerenberg, Zarnke, Leung 2018).

PRECEDE is kind of educational diagnosing which stands for Predisposing, reinforcing,
Enabling, construct, Education diagnosis and evaluation.
Phases of the care model
 Social assessment: In social prospective it aid to find-out the social issues, problems and
needs of the selected population.
 Epidemiological assessment: It aid to analyse the physical needs of the population related
to the health management. It involves the analysis health of the problems then the
development of the plan and priorities ( Sarkar, Webster, and Gallacher 2018).
 Ecological Assessment: This process involves the analysis of population psychological
behaviour and environmental elements which effects the life style.

 Identification of existing policy's and factors which can aid in the effective
implementation of developing care plan. It also includes the analysis of matching
interventions which can aid in the developing changes for improved services and needs
satisfaction.
PROCEED it stands for policy, regulatory, organizational, construction in education and
Environmental Development (Chaboksavar,Azar, Azadi 2020). Its main responsibility is to
implement the changes and plan along with the analysis of results.
Phases which comes under PROCEED
 Implementation: Designing of the interventions along with assessment of
resources availability, and the final step is implantation of programs with the
newly developed strategy.
 Process evaluation: Its the process of analysing the goals and plane productivity.
In prospect of population services fulfilments.
 Impact evaluation : This is the phase where population behavioural changes are
analysed.
 Outcome evaluation: Identification of positive and negative effect of the plan on
behaviour.
Advantage and Disadvantage PRECDE-PROCEED in comparison to MATCH
 PRECDE-PROCEED is the model which provide valuable instructions to follow which
depends on the current situation of the population. Its very time sensitive and if any one
fails to realise the current situation in the then it can cause the risk or problems. For the
improvement and fixing of the model it replanning. MATCH model is complicated
because it is difficult to attend properly due to its process of involving large group of the
peoples. Some problems are unnoticeable and it can effect most of the people in the plan.
 PRECDE-PROCEED is beneficial because it aid to provide the services and needs
satisfaction with the proper deep study of the problems and needs of the selected
population (Dima, Copelli, and Mindlin 2018).
 MATCH is beneficial because it aid to service the large number of peoples and fulfilment
of their needs for disease management.
Constructs in educational diagnosis

As PRECEDE provides for planning of program which target and focus on public health
in which CED stands for constructs in educational diagnosis. It refers to the construction or
changes to me made in the educational programmes implemented. As the environment is
dynamic and the quality of life of individual is degraded day by day so there is high need to get
the public educated regarding hypertension which is a non communicable disease and have long
duration as well as commonly slow progression (Nau, Nolan, and Smith 2019). In this process a
structure of strategy is deciding on educating the public to prevent them to get affected from
hypertension. The target of the changes and construction of new educational policy is to enhance
the public health by educating the public about the disease, factors causing the disease,
precautions to be taken and changes to be made in life to improve the quality of life. For
example, in the present era of increasing COVID19 cases public should be educated to maintain
social distancing and should know more about the virus in order to save them from getting
affected. So different ways are constructed to educate the public about its consequences.
Policy
It is the backbone and support system . It provides structure for implementing and
evaluating the public health program. According to study, proceed stands for policy, regulatory,
organisational, construct in, educational, environmental and development respectively. In this
policy diagnosis plays an specific role. It is compatibility check program goals, plan of
organisation, objectives with those of organisation as well as its administration. It is process
where goals and objectives are being ensured whether the program goals relevant to mission
statements,rules and regulation that are applied for sustainable program. In proceed term
implementation refer as design intervention where the structure of any health program is
constructed, availability of resources is compulsory, to determine if program is reaching
expected target population and achieving the desirable goals. Lastly, outcome is a decrease in the
incidence or pre valence of the identified negative drawback or there is increased in positive
behaviour. Nowadays,hypertension is fairly common. According to view, patient suffer and
experience symptoms, some are minor and some are major. People should consult doctor and
doing proper meditation and several ways are there in brief which can applicable. The people
should be aware about this sort of serious issue and educate respective facts about hypertension.
Hypertension intervention for patients

Poor quality of life of individual is a major cause of hypertension these days. The busy
schedule, high stress and heavy work load also causes hypertension (Bakris, Ali, and Parati
2019). Changing in lifestyle can help way much more to control the hypertension such as
decrease in amount of salt in diet, stress management, weight management, alcohol intake
reduction, etc. stress is a main root of hypertension ,due to lack of activity, obesity and family
history etc. all these risk factor if not controlled properly it can create a problem. Issue like heart
attack, stroke,cardiac vascular problems as well. Adopting a life style modifications such as
DASH (dietary approaches to stop hypertension) diet plan may help a lot in these cases. They
always prefer and suggest the food which are rich in nutrients, hydrating fruits and vegetables
food rich in fruits, vegetables and fish and limiting the use of salt, sweet, malcohol and uses of
alcohol is prohibited.
Case Study
A 40 years old male businessman visited hospital having symptoms like headache,
dizziness, drowsiness, fatigue, blurred vision, nausea and uneasiness. He was facing the
symptoms since 3 months. He had recently diagnosed with hypertension. The weight of the
patient is 90 kilograms and the height of the patient is 5 feets and 6 inches. Blood pressure
measure shows 150/100 mmHg and the pulse rate is 88 beats per minute. The patient is having a
habit of smoking. The patient also drinks occasionally. It is also mentioned that the person is not
having his meals on time due to high engagement ion business and suffers from high stress
everyday. This shows that the person is suffering from hypertension.
Recommendations
As the symptoms shows situation of high blood pressure so the person is recommanded
the medication Diuretics, calcium-channel blockers, beta blockers, etc. Further it is
recommanded to change in the lifestyle of the patient. As patient has high weight so he should
exercise daily. The alcohol consumption is occasionally and it should be two or fewer drinks
only. Patient should work on its smoking habit to quit it as quickly as possible as it can worse the
situation. It is also recommanded to the patient to continue the medication and if any side effects
persist then immediately consult again in the hospital as the recommanded medication has its
own side effects depends on person to person (Phillips, Xu, Peterson, Arnold 2018). It is
observes that the patient doesnot have a proper siet schedule hence he should take care of his diet

as much as possible and should fix a proper diet plan for healthy lifestyle. The patient should
also work to manage its stress as soon as possible.
Discussion
Hypertension is one of the most prevalent disease in the world and can be due to lack of
activity, stress, obesity, family history, etc. if it is not treated or controlled properly may develop
several health issues like chronic heart failure, attack, stroke, or kidney disease. Hence, a person
suffering from hypertension should mange his blood pressure using the prescribed
antihypertensive medication and should also adopt lifestyle modifications like Dietary
Approaches to stop Hypertension (DASH) diet plan which suggest the food which are healthy to
eatr like fruits, fish and vegetables and limiting the use of salt in the diet. It is recommended in
this situation that sodium should me less than 1500 mg/day and alcohol intake should be upto
two or fewer drinks. Further a proper schedule to exercise daily is also recommanded. So to
prevent from complications all the above guidelines should be followed carefully.
Government polices and guidelines for hypertension interventions
UK government and world health care organization have provide multiples guidelines for
the hypertension interventions as it is related to the individuals life. Medications, medical test
and treatment methodology have their own effects for particular disease and patient characteristic
it can be negative or positive (Touyz, 2019). So previous of treatment and medication
prescription doctors and nurses have to consider the health care guidelines and protocol's. Some
of the UK government protocols and guidelines are CG127, NG28,OS181 and Os28, NICE
guidelines are explained below.
NICE- Has published the guidelines for hypertension diagnosing and management in 28
August 2019. known as [NG136] according to this protocol the professional of health care
organization who is measuring the blood pressure should properly tried for it, the tool which is
use for the blood pressure measurement and other health care treatment, should be validated.
Blood pressure measurement should be conducted in the standardized environmental.
 While measuring the blood pressure in both arms, if the measurement of both arms is
differ from each other in range of the 15 mm Hg, then repeated measurement should be
done.

 During the blood pressure measurement at clinic if it range from 140/90 mm-Hg or
higher. So it need take second measurement of the patient during consultation. Then after
this if second measurement calculation is substantially different from the previous results,
then consider the lower of last 2 measurement as clinical blood pressure.
 Once the clinical calculation of blood pressure get confirmed then note the measurement
if it range between 140/90 mm-Hg and 180/120 mm-Hg. Then it need to be offer ABPM
(ambulatory blood pressure monitoring) to the patient in order to confirm the
hypertension.
 The other option for the confirmation is of hypertension if patient can not tolerate
ABPM, is home blood pressure monitoring (HBPM).
 When waiting for the hypertension diagnosing confirmation there are some other
procedure which has to be conduct. Such as testing for the analysis of organ damage,
with the aid of cardiovascular risk assessment tool.
 If the clinic blood pressure range in 140/90 mm-Hg or higher and if ABPM or HBPM
average range in 135/85 mm-Hg or higher then consider it as confirmation of
hypertension.
Risk and benefits outcomes of the medical interventions for hypertension patient
Benefits of the hypertension treatment is that it decreases the cardiovascular improper
activities and the reduces the rate of CV morbidity and mortality. It reduces approx 11% of the
CV event and according to some research articles approx 41% of the stroke case reduction, 22%
of myocardial infarction reduction. In the heart failure prospect it reduces the cases more then
51%.
Limitation of the hypertension treatment and interventions. The excessive reduction of
the blood pressure cases the deleterious, mainly in the old age patient and in the case of patient
who is going trough with the coronary heart disease too along with the hypertension. Their are
some treatment obstacles which can also be as risk factor for the hypertension treatment such as
low rate of blood pressure control, Poor adherence to the treatment is one of the higher risk
factor which work as a barrier in the reduction and control of diseases. Because there are lots of
patient who just discontinue their treatment. There are multiple factors which are effecting the
control and reduction of the hypertension such as the patient forget to have their proper

medication. The reason behind poor adherence of the treatment is side effects of the drugs and
the tolerance problem related to the medication or interventions (Baggioli and Grieninger 2019).
For the control of hypertension the best interventions is management of proper life style with
healthy and hygienic habits, but there is the risk of unemployment, lack of eduction , and
unhealthy culture of the society.
CONCLUSION
From the complete study of nursing assessment for the log term medical conditions
related to the Hypertension and its management techniques. it has been analysed that nursing
assessments are the important for the effective management and control of the log term disease,
as it involves the use of appropriate care framework for management of health care issues . For
population and individual, and this frameworks involve the proper steps of the care plan
development. Such for the hypertension management the most effective frameworks is
PRECDE-PROCEED. Because provide the structural support for the care plan construction.
These frameworks helps the nurses to assess the problem and provide the best primary and
secondary care to the population or individual. In the UK there are some relevant guidelines to
treat and manage HBP patient, which has to be follow in the care plan such as NICE and CG127
guidelines. Their are the multiple benefits and risk related to the hypertension interventions,
which can cause the other complications of health, in order to prevent those risk nurses have to
conduct the calculative analysis of interventions effects and patient characteristic.

REFERENCE
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