NURSING DIAGNOSIS: Cardiac Output, risk for decreased
Nursing Care Plan: Decreased Cardiac Output — Hypertension Nursing Care Plans
Hypertension Nursing Care Plans Risk factors may include
- Increased vascular resistance, vasoconstriction
- Myocardial ischemia
- Ventricular hypertrophy/rigidity
Hypertension Nursing Care Plans Possibly evidenced by
- [Not applicable; presence of signs and symptoms establishes an actual diagnosis.]
Hypertension Nursing Care Plans Desired Outcomes
Circulation Status (NOC)
- Participate in activities that reduce BP/cardiac workload.
- Maintain BP within individually acceptable range.
- Demonstrate stable cardiac rhythm and rate within patient’s normal range.
6 Hypertension Nursing Care Plan (NCP)
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Decreased Cardiac Output — Hypertension Nursing Care Plan (NCP)
| Nursing Interventions | Rationale |
| Monitor BP. Measure in both arms/thighs three times, 3–5 min apart while patient is at rest, then sitting, then standing for initial evaluation. Use correct cuff size and accurate technique. | Comparison of pressures provides a more complete picture of vascular involvement/scope of problem. Severe hypertension is classified in the adult as a diastolic pressure elevation to 110 mm Hg; progressive diastolic readings above 120 mm Hg are considered first accelerated, then malignant (very severe). Systolic hypertension also is an established risk factor for cerebrovascular disease and ischemic heart disease, when diastolic pressure is elevated. |
| Note presence, quality of central and peripheral pulses. | Bounding carotid, jugular, radial, and femoral pulses may be observed/palpated. Pulses in the legs/feet may be diminished, reflecting effects of vasoconstriction (increased systemic vascular resistance [SVR]) and venous congestion. |
| Auscultate heart tones and breath sounds. | S4 heart sound is common in severely hypertensive patients because of the presence of atrial hypertrophy (increased atrial volume/pressure). Development of S3indicates ventricular hypertrophy and impaired functioning. Presence of crackles, wheezes may indicate pulmonary congestion secondary to developing or chronic heart failure. |
| Observe skin color, moisture, temperature, and capillary refill time. | Presence of pallor; cool, moist skin; and delayed capillary refill time may be due to peripheral vasoconstriction or reflect cardiac decompensation/decreased output. |
| Note dependent/general edema. | May indicate heart failure, renal or vascular impairment. |
| Provide calm, restful surroundings, minimize environmental activity/noise. Limit the number of visitors and length of stay. | Helps reduce sympathetic stimulation; promotes relaxation. |
| Maintain activity restrictions, e.g., bedrest/chair rest; schedule periods of uninterrupted rest; assist patient with self-care activities as needed. | Reduces physical stress and tension that affect blood pressure and the course of hypertension. |
| Provide comfort measures, e.g., back and neck massage, elevation of head. | Decreases discomfort and may reduce sympathetic stimulation. |
| Instruct in relaxation techniques, guided imagery, distractions. | Can reduce stressful stimuli, produce calming effect, thereby reducing BP. |
| Monitor response to medications to control blood pressure. | Response to drug therapy (usually consisting of several drugs, including diuretics, angiotensin-converting enzyme [ACE] inhibitors, vascular smooth muscle relaxants, beta and calcium channel blockers) is dependent on both the individual as well as the synergistic effects of the drugs. |
| Administer medications as indicated:Thiazide diuretics, e.g., chlorothiazide (Diuril); hydrochlorothiazide (Esidrix/HydroDIURIL); bendroflumethiazide (Naturetin); indapamide (Lozol); metolazone (Diulo); quinethazone (Hydromox);
Loop diuretics, e.g., furosemide (Lasix); ethacrynic acid (Edecrin); bumetanide (Bumex), torsemide (Demadex);
Potassium-sparing diuretics, e.g., spironolactone (Aldactone); triamterene (Dyrenium); amiloride (Midamor); Alpha, beta, or centrally acting adrenergic antagonists, e.g., doxazosin (Cardura); propranolol (Inderal); acebutolol (Sectral); metoprolol (Lopressor), labetalol (Normodyne); atenolol (Tenormin); nadolol (Corgard), carvedilol (Coreg); methyldopa (Aldomet); clonidine (Catapres); prazosin (Minipress); terazosin (Hytrin); pindolol (Visken);
Calcium channel antagonists, e.g., nifedipine (Procardia); verapamil (Calan); diltiazem (Cardizem); amlodipine (Norvasc); isradipine (DynaCirc); nicardipine (Cardene);
Adrenergic neuron blockers: guanadrel (Hylorel); guanethidine (Ismelin); reserpine (Serpalan);
Direct-acting oral vasodilators: hydralazine (Apresoline); minoxidil (Loniten);
Direct-acting parenteral vasodilators: diazoxide (Hyperstat), nitroprusside (Nitropress); labetalol (Normodyne);
Angiotensin-converting enzyme (ACE) inhibitors, e.g., captopril (Capoten); enalapril (Vasotec); lisinopril (Zestril); fosinopril (Monopril); ramipril (Altace). Angiotensin II blockers, e.g., valsartan (Diovan), guanethidine (Ismelin). |
Diuretics are considered first-line medications for uncomplicated stage I or II hypertension and may be used alone or in association with other drugs (such as beta-blockers) to reduce BP in patients with relatively normal renal function. These diuretics potentiate the effects of other antihypertensive agents as well, by limiting fluid retention, and may reduce the incidence of strokes and heart failure.These drugs produce marked diuresis by inhibiting resorption of sodium and chloride and are effective antihypertensives, especially in patients who are resistant to thiazides or have renal impairment.
May be given in combination with a thiazide diuretic to minimize potassium loss.
Beta-Blockers may be ordered instead of diuretics for patients with ischemic heart disease; obese patients with cardiogenic hypertension; and patients with concurrent supraventricular arrhythmias, angina, or hypertensive cardiomyopathy. Specific actions of these drugs vary, but they generally reduce BP through the combined effect of decreased total peripheral resistance, reduced cardiac output, inhibited sympathetic activity, and suppression of renin release. Note: Patients with diabetes should use Corgard and Visken with caution because they can prolong and mask the hypoglycemic effects of insulin. The elderly may require smaller doses because of the potential for bradycardia and hypotension. African-American patients tend to be less responsive to beta-blockers in general and may require increased dosage or use of another drug, e.g., monotherapy with a diuretic.
May be necessary to treat severe hypertension when a combination of a diuretic and a sympathetic inhibitor does not sufficiently control BP. Vasodilation of healthy cardiac vasculature and increased coronary blood flow are secondary benefits of vasodilator therapy.
Reduce arterial and venous constriction activity at the sympathetic nerve endings.
Action is to relax vascular smooth muscle, thereby reducing vascular resistance.
These are given intravenously for management of hypertensive emergencies.
The use of an additional sympathetic inhibitor may be required for its cumulative effect when other measures have failed to control BP or when congestive heart failure (CHF) or diabetes is present. |
| Prepare for surgery when indicated. | When hypertension is due to pheochromocytoma, removal of the tumor will correct condition. |
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