Nursing Care Plan for Hypertension (2025): Step-by-Step Guide with Assessment, Interventions & Outcomes

Posted on by Soumya Ranjan Parida
12 Nursing Care Plans for Hypertension – Comprehensive Notes

12 Nursing Care Plans for Hypertension

Comprehensive Nursing Notes

Hypertension Overview

Hypertension (high blood pressure) is a chronic medical condition where the blood pressure in the arteries is persistently elevated, increasing the risk of heart, brain, kidney, and other diseases. The focus word for this note is Hypertension.

Hypertension blood pressure chart

Classification of Blood Pressure for Adults (AHA Guidelines)

  • Hypertension affects over 1.2 billion adults worldwide.
  • It is a major cause of cardiovascular diseases and premature mortality.
  • Most people with hypertension are asymptomatic (“silent killer”).
  • Early diagnosis and comprehensive management are crucial for preventing organ damage.

Classification & Pathophysiology

Blood Pressure Categories (mmHg)

Category Systolic Diastolic
Normal <120 <80
Elevated 120-129 <80
Stage 1 Hypertension 130-139 80-89
Stage 2 Hypertension ≥140 ≥90
Hypertensive Crisis >180 >120

Pathophysiology Flowchart

Hypertension pathophysiology diagram

Interaction of genetics, lifestyle, and organ systems (renin-angiotensin-aldosterone, vascular tone, kidney, and heart function) lead to increased peripheral resistance and/or cardiac output, resulting in hypertension.

Nursing Assessment

Comprehensive assessment is vital for diagnosis, monitoring, and management of hypertension.

  • Confirm blood pressure using validated technique in both arms.
  • Assess for symptoms: headache (occipital, morning), visual disturbances, dizziness, fatigue, chest pain, nosebleeds.
  • Collect health history (risk factors: obesity, family history, smoking, diet, stress, comorbidities).
  • Physical: BMI, heart sounds, peripheral pulses, edema, fundoscopic exam.
  • Evaluate for target organ damage: renal (creatinine, albuminuria), heart (ECG, LV hypertrophy), retina, brain, and vessel changes.

Sample Laboratory Investigations:

  • Renal function: Creatinine, GFR, urinalysis
  • Lipids profile: cholesterol, LDL, HDL, triglycerides
  • Electrolytes (especially in those on diuretics or ACE inhibitors)
  • Fasting glucose or HbA1c
  • ECG for left ventricular hypertrophy/ischemia

Mnemonics & Study Tips

Hypertension Mnemonic: DIURETIC
(for key nursing interventions and monitoring)
  • Daily weight
  • Intake and Output monitoring
  • Urine Output (monitor hourly)
  • Response of BP – monitor frequently
  • Electrolytes – monitor K+, Na+, Ca2+, Mg2+
  • Take pulses (apical & peripheral)
  • Ischemic episodes: Assess for angina, CVA, renal involvement
  • Complications: Watch for target organ damage
Mnemonic for Antihypertensive Drugs: ABCD
A: ACE inhibitors/ARBs
B: Beta-Blockers
C: Calcium channel blockers
D: Diuretics
Hypertension Complications (The 4 C’s):
  • C – Coronary artery disease
  • C – Congestive heart failure
  • C – Cerebrovascular accident (stroke)
  • C – Chronic renal failure

12 Comprehensive Nursing Care Plans

Each nursing care plan includes: Assessment, Diagnosis, Interventions, and Rationale. Expand any plan for rich details.

1. Ineffective Health Maintenance
Assessment: Patient exhibits lack of routine BP monitoring, poor adherence to diet/medication, and miss follow-ups.
Nursing Diagnosis: Ineffective Health Maintenance related to insufficient knowledge of hypertension management.
Interventions & Rationales:
  • Assess patient understanding and daily habits (Rationale: Establish baseline knowledge and barriers).
  • Set educational goals with patient/family (Rationale: Promotes participation and motivation).
  • Create individualized written and visual tools for BP monitoring and medication schedules (Rationale: Enhances retention and compliance).
  • Refer to community resources and telehealth check-ins (Rationale: Ongoing support increases success).
2. Deficient Knowledge
Assessment: Patient displays confusion about medications or diet; reports skipping doses or consuming high-sodium foods.
Nursing Diagnosis: Deficient knowledge regarding hypertension and its management.
Interventions & Rationales:
  • Assess baseline knowledge about hypertension, purpose of each medication (Rationale: Tailors the teaching plan).
  • Use simple language and visual aids (Rationale: Increases clarity and recall).
  • Demonstrate BP self-monitoring and request return demonstration (Rationale: Ensures skill acquisition).
  • Provide a DASH diet guide and refer to a dietician as needed (Rationale: Increases dietary adherence).
3. Risk for Decreased Cardiac Output
Assessment: Monitor vital signs (BP, apical/pulse rate), skin temperature, color, urine output, crackles in lungs.
Nursing Diagnosis: Risk for decreased cardiac output related to increased afterload and myocardial workload.
Interventions & Rationales:
  • Monitor BP and HR every shift, check for S3/S4 heart sounds (Rationale: Detects cardiac compromise early).
  • Administer antihypertensive medications as ordered (Rationale: Reduces myocardial workload).
  • Monitor for edema and signs of fluid overload, including weight gain and crackles (Rationale: Prevents decompensation).
  • Reinforce medication timing and dosage (Rationale: Prevents fluctuations in BP and workload).
4. Activity Intolerance
Assessment: Assess fatigue after minimal effort, changes in pulse, respiratory rate with activity.
Nursing Diagnosis: Activity intolerance related to imbalance between oxygen supply and demand.
Interventions & Rationales:
  • Assess patient’s current tolerance and any precipitating symptoms (Rationale: Baseline for progress).
  • Encourage gradual activity progression; schedule rest (Rationale: Prevents fatigue and overexertion).
  • Teach energy conservation strategies (Rationale: Maximizes daily functioning).
  • Monitor vital signs pre and post activity (Rationale: Identifies abnormal responses).
5. Acute Pain
Assessment: Reports of headache, facial pressure, visual disturbances.
Nursing Diagnosis: Acute pain related to increased cerebral vascular pressure.
Interventions & Rationales:
  • Ask patient about pain location, duration, scale (Rationale: Individualizes relief efforts).
  • Maintain calm environment, dim lights (Rationale: Lowers CNS stimulation).
  • Provide prescribed analgesics and non-pharmacologic measures (cold pack, relaxation techniques) (Rationale: Reduces pain intensity).
  • Reassess pain after interventions (Rationale: Evaluates effectiveness).
6. Anxiety
Assessment: Restlessness, nervousness, tachycardia, verbalization of anxiety.
Nursing Diagnosis: Anxiety related to new diagnosis and perceived threat to health.
Interventions & Rationales:
  • Provide honest communication; validate concerns (Rationale: Reduces fear from unknown).
  • Encourage expression of feelings (Rationale: Promotes emotional release).
  • Teach relaxation methods: deep-breathing, guided imagery (Rationale: Calms the CNS).
  • Involve family/support system (Rationale: Strengthens coping resources).
7. Imbalanced Nutrition: More Than Body Requirements
Assessment: High BMI, abdominal obesity, excessive caloric or sodium intake.
Nursing Diagnosis: Imbalanced nutrition related to habitual intake of excess calories or salt, sedentary lifestyle.
Interventions & Rationales:
  • Obtain food habits and favorite foods (Rationale: Basis for modification).
  • Educate about DASH diet, sodium limits, and healthy meal planning (Rationale: Encourages positive change).
  • Set realistic weight loss and nutrition goals (Rationale: Enhances motivation and success).
  • Monitor BMI, weight, waist circumference (Rationale: Tracks progress).
8. Risk for Noncompliance
Assessment: History of missed appointments, inconsistent medication use, or lifestyle changes.
Nursing Diagnosis: Risk for noncompliance related to complex treatment regimen and lack of support.
Interventions & Rationales:
  • Identify barriers to adherence (cost, side effects, understanding) (Rationale: Target obstacles directly).
  • Simplify medication and monitoring schedules if possible (Rationale: Increases adherence).
  • Offer motivational interviewing and peer support referrals (Rationale: Sustains engagement).
  • Follow up with reminder calls or messages (Rationale: Reduces missed appointments).
9. Risk for Decreased Tissue Perfusion
Assessment: Weak pulses, pale/cool extremities, numbness/tingling, kidney dysfunction signs.
Nursing Diagnosis: Risk for decreased tissue perfusion related to vascular changes or complications of hypertension.
Interventions & Rationales:
  • Assess all peripheral pulses and capillary refill daily (Rationale: Early detection of perfusion issues).
  • Monitor urine output, creatinine/BUN trends (Rationale: Renal perfusion indicator).
  • Educate on symptoms requiring immediate medical attention (loss of vision, weakness, chest pain) (Rationale: Timely treatment prevents complications).
  • Apply antiembolic devices if bed-bound (Rationale: Reduces risk of DVT).
10. Ineffective Coping
Assessment: Mood changes, poor stress management, verbalizes inability to cope.
Nursing Diagnosis: Ineffective coping related to chronic illness and life changes.
Interventions & Rationales:
  • Assess coping mechanisms and support systems (Rationale: Identifies at-risk patients).
  • Refer to counseling or social work (Rationale: Professional help can enhance coping).
  • Encourage journaling or stress management activities (Rationale: Promotes adaptive responses).
  • Set short-term achievable goals (Rationale: Builds confidence and reduces overwhelm).
11. Risk for Electrolyte Imbalance
Assessment: Medication history (diuretics/ACE inhibitors), signs of hypo/hyperkalemia, muscle cramps, ECG changes.
Nursing Diagnosis: Risk for electrolyte imbalance related to antihypertensive therapy.
Interventions & Rationales:
  • Monitor daily weights, intake/output, and lab results (Rationale: Early detection of imbalances).
  • Educate regarding symptoms of electrolyte loss (muscle cramps, irregular heartbeat) (Rationale: Promotes self-monitoring).
  • Report abnormal lab to provider and withhold medication as directed (Rationale: Prevents adverse outcomes).
  • Encourage adherence to follow-up appointments (Rationale: Ongoing safety).
12. Readiness for Enhanced Health Management
Assessment: Patient verbalizes interest in learning; actively engages in health-related goal setting.
Nursing Diagnosis: Readiness for enhanced health management evidenced by seeking information and positive attitude.
Interventions & Rationales:
  • Provide current, evidence-based resources (booklets, videos) (Rationale: Reinforces learning).
  • Encourage involvement in community programs (Rationale: Social support fosters long-term changes).
  • Establish a collaborative action plan (Rationale: Increases autonomy and motivation).
  • Recognize and praise healthy behaviors (Rationale: Builds self-efficacy).

DASH Diet for Hypertension

Key Elements of DASH (Dietary Approaches to Stop Hypertension):
  • Rich in fruits, vegetables, low-fat dairy
  • Includes lean meats, with limited red/processed meats
  • Low in sodium (≤1500–2300 mg/day), low in saturated fat
Group Servings/Day Key Examples
Grains6–8Whole wheat, brown rice, oats
Vegetables4–5Leafy greens, carrots, broccoli
Fruits4–5Bananas, berries, oranges
Low-fat dairy2–3Milk, yogurt
Lean meats/fish≤6 ozChicken, fish
Nuts/seeds4–5/weekAlmonds, sunflower seeds
Fats/oils2–3Olive oil, soft margarine
Sweets5/weekFruit salad, sorbet

References & Further Reading

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