Conditions › Cardiovascular
Hypertension Nursing Care Plan and Interventions
Hypertension nursing care means measuring BP accurately, starting lifestyle changes and giving first-line drugs (ACE inhibitors or ARBs, thiazides, calcium channel blockers) safely. Check hold parameters before each dose, watch for orthostatic hypotension and falls, and teach home monitoring so the client reaches the BP goal.
Hypertension nursing care plan
| Nursing problem | Goal | Key interventions |
|---|---|---|
| Risk for decreased cardiac output and organ damage | BP at the goal the provider sets, confirmed with home readings. | |
| Risk for falls (orthostatic hypotension from BP drugs) | Rises slowly, no falls, reports dizziness. | |
| Health maintenance: needs teaching | States diet, activity and medication plan and takes meds even when feeling well. |
Problem wording is plain-language nursing diagnosis style. Your program may require NANDA-I labels and your own assessment data.
What it is
Hypertension: what it is
Blood pressure that stays at 130/80 mm Hg or higher. Most is primary (no single cause); secondary HTN comes from another disease. 1,2
One high reading isn't HTN. Diagnosis uses an average of 2 or more readings on 2 or more occasions.
BP categories (adults)
Normal: under 120/80. Elevated: 120 to 129 and under 80. Stage 1: 130 to 139 or 80 to 89. Stage 2: 140 or higher, or 90 or higher. 3,1
Use the higher category: 136/92 is stage 2 because the diastolic is 90 or higher.
Why high BP damages organs
Constant high pressure strains the heart and injures the small vessels that feed the brain, eyes, kidneys and heart. 4,2
Long-term results: stroke, heart attack, heart failure, kidney disease and vision loss.
Assessment: what you will see
The silent killer
Usually no symptoms for years. Most clients feel fine, so it is found on routine BP checks. 2,3
Feeling fine is not a reason to skip pills. That is the teaching point that matters most.
Measuring BP accurately
Client seated with back supported, feet flat, legs uncrossed and arm supported at heart level, using the right cuff size. 1
A cuff that is too small reads falsely high; one that is too large reads falsely low.
Priority: what the nurse does first
Beta blockers: hold parameters
Check apical pulse and BP first. Hold for a heart rate under 60 or a low BP and notify the provider. 5
Never stopped suddenly: tapering prevents worsening angina or a heart attack.
Orthostatic hypotension and falls
BP meds can make pressure drop on standing. Rise slowly, sit on the bed edge first, and report dizziness. 6,7
Antihypertensives are a known fall risk. Keep the call light close.
Nursing interventions and treatment
Lifestyle changes come first
DASH-style diet, sodium no more than 2,300 mg a day, 150 minutes of activity a week, weight loss, less alcohol, no smoking. 8,2
Lifestyle changes stay in the plan after meds start. They work together.
First-line BP meds
Thiazide diuretics, calcium channel blockers, ACE inhibitors and ARBs. Stage 2 often starts with two drugs at once. 9
Two drugs in one combination pill makes daily adherence easier.
ACE inhibitors (-pril) and ARBs
Block angiotensin II to relax vessels. Check BP and potassium. ACE cough is common; angioedema is an emergency. Both avoided in pregnancy. 10,11
No potassium salt substitutes. An ARB (-sartan) is the usual swap for an ACE cough.
Thiazides and calcium channel blockers
Thiazides (hydrochlorothiazide) remove sodium and water but can drop potassium. CCBs (amlodipine) relax arteries; ankle swelling is common. 12,13
On a thiazide, leg cramps or weakness can mean low potassium. Report it.
Evaluation: is care working?
Goal and home monitoring
Goal for most adults: under 130/80. Teach home BP checks with a log to bring to visits. 9,3
BP still high on meds? Check adherence first, before drugs are added or switched.
Client teaching
Client teaching
Take BP meds daily even when you feel fine, and don't stop them on your own. Treatment is usually lifelong. 9,2
High readings with severe headache, chest pain, blurred vision or shortness of breath need care now.
NCLEX traps
Hypertension vs hypertensive crisis
Hypertension: 130/80 or higher, chronic, usually silent, treated over weeks. Crisis: above 180/120; check now for new organ damage. 1,9,14
New organ damage makes a crisis an emergency. Without it, it's severe hypertension (old term: urgency).
Try a hypertension question
NCLEX-style, approved by a licensed RN. Pick an answer, check it, then read the rationale.
Question 1 · Management of Care
A client newly diagnosed with hypertension is being discharged today. Which task related to medication teaching is appropriate to delegate to the LPN/LVN?
Show answer and rationale
Answer: B. Reinforcing teaching that the RN has already provided is within the LPN's scope because it does not require initial clinical judgment. Providing the initial teaching session, evaluating the client's understanding, and developing the teaching plan all require the RN's assessment and judgment skills and cannot be delegated. The RN keeps anything that is new, requires evaluation, or involves initial teaching, while reinforcement of established teaching can be safely assigned to the LPN.
Checked against: OpenStax Fundamentals of Nursing, 15.4; OpenStax Psychiatric-Mental Health Nursing, 13.5
Keep studying hypertension in NurseLingo Pro
Pro has 63 hypertension questions like these, with a rationale for every answer. Everything for hypertension in one place. A free account gets 5 free opens of any condition; Pro opens all 277.
Test yourself: free cardiac practice questions with answers and rationales.
Frequently asked questions
What are the priority nursing diagnoses for hypertension?
Common nursing problems for hypertension include risk for decreased cardiac output and organ damage; risk for falls (orthostatic hypotension from bp drugs); health maintenance: needs teaching. Choose the ones your assessment supports and rank airway, breathing and circulation problems first.
What does the nurse do first for hypertension?
Check apical pulse and BP first. Hold for a heart rate under 60 or a low BP and notify the provider. BP meds can make pressure drop on standing. Rise slowly, sit on the bed edge first, and report dizziness.
More cardiovascular
Related cheat sheets
Sources
- OpenStax Fundamentals of Nursing, 7.2
- OpenStax Medical-Surgical Nursing, 12.4
- OpenStax Pharmacology for Nurses, 18.1
- OpenStax Fundamentals of Nursing, 40.3
- OpenStax Pharmacology for Nurses, 18.4
- OpenStax Pharmacology for Nurses, 34.2
- OpenStax Fundamentals of Nursing, 9.1
- OpenStax Nutrition for Nurses, 12.2
- merckmanuals.com
- OpenStax Pharmacology for Nurses, 18.2
- OpenStax Pharmacology for Nurses, 18.3
- OpenStax Pharmacology for Nurses, 18.6
- OpenStax Pharmacology for Nurses, 18.5
- aafp.org
For study only, not medical advice. Follow your program, your facility's policies and the provider's orders.