What are the nursing diagnoses and nursing measures for hypertension?

First, physical discomforts such as headaches and head fullness are mostly related to cerebral vasospasm and intracranial pressure fluctuations caused by elevated blood pressure.； The second is the potential risk of hypertensive emergencies and target organ damage to the heart, brain, kidneys, and eyes. ； Third, the knowledge base on disease recognition, medication and lifestyle intervention is insufficient. The corresponding core logic of nursing work can actually be summarized as "first respond to emergencies, stabilize indicators, and then help patients establish long-term blood pressure control habits." There is no universal standardized plan, and everything is adjusted according to the actual situation of the patient.

The 62-year-old Uncle Zhang who I managed last week was a typical example. When he arrived, he was carrying a vegetable basket and said that he had had a headache for three days and thought it was a heat cold. When the systolic blood pressure was measured, it was 187 mmHg. His face turned red and he felt a little dizzy when he spoke. At that time, he was first helped to lie half down on a flat car, and the head of the bed was raised 15 degrees. The blood pressure of both upper limbs was measured first. The pressure difference was only 8mmHg. The risk of aortic dissection was temporarily ruled out. He quickly followed the doctor's instructions and gave him sublingual short-acting antihypertensive drugs. He measured his blood pressure every 10 minutes. He said that the headache had subsided in more than half an hour. This was the most direct nursing measure to deal with the discomfort of head swelling. Lower the blood pressure first to relieve the symptoms, and at the same time, check for the most dangerous emergency risks.

Don’t think that everything will be fine once your blood pressure drops to normal. The prevention and control of potential complications is the focus throughout the entire care cycle. In fact, there are still many academic circles that have not yet fully unified opinions, such as the frequency of blood pressure measurement at home. The 2023 version of the Chinese Hypertension Guidelines recommends that patients with stable blood pressure should measure 1-2 days a week, and take the average of the two measurements each time. However, Some European and American guidelines recommend that as long as there is no discomfort, the test can be measured once a month. In our clinic, we generally make flexible adjustments: patients who have just adjusted their medication regimen and have recently fluctuated in their work, rest and diet must be tested once every morning (one hour after getting up without taking antihypertensive drugs or eating) and once every night (before going to bed). If the test is stable for 2 consecutive weeks, it will be reduced to 2 days a week. The standard will not be imposed. Regarding exercise, some patients feel that high blood pressure will easily burst blood vessels when they move, and some feel that they should exercise vigorously to lower blood pressure. In fact, our judgment standard is very simple: the systolic blood pressure should be stable below 160 before exercising, and choose activities that do not involve strenuous efforts such as brisk walking and Tai Chi. If the blood pressure exceeds 180 and you still run marathons or lift weights, you are really making fun of your own blood vessels.

Many patients return to the hospital shortly after being discharged. The problem is that "a piece of knowledge is missing." There was a 38-year-old Internet programmer whose blood pressure was 190/110 when he was admitted to the hospital. He also had trace amounts of urinary protein and had early kidney damage. When I asked him, I learned that he had been diagnosed with high blood pressure during a physical examination 3 years ago. When we gave him nursing education, we didn’t use dry professional terminology, but gave him a detailed account: the two antihypertensive drugs you take every day now only cost 3 yuan in total. If you don’t ignore them, you will be hospitalized for at least hundreds of thousands of yuan next time you have a stroke, and you won’t even be able to go to work after you become paralyzed. Which one is more cost-effective? We didn’t say anything about “daily sodium intake ≤ 5g” in our diet. We just showed him the beer caps we brought with us and told him that we only eat so much salt in a day. We should touch salt-containing things such as takeaways, cured meats, and pickles at most once a week, but he remembered it.

In fact, the care of high blood pressure is both difficult and simple. It is like regulating the pressure of an old water pipe at home. You cannot tighten it too hard all at once, nor can you ignore it and let it continue to overpressure and burst. It must be adjusted slowly according to the actual situation. The patient himself must learn to be the "pressure regulator" in order to really stabilize the blood pressure.