NIGHTINGALE INSTITUTE OF NURSING

LESSON PLAN
ON
HYPERTENSION

SUBMITTED TO- SUMBITTED BY-

Miss. Yashswi Chauhan
External Examiner M.Sc 1st year

SUBMITTED ON:-
23/06/2016
GENERAL INFORMATION:-
SUBJECT : MEDICAL SURGICAL NURSING

TOPIC : HYPERTENSION

GROUP : GNM 2ST YEAR

DATE : 23/06/2016

TIME : 9:00 A.M. TO 10:00 AM

PLACE : CLASS ROOM

METHOD OF TEACHING : LECTURE CUM DISCUSSION

LANGUAGE : ENGLISH

NAME OF STUDENT TEACHER : YASHSWI CHAUHAN

NAME OF SUPERVISOR :

PREVIOUS KNOWLEDGE OF THE GROUP : THE GROUP IS ALREADY HAVING BASIC KNOWLEDGE ABOUT THE TOPIC
GENERAL OBJECTIVES:-
At the end of the demonstration the students gain the knowledge about the definition, etiology, types, pathophysiology, sign and symptoms,
diagnostic test, treatment and nursing management of hypertension.

SPECIFIC OBJECTIVES: - after the class students will be able to-

 Define hypertension
 List down the etiology of the disease.
 Enumerate the clinical manifestations of the disease.
 Types of hypertension.
 Pathophysiology of hypertension.
 List down the diagnostic evaluations of the disease.
 Describe the management of the disease.
 Enlist the nursing diagnosis of hypertension.
 Enlist the facts about hypertension.
TIME SPECIFIC CONTENT TEACHING LEARNING A.V. EVALUATION
OBJECTIVES ACTIVITY AIDS
DEFINITION-

1min Define hypertension It is defined as persistent elevation of B.P above Student teacher helps the ppt
140mm of hg diastolic B.P 90 mm of hg. student to tell the definition
of oral cancer
Divided into stages:-
Stage 1 – 140 and 90-99 hypertension systolic B.P
Stage 2 – systolic 160 mm of hg diastolic above
90 mm of hg

INCIDENCE-

1min Enumerate the in the US, around 75 million people have Student teacher help the ppt What is the
incidence of hypertension, with more people dying of student to tell about the incidence rate of
hypertension hypertension-related cardiovascular disease than incidence of hypertension hypertension
from the next three deadliest diseases combined.

The number of people living with hypertension

(high blood pressure) is predicted to be 1.56
billion worldwide by the year 2025.

ETIOLOGICAL FACTORS

3min Enumerate the It is of 2 types- Student teacher helps the ppt What are the
etiology of oral cancer Modifiable factor & non modifiable factor student to tell about the causes of
etiology factor of hypertension
hypertension
Modifiable factor
 Diet factor
  Bad habits -smoking
-alcoholism
-tobacco chewing
 Stress
 Obesity
 Life style changes

Non modifiable factor

 Family history
 Age
 Gender- higher in male than female about
of age of 55 years.
 Ethnicity- in black colour people there is
increase prevalence of hypertension in
black colour people.

TYPES OF HYPERTENSION
3min Enumerate the types 1) Primary hypertension Student teacher help the ppt What are the
of hypertension 2) Secondary hypertension student to tell about the types of
3) White coat hypertension types of hypertension hypertension
4) Isolated systolic hypertension
5) Malignant hypertension

PRIMARY HYPERTENSION

There is no identifiable cause, the etiology is

multifactorial both systolic and diastolic B.P
increases there is mild variation in B.P

SECONDARY HYPERTENSION
There is particular cause this results from a
identifiable cause, various specific disease state or
problem responsible for the elevation of B.P
Example-
 Arterial disease
 Renal disease
 Any tumour
 Pregnancy

WHITE COAT HYPERTENSION

Hypertension in people who are non motensive

when there hypertension checked by a health care
professional and intermittent vasovogal responses
upon from transial elevation B.P

ISOLATED SYSTOLIC HYPERTENSION

It occur when systolic B.P is 140 mm of hg but

diastolic B.P remain normal or less than 90 mm of
hg it’s because of increase cardiac output or
atherosclerosis increased change in blood vessel it
increase with advancing age.

MALIGNANT OR ACCELERATED
HYPERTENSION

It is characterised by diastolic B.P will be above

110-120 mm of hg & it exceed 140 mm of hg it
results when hypertension is untreated or is
unresponsive to test & become a severe
 emergency condition causing hypertensive crisis
with palpiledima (swelling on the eyes) retinal
haemorrhage (red eye).

PATHOPHYSIOLOGY
Any factor producing an alteration in peripheral
4min Explain the vascular resistance, heart rate or volume student teacher help the chart Explain the
pathophysiology of student to tell about the pathophysiology
hypertension pathophysiology of of hypertension.
Rennin produces hypertension

Angiotensin 1 angiotensin 2 angiotensin 3

Vasoconstriction aldosterone secretion

Increased peripheral sodium and fluid

Resistance retension

Increased cardiac out put

Elevation of blood pressure

CLINICAL MANIFESTATION
3min Enlist the clinical Student teacher helps the Flash Enlist the
manifestation of  Retinal damage, haemorrhage. student to tell about the card clinical
hypertension  Exudates formation clinical manifestation of manifestation.
 Arteriolar narrowing hypertension.
 Cotton pool spot on eye
 Nocturia
 Hemiplegia
 Occipital headache
 Fatigue
 Dizziness
 Palpitation
 Blurred vision
 Alteration in speech
 Epistaxis
 Sudden falling

DIAGNOSTIC STUDIES

2min Enlist the diagnostic  History & physical examination- more Student teacher help the Flip What are the
evaluation. important is retinal examination students to tell about the chart diagnostic
 Laboratory test- CBC diagnostic evaluation evaluations
Blood-glucose fasting level
HDL-high density lipoprotein
LDL-low density lipoprotein
 Urine analysis 24 hours urine protein level
 Radiographic study-
Chest x-ray, ECG, radioecocardiography
IVP- intravenous pyelography

MANAGEMENT
3min Enumerate about the 1.Non pharmacological management
collaborative care.
The goal of treating of client is prevent associated ppt What is the
morbidity and mortality. management for
 WEIGHT REDUCTION- hypertension
Reduction of 10 kg weight will reduce 5-
20 mm of hg units of B.P
 DIET MODIFICATION
Reduced dietary intake of saturated fat &
increase the proportion poly unsaturated
fat
1) Increase the fruits and vegetable
2) Low dairy products
3) Na restriction up to 2.4-6 gram/day
4) Restrict the consumption of
alcohol, caffeine.
5) Stop smoking
 PHYSICAL ACTIVITY & EXERCISE
A regular programme of aerobic exercise
facilitates cardio vascular function. Daily
walking of 30 minutes will reduce 4-9 mm
of hg in a week.
 STRESS REDUCTION
Stress increase peripheral vascular
resistance and cardiac output.
1. Yoga
2. Psychotherapy
3. Bio feedback measures can be
taken to reduce the stress.

PHARMACOLOGICAL MANAGEMENT
 Diuretics- this increase the urine output
Polythiazide, chlorothiazide. Student teacher helps the
 Loop diuretics- lasix it act as a loop of student to tell about the
Henley it prevents reabsorption of water & management.
electrolyte.
 Potassium sparing diuretic- sponolactone
this will block the aldesterone secretion.
 Vasodilator- they directly act on the
smooth muscle of wall of arterioles &
causing vasodilatation.
This will dilate the wall of small arterioles.
It act on the smooth muscle & it given in
emergency.
 Adrenergic inhibiting agent
A. Beta blockers- propanolol,
atenalol, this block the beta
receptors & reduce heart and C.O
and pulse rate.
B. Alpha- adrenergic inhibitors-
prasozine hydro chlorate this will
block the alpha- receptors and
peripheral vasodialation occur and
pulse rate reduced.
C. Central acting adrenergic
inhibitors- clonidine, this will
block the entry of calcium into
smooth muscle all and interfere
with the intracellular release the cat
and this will slow the velocity of
conduction of cardiac impulse this
will cause vasodilatation and
decrease the peripheral vaso
 resistance and decrease the after
load.
 Angiotensin converting enzyme
e.g. captopril
lisinopril
This drug will inhibit the conversion of
angiotensin 1 to angiotensin 2.
COMPLICATION Student teacher help the ppt What are the
1min Enlist the student to enlist the complications
complication of  Heart failure complication of for hypertension
hypertension  Left ventricular hypertrophy hypertension
 Renal insufficiency
 Aneurysm

NURSING MANAGEMENT

2min Enlist the nursing NURSING DIAGNOSIS Student teacher helps the ppt What are the
management for   Risk for decreased cardiac student to tell about the nursing
hypertension output related to increased after load, nursing management. management for
vasoconstriction, myocardial ischemia, oral
ventricular hypertrophy. hypertension
  Acute pain: headache related to increased
cerebral vascular pressure.
 Ineffective Tissue Perfusion: cerebral,
renal, cardiac related to impaired
circulation.
  Knowledge deficit related to lack of
information about the disease process and
self-care.
2min Fasts on hypertension
Here are some key points about hypertension.
More detail and supporting information is in the
body of this article.
 Hypertension is defined as blood
pressure higher than 140 over 90 mmHg
(millimeters of mercury).
 A diagnosis of hypertension may be made
when one or both readings are high: systolic
(the pressure as the heart pumps blood around
the body), given first; or diastolic (pressure as
the heart relaxes and refills with blood), given
second.

 Modern lifestyle factors are responsible

for a growing burden of hypertension: physical
inactivity, salt-rich diets with processed and
fatty foods, and alcohol and tobacco use.

 High blood pressure can also be secondary

to other conditions - kidney disease, for
example - and can be associated with some
medications.

 Hypertension itself does not cause

 symptoms but in the long-term leads to
complications caused by narrowing of blood
vessels.

 Doctors diagnose high blood pressure over

a number of visits using a sphygmomanometer,
which involves applying an inflatable cuff to
the upper arm.

 Lifestyle measures are used first to treat

high blood pressure, including salt restriction
and other dietary changes, moderation of
alcohol, and stress reduction.
 One or more drugs from a number of
different classes may be used for treatment.

SUMMARY:-
Today we have discussed about the definition,
incidence, etiology, types, sign and symptoms,
diagnostic test, treatment and nursing
management and facts of hypertension

BIBLIOGRAPHY:- Ppt
 Smeltzer C. Suzanne, Bare G. Brenda etal,
textbook of medical surgical nursing, Wolters
Kluwer Pvt. Ltd. , Delhi: 12th edition 2010,1st
volume, page no- 1275-1284
 Jacob .Annammaetal, clinical nursing
procedures: the art of nursing practice, Jaypee
publication, Delhi: 1st edition 2007, volume 1st,
page no-115.
 en.m.wikipedia.org/wiki/
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