Nursing Care Plan for Hypertension : Assessment, Diagnosis and Interventions

Hypertension

The definition of hypertension, many raised by health experts. WHO suggests that hypertension occurs when blood pressure above 160/95 mmHg, meanwhile, Smelttzer & Bare (2002:896) suggests that hypertension is a persistent blood pressure or continuous thus exceeding the normal limit in which the systolic pressure above 140 mmHg and diastolic pressure above 90 mmHg.
There are differences about the limits of hypertension as proposed by Kaplan (1990:205), namely men, aged less than 45 years, said hypertension when blood pressure when lying above or equal to 130/90 mm ​​Hg, whereas at the age of 45 years, said hypertension when blood pressure above 145/95 mmHg.Whereas in women with blood pressure above 160/95 mmHg.
Based on these definitions can be concluded that hypertension is an increase in blood pressure where systolic pressure over 140 mmHg or diastolic over 90 mmHg.

The classification of hypertension are also expressed by many experts, including WHO set a classification of hypertension into three levels namely:
Level I: increased blood pressure without symptoms of the disorder or damage to the cardiovascular system.
Level II: blood pressure with symptoms of cardiovascular hypertrophy, but without any symptoms of damage or disruption of the appliance or other organs.
Level III: blood pressure increased with obvious symptoms of damage and disruption of the target organ physiology.

The cause of hypertension varied are: stress, obesity, smoking, hypernatremia, water and salt retention that is not normal, sensitivity to angiotensin, obesity, hypercholesterolemia, adrenal gland disease, kidney disease, toxemia gravidarum, increased intra-cranial pressure, caused by brain tumors, influence of certain drugs eg oral contraceptives, high salt intake, lack of exercise, genetics, obesity, atherosclerosis, kidney abnormalities, but largely unknown cause.


Nursing Care Plan for Hypertension

Nursing Assessment Nursing Care Plan for Hypertension
According to Doenges, (2004:41-42) and argued that the assessment of patients with hypertension include:

a. Activity and rest include: weakness, fatigue, shortness of breath, heart frequency increases, changes in heart rhythm.
b. Circulation includes: a history of hypertension, coronary heart disease, episodes of palpitations, increased blood pressure, tachycardia, sometimes sounding S2 heart sounds at the base of S3 and S4.
c. Ego integrity include: anxiety, depression, euphoria, irritability, facial muscle tension, anxiety, respiratory haul, increased speech patterns.
d. Elimination include: history of kidney disease.
e. Food / fluids include: food preferences especially those containing high salt, high fat, and cholesterol, nausea, vomiting, weight changes, a history of diuretic drugs, presence of edema.
f. Neuro-sensory include: complaints headache, throbbing, sub-occipital headache, weakness on one side of the body, visual disturbances (diplopia, blurred vision), epistaxis.
g. Pain / discomfort: include intermittent pain in the limbs, sub-occipital headaches severe abdominal pain, chest pain.
h. Respiratory include: shortness of breath after activity, cough with or without sputum, smoking history, medication use respiratory Bantu, additional breath sounds, cyanosis.
i. Security include: gait disturbance, paresthesia, postural hypotension.
j. Pembalajaran / extension in the presence of family risk factors are arteriosclerosis, heart disease, diabetes, kidney disease.

Nursing Diagnosis Nursing Care Plan for Hypertension (Doengoes, 2004)
a. Decreased cardiac output
b. Activity intolerance
c. Acute pain
d. Imbalanced Nutrition: More Than Body Requirements
e. Ineffective coping

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Nursing Care Plan for Hypospadias with Assessment and Diagnosis

Nursing Care Plan for Hypospadias with Assessment and Diagnosis

Hypospadias
A. Definition of Hypospadias
   Hypospadias is a congenital abnormality, the location of the external urethral meatus is located more towards the proximal ventral surface of the penis. In normal circumstances the external urethral meatus is located on the tip of the glans penis (the most distal).

B. Etiology of Hypospadias
   Is one of the bases of congenital anomalies, most often in male genitalia, occurring in one in 350 male births, can be associated with other congenital abnormalities such as renal and genetic anomalies such as Klinefelter syndrome.

C. Signs and symptoms of Hypospadias
   Signs and symptoms of hypospadias may include:
    The opening of the urethra at a location other than the tip of the penis.
    Spray urine to exit abnormally.
    Hole penis that does not exist at the tip of the penis, but is below or at the base of the penis.
    The penis curved downward.
    The penis looks like a hooded due to abnormalities in the skin of the penis forward.
    If urination, the child should be seated.

D. Management of Hypospadias
   Corrective surgery should be done at pre-school age. In infants cordectomy performed to straighten the penis at the age of 2-4 years of reconstruction of the second stage consists of urethral reconstruction.

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What is Nursing Diagnosis

What is Nursing Diagnosis - And Why Should I Care?
One of the most frequent questions we get goes something like this….”My patient has Congestive Heart Failure. What is the highest priority/most likely nursing diagnosis?”
There is no right answer, because it’s the wrong question! Assigning a nursing diagnosis based on a medical diagnosis skips several steps essential to optimal and safe patient care. A medical diagnosis is only one piece of the puzzle; it does not by itself, provide the depth of information necessary to make an accurate nursing diagnosis.

There is no right answer, because it’s the wrong question! Assigning a nursing diagnosis based on a medical diagnosis skips several steps essential to optimal and safe patient care. A medical diagnosis is only one piece of the puzzle; it does not by itself, provide the depth of information necessary to make an accurate nursing diagnosis.

WHAT IS A NURSING DIAGNOSIS?
Maybe the easiest thing is to start with what a nursing diagnosis is NOT.

A nursing diagnosis is NOT:
    > Merely a label that you make up that “sounds like” it explains what you are seeing in your patient.
    > Another way of explaining the medical diagnosis, or of renaming a medical condition.
    > Something that “goes with a particular medical diagnosis”.

Nursing diagnosis is defined as “a clinical judgment about individual, family, or community experiences/responses to actual or potential health problems/life processes. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability.” (Herdman, 2012, p. 515). 

In other words, a nursing diagnosis is a judgment based on a comprehensive nursing assessment. The medical diagnosis provides one important piece of data, but it does not provide anywhere near the depth of information necessary for making an accurate nursing diagnosis.

WHY SHOULD YOU CARE?
Because an accurate nursing diagnosis based on a thorough assessment results in more effective and safer patient care. Period.

Let’s take a look at an example:

A man is admitted through the Emergency Department with a medical diagnosis of Viral Pneumonia with the following profile:

    > Age 78;
    > Dyspneic and demonstrating very shallow breathing;
    > Pulse oximeter is showing 90% on 4L of O2;
    > History of COPD.

What is the primary nursing diagnosis? 

Did you think of impaired gas exchange? Seems obvious, doesn’t it, considering the data and medical diagnosis? However, the question the nurse should ask is this: “What is causing the low SpO2?”

After completing a thorough assessment, the nurse discusses her findings with the patient, including the very shallow breathing. She learns the patient is breathing shallowly because he’s in pain. He’s suffering from posthepatic neuralgia as a result of a very painful course of shingles. In this example, the assessment-based, primary nursing diagnosis is chronic pain.

Consider these two scenarios:
Nursing Diagnosis Linked to the Medical Diagnosis
A care plan is developed to address the nursing diagnosis of impaired gas exchange, based on the medical diagnosis of Viral Pneumonia. The posthepatic neuralgia as a cause for shallow breathing is not identified and overlooked in treatment.

OR

Nursing Diagnosis Linked to Nursing Assessment and Critical Thinking
A care plan is developed to address the nursing diagnosis of chronic pain, with treatment designed to resolve this as the primary cause of the shallow breathing, and to prevent recurrence.
Which scenario provides the best patient care and outcome? What do you think the relationship is – or is not – between medical diagnosis and nursing diagnosis?

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NANDA International Leg

NANDA International (formerly the North American Nursing Diagnosis Association) is a professional organization of nurses standardized nursing terminology that was officially founded in 1982 and develops, researches, disseminates and refines the nomenclature, criteria, and taxonomy of nursing diagnoses. In 2002, NANDA relaunched as NANDA International in response to the broadening scope of its membership. NANDA International published Nursing Diagnosis quarterly, which became the International Journal of Nursing Knowledge in 2002. Other related international associations are ACENDIO (Europe), AENTDE (Spanish language), AFEDI (French language) and JSND (Japan). The Membership Network Groups foster collaboration among NANDA-I members in countries (Brazil, Colombia, Ecuador, Mexico and Nigeria-Ghana) and for languages: the German Language Group (Germany, Austria, Switserland) and the Dutch Language Group (Netherlands and Belgium)

History
   In 1973, Kristine Gebbie and Mary Ann Lavin called the First National Conference on the Classification of Nursing Diagnoses. It was held in St. Louis, Missouri. Attendees produced a beginning classification, an alphabetized list of nursing diagnoses. The conference also created three structures: A National Clearinghouse for Nursing Diagnoses, located at Saint Louis University and led by Ann Becker; a Nursing Diagnosis Newsletter, edited by Anne Perry; and a National Conference Group to standardize nursing terminology and led by Marjory Gordon. In 1982 NANDA was formed. It included members from the United States and Canada.
   NANDA developed a nursing classification to organize nursing diagnoses into different categories. Although the taxonomy was revised to accommodate new diagnoses, in 1994 it became apparent that an overhaul was needed. In 2002 Taxonomy II, which was a revised version of Gordon's functional health patterns, was released.
   In 2002, NANDA became NANDA International in response to requests from its growing base of membership from outside North America. The acronym of NANDA was retained in the name because of the name recognition, but it is no longer merely "North American", and in fact boasts members from 32 countries as of 2010.


Lihat juga
NANDA
Taxonomy II : Domain
Taxonomy II : Domains, Diagnosis
 Nursing Outcome Classification
Nursing Interventions Classification

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Nursing Management

Nursing Management is the leading monthly source for practical, educational, cutting-edge information for nurse leaders. The Nursing management will perform a leadership functions of governance and decision-making within organizations employing nurses. A good nurse manager should be open to anything in the environment and be sensitive to the needs of the staff under her/his management.

In this website, we do not talking about some one who has profession as a Nurse manager. But we try to give many information what the nurses can do with his profession, especially how to manage health care delivery across the continuum of care.

In the other word, we write how the nurses make the Nursing Care Plan (NCP) and do the Nursing Intervention to the patient when they are admission, during treatment and discharge from hospital (Implementation of nursing care plan ).


Nursing Intervention

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Nursing Care Plan

Nursing Care Plan (NCP) is an essential part of nursing practice that provides a written means of planning patient care and discharge planning based upon nursing diagnosis using some guide to meet the patient's needs.

Care planning provides a "road map" of sorts, to guide all who are involved with a patient or resident's care. The care plan has long been associated with nursing, and many people believe (inaccurately, in my opinion) that is the sole domain of nurses.

Nursing Care Plan is a set of actions from the nurses, They will implement care plan to resolve nursing problems which happened to the patient during treatment. The Nurses identified all of patient's problem by accurate and comprehensive assessment. The creation of the plan is an intermediate stage of the nursing process. It guides in the ongoing provision of nursing care and assists in the evaluation of that care.

To decided of Nursing Care Plan, For the first step the nurse collects subjective data and objective data, and then organizes the data into a systematic pattern as standard plans of care such as Marjory Gordon's functional health patterns. This step helps identify the areas in which the client needs nursing care.

Once the initial assessment is completed, a problem list should be generated. The nurse have to look at each problem and put the question "Can we make this problem better?" or "Can we keep this from getting any worse, or developing complications?".


After that, the nurse will put timing (review period) when the problem resolve or show signs of improvement. In the acute setting, the review period may be as short as next shift, next day or next week. In the long-term or home health setting, the review period will likely be longer.

When the problem is not getting better or not likely to improve, and deterioration is inevitable, then the nurse will decided last question "What can we do to provide optimal quality of life, comfort and dignity for this person?"

To make a better Nursing Care Plan, the Nurses must follow the steps of the nursing process bellow :

1. Assessment (collect data from medical record, do a physical assessment of the patient, assess ADL's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)



2. Determination of the patient's problem(s)/Nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)



3. Planning (write measurable goals/outcomes and nursing interventions)



4. Implementation (initiate the care plan)



5. Evaluation (determine if goals/outcomes have been met)

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Nursing Care Plans Ebook and Software

Nursing Care Plan (NCP) as an essential part of nursing practice for the nurses during taking care of patients in the hospital or at home (home care) that using some guide to meet the patient's needs, now days are available in a format eBook and software.

Most popular of NCP eBook sell on the market are Critical Care Nursing Care Plans, Maternal-Infant Nursing Care Plans, and NCP Guidelines for Individualizing Patient Care. For some countries, they have started using network connection between nursing division (hospital ward or department) especially in the private hospital with International standard. To provide good quality of Nursing Care Plan, They will set their project using Nursing Care Plan Software such as NCP Secure Entry Client Software.

Critical Care Nursing Care Plans eBook :

This eBook provides specific, detailed information to assist the nurses in identifying needs and plans of care base on NANDA nursing diagnoses. Interesting eBook for the nurses who work in the emergency unit and ICU, Also enable them to develop their own specific nursing care plans for managing acutely ill patients.

Maternal-Infant Nursing Care Plans eBook :

NCP eBook which easy-to-use for the nurses or midwife that focus on nursing care plans for healthy clients during pregnancy, labor and delivery, postpartum, and the newborn periods. Additional diagnoses and plans are included for common perinatal and neonatal complications. The user can easily design a client-specific plan of care with interventions that are based on the latest research and current practice.

It used information to guide the nurses or midwife by care paths and flow charts system in a clear concise review of the physiological and psychological changes associated with each perinatal period. Nursing care plans procedure start from basic step like emphasizing assessments, interventions and evaluations for normal healthy pregnancies. This eBook is a helpful complement to other maternal-child nursing texts and in nursing practice.

Guidelines for Individualizing Patient Care eBook :

A comprehensive Nursing care plans for the nurses which including of rationales for every intervention. These eBook also contains comprehensive Critical thinking emphasized throughout, promoting thoughtful decision making and better individualization care. It is not only available in the PDF format, but also available in CD-ROM.

NCP Secure Entry Client Software :

The NCP Secure Entry Client proves, how easy it is to use NCP VPN clients. Part of its user friendliness is due to its intuitive GUI. used in connection with IPsec gateways from third party manufacturers - as an alternative to their VPN clients - due to their extensive security and telecommunications performance features.


The NCP Secure Entry Client software has integrated, dynamic personal firewall and it's predestined for deployment in the most remote access projects which no central management of teleworking stations is required.

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